Luminous: What Can Psychedelics Teach Us About Dying?

TTBOOK Presents Luminous episode 1. A door with magical colors coming out.

"A being made of prismatic light stands in the dark, peeking through a keyhole to glimpse a colorful outdoor landscape on the other side." Mark Riechers/Midjourney (TTBOOK)

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Original Air Date: 
April 08, 2023

In the first episode of "Luminous," our series about the philosophy and the future of psychedelics, how can psilocybin ease our fears about dying? And how can psychedelics change the way we approach the end of life?

Roland Griffiths
Articles

Roland Griffiths helped pioneer the use of psychedelics to treat people with cancer who are scared of dying. Then he got his own terminal diagnosis. He talks with Steve Paulson about his personal LSD journey when he "talked" with his cancer.

Length: 
18:42
an older woman with her hands folded.
Articles

A decade ago, Lou Lukas took part in one of the first trials of psilocybin-assisted therapy. Today, she's a palliative medicine physician and an advocate for psychedelic-assisted therapy โ€“ especially for people living in fear near the end of life.

Length: 
15:06
Anthony Bossis
Audio

Tony Bossis was one of the lead investigators on the 2016 study that found stress reduction in cancer patients after a single dose of psilocybin. He's fascinated by how the mystical experiences of the great religions map onto psychedelic experiences.

Length: 
14:08
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Show Details ๐Ÿ“ป
Airdates
April 08, 2023
Guests: 
Lou Lukas
Palliative Medicine Physician
Clinical psychologist
Full Transcript ๐Ÿ“„

- [Anne] It's To the Best of Our Knowledge. I'm Anne Strainchamps.

- [Steve] And I'm Steve Paulson.

- [Anne] And this is the first episode of a new project we're launching this year called Luminous, a series on the philosophy and future of psychedelics.

- [Steve] I've been covering the psychedelic revival for the last decade, and there is a lot to talk about. Not just the new therapies we're likely to see in the next few years, but also big existential questions. The nature of consciousness and reality itself and how psychedelics might change the way we approach the end of life.

- [Anne] They can ease the fear of death for patients with terminal diagnoses, but how and why?

- [Steve] What could psychedelics teach us about dying?

- [Roland] Yeah, nice to see you, Steve.

- [Steve] Oh, I'm so glad we could have this conversation now.

- Yeah.

- So how are you feeling now?

- [Roland] Well, it on one hand, never better, emotionally and spiritually. Medically, not so great. I have this stage four cancer diagnosis that's been pretty resistant to treatment.

- [Steve] This is Roland Griffiths, arguably the most important psychedelic researcher of our time. The psycho-pharmacologist who brought psilocybin, the active ingredient in magic mushrooms, back into the field of medical research for the first time in decades. I've known Roland for years, but this conversation took us to a whole different place. It's January of 2023, the first time we've talked since his diagnosis with terminal cancer, and I'm catching him in the middle of his third round of chemotherapy. So this is a really daunting prognosis, and most people, I think would be, would be really scared or would be trying to just forget about the whole prospect of what's ahead and the thought of dying. You seem to be in a different place. And I'm wondering how you got there.

- [Roland] I wonder too. It's really been quite fascinating because this came about after just a routine screening colonoscopy. Came out of that with a significant colon tumor. And in just a few days, it was clear that it was metastatic to the liver, meaning that it was a stage four. And it was completely outta left field. It just seemed unreal to me, frankly. And then very quickly, when the kind of the depth of it finally came through, where I wanted to sit with this was in gratitude for the miracle of existence, the miracle of life. The fact that we're here as sentient, conscious creatures aware that we're aware.

- [Steve] So you just decided that you wanted to have a more positive attitude and somehow that happened, you got there.

- [Roland] Yeah, but it's more than an attitude. I mean, I now have about 30 years of meditation experience. And the diagnosis was a phase shift. Whatever degree of awakeness I had previously was just ramped way higher. It's that, it's leaning into the present moment with the gratitude and the wonder and the curiosity of what we're doing here.

