Could psychedelics ease suffering for the dying — and those they leave behind?
A few months ago, one of my best friends introduced me to an organization called End Well. A non-profit foundation, it was founded in 2017 by Dr. Shoshana Ungerleider, who hosts the TED Health Podcast and is a frequent medical contributor on CNN, MSNBC and CBS News. She’s a doctor of internal medicine who, after seeing so many patients suffer great physical and emotional pain as they died in a hospital surrounded by strangers, figured there had to be a better way.
The operating belief of End Well is that “all people should experience the end of life in a way that matches their values and goals” and that a cultural shift in thinking about mortality could eliminate a lot of needless suffering. Bringing leaders and advocates together from healthcare, design/tech, and the community, in its first four years End Well has attracted a lot of high-level attention.
I’ve reached a stage in life wherein the prospect of mortality has gone from being a distant unpleasantness, best ignored, to an unavoidable, approaching certainty. I am not terminally ill and, thank God, neither is my husband nor my sons. But dire illnesses and sudden ends have befallen enough of my near and dear ones to make me regard every day, whether I spend it in Paris or in line at the DMV, as a gift. And while I’m no Dr. Ungerlieder, I’ve witnessed some of the needless suffering she’s talking about. So when my BFF forwarded me a notice about a virtual End Well event, I was intrigued enough to join their email list.
Since then, End Well has sponsored a lot of talks and symposiums, none of which I attended despite my lofty intentions. I may have accepted my mortality, sort of, but it’s still not my favorite thing to think about. Not when I could be scouring the latest sale at Cute Shoes That Don’t Hurt! or planning our next trip.
But speaking of planning trips, EndWell’s latest event was so intriguing that I couldn’t pass it up. Titled “The End in Mind: Psychedelic Medicines and Ending Well,” it was a day-long virtual conference featuring an array of fascinating speakers from a range of disciplines, including patient advocates and even Melissa Etheridge. And it was about the possible benefits of taking an assisted inward trip prior to the Big Trip that awaits us all. Even better, the conference was free. I registered with some temerity, and here’s why.
I was a young teen in the late 60’s when psychedelics made their first foray into popular culture. Too young and on the wrong coast for Woodstock, I nevertheless grew up less than 25 miles from San Francisco’s Haight-Ashbury, and a friend of a friend knew Ken Kesey. It was a time of cultural disruption like nothing I’ve ever known — the closest experience would be watching the country’s agonizing split along idealogical tectonic plates while the Tea Party birthed the Trump administration. But that has been characterized by societal contraction, whereas the 60s ushered in wild expansion. In my freshman year of high school I went to classes wearing madras dresses topped with Peter Pan collars. By my junior year I wore Navy surplus bellbottoms with tie-dyed tee shirts and anti-Viet Nam-war arm bands.
Those were heady days, pardon the pun. But with the “turn on, tune in, drop out” mentality espoused by Timothy Leary there was a kind of ungoverned wildness that frankly scared me. Suddenly it seemed LSD and PCP were everywhere, and stories abounded of kids who had bad trips — so bad, in some cases, that they ended up doing stints in mental hospitals like the hapless inmates in Kesey’s One Flew Over the Cuckoo’s Nest. Some of the devotees of mind-altering drugs developed an agressive zeal, believing that everybody, ready or not, needed their minds blown. It became a fad to spike party drinks and food with acid or angel dust, just to see what would happen. Several of my friends experienced this first hand and were deeply shaken by it.
It was a bad time to have an anxiety disorder, especially since such a thing was so poorly understood at the time that it barely had a name. But I was a kid prone to the heebie-jeebies, to sudden and terrifying episodes in which I felt dissociated, adrift, and alienated from everything and everyone around me as my heart pounded and my chest heaved with shallow breaths. The prospect of having any control of my agitated mind wrenched out from under me by the unwitting ingestion of a hallucinogen was my worst nightmare. I quickly learned to touch nothing at a party that I hadn’t opened myself, and if I set a drink down somewhere I refused to touch it again, lest somebody had slipped something into it.
Yet previously, at the age of fourteen, I’d had an experience of the kind of sudden expansion and illumination that the head-trippers crowed about — but mine arose organically and spontaneously. I was studying in our local library branch on a Saturday afternoon, and something I read gave rise to a thought: we are all one. Words can’t really do justice to what happened next. I was suddenly suffused with a deep, unshakeable knowledge, a blissful realization that everything and everyone around me was connected. And not just connected, but intrinsically a part of a magnificent whole. All sense of separation evaporated as I gathered my books and walked — nearly floated — out of the library and wended home through a mile and a half of my ordinary suburban neighborhood. Except now it was anything but ordinary: each tree, each leaf, each rock, each person or dog I passed radiated with kinship, with inclusion; we were all part of the same thing, and that same thing was marvelous.
I felt the very opposite of alone and cut off. I was full of a quiet, all-encompassing joy. Moreover there was a sense of utter safety, because even if something happened to disrupt my existence it didn’t really matter. I was part and parcel of all existence, indistinguishable and inextinguishable. I didn’t want the feeling to fade, but I was aware that I wouldn’t be able to sustain this elevated state — and sure enough, by the time I walked through the front door of my house I was back to being plain old me, my identity squeezed back down into the persona of a goofy American teenager.
I didn’t tell anyone about that experience at the time, and I’ve rarely spoken about it since. There was something both sacred and vulnerable about the memory of it, one I didn’t wish to expose to the scrutiny of others. Later on, when anxiety had its teeth in me and I felt like a failure of the counterculture because I was too chicken to drop out and drop acid, the memory of that transcendent event made me sad. I never doubted its authenticity, but now I attributed it to a kind of innocence or internal purity that I had somehow, through some fault of my own, lost. I was pretty sure that whatever dwelt within the deeper strata of my personality could not be good and was better left where it was, firmly tamped down.