- [Steve] But what I find so fascinating, so amazing about what you're saying is that you're saying until you got this, essentially this terminal diagnosis, you couldn't fully lean in. You couldn't have that full awareness that you have now. You had to have that diagnosis to get there. For you personally.

- [Roland] Yeah, for me personally. But my, yes, it came as this very powerful further awakening. It seems, in principle, it shouldn't take a terminal diagnosis. But then also it's a throughline with the work with psychedelics, and we've been doing work now for 25 years on psychedelic drugs and their close cousins, in some sense, of awakening experiences and this experience of existential wonder.

- [Steve] And I wanna talk about that because the parallels between your personal experience now and some of your early studies of people who took psilocybin specifically to help them deal with end-of-life anxiety. I mean, wow, you are living what you studied.

- [Roland] Yeah, yeah.

- [Steve] It was Roland Griffith's fascination with meditation that originally sparked his interest in studying psychedelics. At the time, no one could do this research legally. But Roland had an international reputation as an expert on drug addiction. And he persuaded Johns Hopkins University and various government agencies to allow him to run a clinical trial with psilocybin, specifically to see if it could elicit transcendent experiences. The results were remarkable. Of the 36 people in that first study, 61% had what Roland called mystical experiences. A follow-up study found 75% had them. And 14 months later, two-thirds of those people described this as one of the five most meaningful experiences in their lives. This is how he put it to me in 2010.

- [Roland] I would sit down with volunteers after these sessions and say, "Well, so what was it like?" And very often people would kinda look at the floor and look away, and then they would start to describe this sense of the interconnectedness of all things, their heart opening, and it was amazing to me. I mean, I was sitting there talking to a newly minted mystic.

- [Steve] So what did you take away from this study? Did you come to, I don't know, philosophical conclusions about how we're wired, why we respond so strongly to a substance like psilocybin?

- [Roland] The fact that psilocybin can occasion these kinds of mystical type experiences that map on so clearly to naturally occurring or spontaneously occurring mystical experiences reported by mystics throughout the ages. The fact that it can do this with such high probability in so many people, indicates that we're biologically wired to have these kinds of experiences.

- [Steve] At Johns Hopkins, Roland led a series of clinical trials with psilocybin for treating major depression and nicotine addiction. The results showed real therapeutic benefits. Perhaps the most dramatic results were for treating cancer patients who were scared of dying. In one study published in 2016, a single large dose of psilocybin led to a significant drop in depression and anxiety. And after six months, 80% of those participants continued to feel less anxious and had more life satisfaction. So I wanna get even more personal here, because up until very recently, you have not wanted to talk publicly about your own psychedelic experiences and for understandable reasons. The whole field of psychedelic research has struggled for legitimacy for decades and you have been the most visible scientist in the field over at least the last two decades. But since your cancer diagnosis, you have started to talk about your own experiences. So I have to ask you, have you had psychedelic experiences since your diagnosis?

- [Roland] Let me start from the beginning. So I had a few uneventful psychedelic experiences as a college student. They weren't meaningful, and frankly, I'd largely forgotten about them. And then it was after I initiated a meditation practice that I got really curious about the nature of inner experience. And so that was the motivation for starting the psychedelic work. And that work became astonishing to me. I mean, because people did have these incredible experiences to which they attributed this deep meaning and spiritual significance. But I did not reengage personally with psychedelics until, oh, at least 10 years after we initiated those studies.

- [Steve] Oh, that's interesting. So you had been seeing the profound impact of this on all these people, and yet you didn't wanna try this again yourself for 10 years?

- [Roland] Yeah, so there's such a prohibition against psychedelic use, that I thought it would undermine my credibility as an investigator if I became a psychedelic proponent. But eventually, curiosity got the better of me. And I have subsequently had, not a lot, but some experiences with different compounds. It has dovetailed in a very interesting way with what I've learned from meditation. And my own sense is that meditation is the tried and true way to investigate the nature of mind. And I think of psychedelics as, in some respects, meditation on steroids. And so to bring this up to the question about, well, so after the diagnosis, have you tried psychedelics? I did have a significant experience, in this case it was with LSD. And I went in to use it as an opportunity to dialogue with the cancer.

- [Steve] So you asked your cancer questions during your LSD journey?

- I did, I did. And I did this repeatedly over the course of almost 12 hours. So I repeatedly returned to the two major questions. One is, "What's going on here? Do I have to die?" And the answer was, "Yeah, this is the way it's supposed to be." And then I asked, "Well, how am I supposed to be with this? What am I to do? Am I doing what I should be doing?" And the answer came back, "Yes, you're doing exactly what you should be doing. There's something that you have to say about this." And that felt good to me. And then, of course, this is an entity other than myself. So then I decided I'd negotiate and say, "Well, so how about giving me more time? How about several years?" And I got no answer.

- [Steve] So there's the emotional response. Of course, you must have felt wonderful. I mean, I'm sure you would've liked to get the answer, yes, you can have several more years. But you talked about you were dialoguing with an entity. Do you think there was some intelligence you were communicating with? Or was it some deeper part of yourself? Who do you think you were talking to?

- [Roland] So I would default to thinking that that's my own internal wisdom coming up. Granted, that is my own, you know, world view perspective based on the fact that I'm trained as a scientist.

- [Steve] And you've been pretty upfront over the years. I mean, as a reduction of scientist, that's kind of how you identify yourself, right?

- Yeah.

- You are not, certainly not a conventionally-religious person and I don't know if you think there is some transcendent essence out there, intelligence, but my sense is probably not.

- [Roland] Well, what I do feel very strongly is that we're living within a mystery that far outstrips our science and our ability to understand what's going on. I mean, science makes a wonderful account. And I'm a scientist, I believe in the scientific method. But that certainly doesn't address the nature of consciousness. So we are in this mystery, and I find that to be enthralling. And so that mystery, I think for some people, is synonymous with ultimate reality. And some people might call it God. I have no idea if that's right. But I do have a great curiosity and a great reverence for the nature of the mystery.

- [Steve] I wanna end where we started, coming back to your own story, your cancer diagnosis. And you have said that remarkably, in this very visceral way, you have discovered the preciousness of life. In some ways, you've never been happier. And what you're saying, I don't wanna be too morbid here, but do you think about how you'd like to die?

- [Roland] Yeah . Yeah, a lot. I don't have a firm vision of that.

- [Steve] You're not gonna do the Aldous Huxley thing of taking a big hit of LSD at the moment of your dying?

- [Roland] Actually, someone just gave me Laura Huxley's book where she has a very clear account of that. So when we work with the terminal cancer patients, I will always ask them, and I spend hours with them, and we treated over 50 people. And I would also ask them, what do you think happens when we die? At that point, a curious question for me to ask, 'cause I couldn't put myself in their shoes at all. But some came out with accounts of afterlife and they're gonna go see their mother and their grandparents, and it's gonna be beautiful. And some would say they believe in reincarnation. And then others would say, nothing happens, lights out, that's it, computer's unplugged. And I would ask them, "Well, what's the probability that that's true? Do you believe that to be completely true? And they'd say, oh yeah. I said, well, what percentage would you put on that? And they would say, oh, 95% . And I would think 5%. If you give me 5%, you know, people bet on the lottery at odds of one and what, 200 million? If you give me a 5%, you should be really interested in what happens when you die. I think I hold that sense, although I put the probability of afterlife, continuity of consciousness, to be a diminishingly small probability. But it's not a zero probability because we are in this mystery. And that's all I need. I don't even need one in 200 million. I'll take it, I'll take one in 10 billion. But to be interested in that process of what it is, because no one knows. And so there's a funny sense I have actually, that that curiosity makes the whole process of dying to be one of interest. So I don't know what that end point looks like. I don't know what I'm ultimately gonna succumb to, whether it's some kind of secondary infection or whatever. It's a, you know, bodily breakdown. I would hope that it would not be painful. And then it's just a question of being deeply interested. But it feels so important to me to leave with the pieces of my life complete. So the relationships that I have with my children, my grandchildren, my friends, my colleagues, my wife. This legacy project of this research will endure in perpetuity focused on the very of heart of what I'm most interested in, are deeply meaningful to me.