In my twenties, I saw a bumper sticker on a car in L.A. that made me roar with rueful laughter: Reality is for people who can’t handle drugs. That’s me, I thought. I had artsy friends who were bold adventurers of the psyche, but I couldn’t join them. Yes, I do grasp the irony of being ashamed of not taking drugs. Such is the power of the environments into which we are born.
My crusty suspicion of altered states of conciousness persisted, and has only recently begun to decalcify. As you’re no doubt aware, psychedelics are undergoing something of a renaissance, or at least a pre-renaissance. Still mostly Illegal and long vilified as dangerous party drugs (and, as party drugs, they certainly can be dangerous), psychedelics were for decades avoided by researchers who wanted to hold onto their funding.
In recent years, that has changed. More and more evidence of these drugs’ potential is making its way from the underground into the light of day. Psychedelics — naturally occuring ones such as psylocybin (magic mushrooms) and ayahuasca as well as lab-created ones such as LSD, MDMA, and ketamine are showing they can, when used properly and with great scrupulousness, treat maladies such as depression, anxiety, PTSD, and addiction with transformative effectiveness. In a significant number of cases, even one such “journey” with the support of a trained guide can bring about long-lasting positive outcomes.
I read Michael Pollan’s book How To Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. I’m a big Michael Pollan fan. I consider him the Carl Sagan of leading edge trends in human development.
His book moved the needle for me in terms of my resistance to the notion that psychedelics might, used correctly, offer something more than either a gonzo trip or a frightening plummet into the abyss. Pollan repeatedly emphasizes “set and setting,” the critical importance of treating these medicines with utmost respect and using them with preparation, a skilled and experienced guide in a safe and supportive environment, and with post-journey integration. He relates his own experiences with several of what he calls “these powerful molecules” — mushrooms, LSD, and ayahuasca among them — vividly, as well as the benefits he feels he received from them. He also gives an overview of the history of psychedelics, how they came to be abused and excoriated as mind-crippling street drugs, and their uncertain road back to serious regard by researchers and practitioners.
I found the book exciting and powerfully persuasive, but for me, still daunting. Would I love to again access that luminous, exalted state I experienced at the age of fourteen? You bet. But am I ready to embark on a journey that, once begun, must be seen through all the way to the end no matter how weird the ride? Not today, thanks.
Still I kept running into articles about this or that psychedelic’s benevolent effect upon those who suffer a variety of psychological and emotional maladies — including those facing life-threatening or life-ending diseases as well as those who are dealing with grief. I currently have loved ones in both of those situations, which means I will also be encountering grief in the foreseeable future. To an anticipatory extent, I already am.
All this is to explain why I spent most of one day this week glued to my laptop taking in the End In Mind conference. Using a mightily sophisticated virtual conference platform, Hubilo, the agenda offered keynote speakers, panels, breakout sessions, and even exhibition and networking lounges. There was more than I could take in in one day, especially sitting down and staring at a screen — but the whole thing was recorded, and I’ve already watched one session I missed the first time.
Like Michael Pollan, great emphasis was given to set and setting and the importance of expert guidance in using these substances — a definite “don’t try this at home” message. But the doctors, research psychologists, clinicians and practioners who spoke all waxed nearly poetic about the transformative nature of the experiences those in their care had undergone, and that they had undergone themselves. “These are meaning-making medicines,” said more than one speaker, and the word “profound” came up a lot. No party animals here. These are serious people.
Some of the most compelling panellists were the patient advocates. These were people who have dismal prognoses themselves, with organ cancers that have returned a second or third time, and who have used “plant medicine,” in their cases psilocybin, to help them confront and make sense of their situations. They spoke of experiencing, during their journeys, a sense of connection and wholeness too powerful to put into mere words, and one that has changed their entire relationship to their lives and imminent deaths. These people are far from grim-faced sad sacks; they are vividly, fully, often humorously alive.
Are they happy they have terminal cancer? Of course not. They are not in denial. They’re straightforward about their losses. It sucks big time to know they’re not going to see their kids finish growing up. But do they feel cut off, isolated by their disease, and terrified at the prospect of death? Emphatically, no. The expansion of their conciousness through the (careful, respectful, guided) use of psilocybin has put them in touch with something greater than their limited, earth-bound selves, but of which they are forever a part. Unlike my fourteen-year-old glimpse, it’s a knowledge that has stayed with them.
Also riveting were the accounts of bereaved parents who have undergone psychedelic therapy to get them out from under an unrelenting, unmoving burden of grief. They haven’t “gotten over it.” Their sense of their dead children hasn’t faded or dulled, and their grief hasn’t disappeared in a poof of magic. But the power of their experiences with the medicines put them in a completely different relationship with the nature of their losses, allowing them to live funtional lives again — even, they would say, allowing them to sustain a relationship with their children on the other side of the veil.
So, like, wow. What if we really could transform the way we handle death and dying? What if we could change the experience of death from a resistant, clinical, terrifying fight against the inevitable to an intimate, compassionate and sacred passage? What if we approached death more like we have learned to approach birth? What if psychedelics could make that more possible for more of us? And what might that mean, if we stop living in terror and denial of death, for how we live our lives?
All the professionals in the field noted that these are early days. There’s a whole lot to learn, and a lot to reconsider from many angles — medical, ethical, legal, policy, and design. But I came away understanding the excitement the presenters expressed about the hopeful future of psychedelics.
Does that mean I’m signing up for a no-cancellation interior cruise any time soon? Well, not exactly. I have deep respect for the power and possible peril of mind-altering medicines. But my mind is beginning to open — to the possibility, when the need, the correct time, and the right set and setting present themselves, of opening a whole lot more.