- [Steve] This has been so beautiful, thank you. Thank you for sharing your thoughts and your experiences and your wisdom. Thank you.

- [Roland] Thank you, Steve.

- [Steve] That's Roland Griffiths, the Founding Director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University. In that legacy project he mentioned, he's now creating an endowed psychedelic research program on secular spirituality and wellbeing to promote human flourishing for generations to come. You'll find a link to the project on our website at ttbook.org/luminous.

- [Anne] Coming up, a palliative medicine physician says something is wrong with the way doctors handle end of life care. And she thinks psychedelics can help.

- [Lou] The feeling that I got regarding all serious illness is that we sent some really smart people to the Louvre and they came back with a plumbing diagram and didn't notice the art.

- [Anne] Meaning we mostly treat the dying body rather than the whole person.

- [Lou] Well, even if you're sick, even if you're dying. When we go to a doctor, we tend to get very technical and very specific. And this is a time when people don't have time and they don't have energy. So what would it be like to offer them the opportunity to have this, sense that experience of vastness in a very natural and organic way?

- [Anne] I'm Anne Strainchamps.

- [Steve] And I'm Steve Paulson. You're listening to Luminous, a special series on our psychedelic future from To the Best of Our Knowledge-

- [Anne] Wisconsin Public Radio and PRX. A decade ago, Lou Lukas was working as the Medical Director of Hospice in the Baltimore area, when she took part in one of the very first trials of psilocybin-assisted therapy. This was with two of the pioneering researchers at Johns Hopkins, Roland Griffiths and Bill Richards. So there was an initial screening, several sessions of preparation, and finally, a glass of water and a capsule.

- [Lou] I just noticed my peripheral vision changing a little bit, as if things were just a little bit glittery. And I said, "I think it's happening now, Bill." And he said, all righty, it's time to put on your eye shades. And I put on my headphones and I laid back on this couch and everything changed . I felt like I was moving on a conveyor belt into a jungle. And what it was leading to was a huge wasp.

- A wasp?

- A wasp. And I'm like, oh, oh, I'm going into a wasp. And then things changed again . One of the pieces of guidance that Roland, in particular, gave me, he said like, "This is a medicine that when you take it, it's going to change the way you perceive the world . So all of the ways that you have perceived the world, this medicine takes that apart. As that happens, your mind's gonna try to tell you a story. It's going to conjure up something terrifying. If you read the ancient literature, it's like people would see demons or dragons. He said, "Modern people don't see demons and dragons. Modern people tend to think either you're going to die or you're going to go crazy. And what I'll tell you is just let it happen. If you fight it, you will lose and if you run, it will chase you."

- [Anne] It's sounding more and more like one of my worst nightmares.

- [Lou] Well, it has that characteristic about it. Everything that you've understood about you is dissolving. Every once in a while there would be a window, and through the window I could see scenes of my life that were horribly boring and mundane and pedestrian. Just being crushed with boredom of like, your life is nothing. Your life is just this maze and you can't get out of it. I'm like, "No, I can get out of here. I can get out of here." And a voice is just laughing. "You can't get out of here." I was like, "No, I can get out of here. I'm gonna study at Johns Hopkins." And this voice said . It was this evil, demonic laugh. "You are not gonna study at Johns Hopkins. This is your life. This is all there is and there will never be anything." "No, no, there has to be more than this. I'll lose my mind." And with that, I remember Roland saying, "If you feel like you're going crazy, go crazy." And I went, "Oh , I'm going crazy." And the next second I was backstroking through this beautiful, bioluminescent subterranean cave. I was in a lagoon in this subterranean cave and I was backstroking through this beautiful landscape. And that's when the real deal happened, that's when I crossed over. And from then on it was scene after scene of illumination. I was in the fullness of the universe, like the Buddhists talk about the boundless abodes. On the outside, it was about a six-hour trip. On the inside, it could've been forever. And in fact, at times it felt like forever.

- [Anne] Today, 10 years later, Lou Lukas is a palliative medicine physician and an advocate for psychedelic-assisted therapy, especially for patients like hers, people who are near the end of life and scared. Walk me through how this works. I mean, normally when somebody is referred to you, some other doctor has said, "There's nothing more we can do for you."

- [Lou] So I get involved a little bit before the nothing more we can do for you. And often another doctor has said, "This person has an illness that's going to take their life. And we don't know exactly how long it's going to be, but how the rest of that life goes is going to depend upon the decisions they make." And so I sit with people and help them understand what their body's doing and why this illness is causing issues, how that illness is going to impact their ability to meet their hopes and dreams and to live into their lives, and then to help them sort through what kinds of choices, in terms of treatment, are available. And there are sometimes when there are treatments that will be helpful and they are congruent with this person's goals. And there are times when the treatments either won't be helpful or the life it leaves them with won't allow them to achieve those goals, and they might not want those treatments.

- [Anne] Is there an example that comes to-

- [Lou] Yeah, I'm trying to think of a good one. So I had a patient recently, when I asked him what was important in his life, he told me that his wife had died 10 years ago and that he'd been longing for her for all of that 10 years. And we talked about this illness. He said, "Thank God. God has finally called me home and I don't want to treat this. I want to go be with my wife." There are lots of people who don't have the calmness and clarity to deal with that, but it might be the same desire. They don't want to, they just get stuck on the merry-go-round of medical treatment.

- [Anne] And probably no idea. I mean, so many questions. What's it like? What's going to happen? Does anything, I mean, is it just like a match blows out, that's it?

- [Lou] Well, you know what's interesting, Anne, is that you talk about that and you have the natural curiosity of a journalist. What happens to most people is that they're so frightened, they can't even be curious and then they start to shut down. They become depressed, they become anxious. And we start scheduling them for medical treatment. So whatever time they do have, they're in treatment that may or may not work, but we haven't questioned whether we can stop treatment because they're too terrified to think about the possibility. And so we're in this cycle of, we lose a sense of meaning. We get trapped into clinging onto this life no matter what it means, even if it means I'm spending three days a week going through treatment and not spending time with my family. And in the end, nobody gets out of here alive, right? You know, we've got a deadline in life and what do I need to do? What gifts do I need to leave to my family? How do I think about passing on some of my wisdom? How do I think about really going out with some joy and some curiosity and really being full of life? There are even people who talk about like an ecstatic grief of this life that we're living is so precious and so sacred. But it's only in that time when you realize that it's short, that there's not that much of it, that you feel the beauty and the magnificence of it. And if you can help to convey that to people, wow, look at this gift we're sharing. Look at the intimacy we're able to have now, just because I realize time is short and I don't have that much more time to hold your hand.

- [Anne] You must be a very unusual palliative care physician, because honestly, I don't think that most palliative care physicians go into such depth. I think it's more focused on, okay, so maybe we add some more morphine.

- [Lou] You know, given the opportunity, most palliative doctors would go into similar territory, I think. And I teach residents and fellows, and there's a sense of, well, what am I here to do? It's like, if you don't talk to people about this, who is?

- Yeah.

- Because even if they have a trusted spiritual advisor, their trusted spiritual advisor doesn't know what's going on with their body. Their pastor doesn't have any idea how sick they are. And if you don't broach this with them, it's like, you know, we're keeping you patched together now, but this might not last. If you don't initiate those conversations of how are we making meaning out of your life, they're never gonna connect with their pastor in a different way. And so our ability to reclaim some of the phonemic origins of medicine. Sort of how do we help people bridge this gap? And not every doctor needs to do this. Some people should be quite technical. You want your surgeon to have precise technical skills. But we need more doctors and more healthcare providers who can bridge that gap. Physicians who are called to this edge walking that I think about, when you've got one foot in the medical world and one foot in the psychospiritual world.

- [Anne] The FDA has not approved psilocybin for medical use. So you cannot now say to a patient, you know, I think you would be a great candidate for psychedelic therapy. But you do have some studies, right, that you're thinking about.

- [Lou] Exactly. And I'm doing a trial of a psilocybin protocol for people who have distress related to pancreas cancer. And as you probably know, pancreas cancer is one of the most lethal of the solid organ cancers.

- [Anne] It's a particularly terrifying one or one of them.

- [Lou] It is and most people who are diagnosed are diagnosed very far along, and we can get people a couple months usually, but not a whole lot longer than that. Some people might live a year, a year and a half. You can imagine being told this.

- Wow.

- And so people who are at our cancer center being treated for their pancreas cancer will be offered admission into this study. We'll take them through this period of about six to eight hours of preparatory counseling, a day long dosing session, and then several sessions of integration afterwards.

- [Anne] I guess what I'm wondering is, what is the experience like for somebody who does have a terminal illness to take psilocybin?

- Yeah.

- What changes? The day after, how do they feel? And the day after that and the day after that?

- Yeah.

- What's different?

- [Lou] It's phenomenal. People say a few different things. First, somewhere between 60 and 80% of people have profound experiences that dramatically change their life and their perception of their illness, which is remarkable because nothing else works like this. And it isn't even the next day, Anne. When they're finished with this, when they kind of come back into consensus reality and they're talking to you, they just look at you like, that was amazing. It's as if, if you've built your reality on this house of cards, of all the stories that you have about yourself, oh, life is hard and then you die and I've got this cancer and I'm really worried and I can't get myself out of it and I'm scared, and every time I feel a bump, I think the cancer's going on. If that's what you came in with and then they just blow, you go through this experience and that whole house of cards of stories just gets washed away. I witnessed one patient just say like, "All that anxiety I felt, it's just stories. I can get a different story, I don't need that story." And then it had that sense of, oh, that worry, I don't have to be that worried. Yeah, I've got cancer, but I don't need to be that worried about it.

- [Anne] Are they less afraid of dying?

- [Lou] There's a wonderful story. Anderson Cooper captured it on "60 Minutes." And this woman who was in the study three years earlier, and who, just before the interview, she was diagnosed with brain met. So she was actively getting worse, and she looked at him and said, "I don't say I'm happy. I say I'm comfortable. I spent my whole life being anxious and I'm comfortable. I'm not afraid to live, I'm not afraid to die. I'm just comfortable." And she kind of giggles. And this is three years after her psilocybin experience. And underneath it all, what people report is love. And just this sense of like, I've been in the presence of love and maybe if we were dropping the stories that we need, like to get through our world, we need a certain level of defense. Like it's a hard world and we put defenses up to keep ourselves physically safe and emotionally safe. And so if we were able to let some of those defenses down, maybe we would have more access to love. And if we have that, then you can really accept a lot of things.

- [Anne] Wow. You know, this does raise the question, why do people have to wait until they're dying? I imagine some of the terminally ill patients must say, "Darn, if I'd only had this revelation, you know, 30, 40 years ago, I might have lived differently."

- [Lou] Well, exactly. And for most people you would use it like a sacrament. And in indigenous cultures we see that this is often a rite of passage, that when you come into adulthood is the first time you would use this. And then perhaps when you got married or perhaps before a child or perhaps every decade or every, you know, whatever the right interval is, you just touch back down and recognize sometimes I'm my individual within my community, but I remember that I'm connected to everything. And it's almost like a ritual bath, like a mikva in Judaism. Perhaps there's this time when I take a psychedelic bath and I remember like, oh, I'm gonna wash myself in the universe. I'm gonna immerse myself in the unconscious mind. I'm going to feel that expansive consciousness and realize that I'm part of everything. And then I'm gonna come back and do the laundry and change the diapers. If you could just wake up a little bit more frequently and remember like, oh, there's more than just this little life that I'm leading. My life is lovely and there's more.

- [Anne] Lou Lukas is a Professor of Palliative Medicine at the University of Nebraska Medical Center. You can learn more about her clinical practice at palliadelic.org. Coming up, what can psychedelics tell us about the nature of mystical experience?

- [Tony] Is this part of our interior, part of human self experience, this transcendence that we speak about? Or is it connecting with some other, something outside of ourselves? And of course, it goes back to what is consciousness? And I think that's the final frontier for science. What is consciousness? What the hell is all this?

- [Anne] It's To the Best of Our Knowledge, from Wisconsin Public Radio, NPRX. You're listening to the first episode of Luminous, our new series on the philosophy and future of psychedelics. I'm Anne Strainchamps.

- [Steve] And I'm Steve Paulson. When I was 14 or 15, I became obsessed with those big, existential questions about why we're here in this universe and whether there's any point to it all. Over the years, I've discovered that a lot of kids worried about those questions, like Tony Bossis.

- [Tony] I think like a lot of kids, I had fear of death as a kid. I'd lay in bed at night, between seven and 10 years of age, and try to imagine what happened after I died. And try to imagine that nothingness and do this kind of thing in my head of imagining nothingness forever and ever and ever and ever, until, of course, that created a fair amount of stress for me. But I think it's fair to say that led to a big interest in comparative religion, as in my teens. And, like many of us, I learned of TM in my early 20s and studied Zen and Vidante Hinduism and the Christian Mystics. And clearly, I think, in an attempt to understand consciousness and death and then all the other facets of spirituality. And you know, in my early 20s, came across this incredible body of literature on psychedelics and realized, I want to do this for a living. I was gonna be a lawyer and after some experiences and reading all of this incredible stuff, I wasn't gonna be a lawyer.

- [Steve] Tony Bossis went on to become a clinical psychologist and today he works with the NYU School of Medicine in their Psychedelic Research Program. He was one of the lead investigators on the landmark 2016 study that found profound stress reduction in cancer patients after a single dose of psilocybin. He's still fascinated by the mystical experiences of the great religions, and he's especially interested in how they map onto psychedelic experiences. I recently caught up with Tony at his private practice in midtown Manhattan, where we talked about his psilocybin studies with cancer patients.

- [Tony] In our trial, and with Hopkins as well, but our NYU trial showed a rapid and sustained and significant reduction in depression, anxiety, hopelessness, and a really complex feature called demoralization, which will now be our primary variable in this new trial we're doing. Demoralization is a deep existential sense of despair, of meaninglessness, of hopelessness, and it's hard to treat. It's becoming a fairly important construct in palliative care because we now know that, through some research, it appears to be a distinct clinical entity from major depression. So as someone who is dying or end of life or palliative care may have depression with those features, that may respond to medication to psycho-pharmacology. It's turning out that for some people that's not helping them and it's those people who have this demoralization.

- [Steve] My reading of that is sort of loss of purpose, loss of meaning.

- Exactly.

- [Steve] They sort of feel like there's no point to it.

- [Tony] Right, exactly. And so that's been harder to reach with medication, so those people have kind of fallen through the cracks. However, it appears now, in this exciting emerging conversation, that they do respond to a meaning making experience. By my eyes, these experiences, potentially the mystical or peak or psychedelic generated experience, what makes them so, I think, effective is their capacity to generate meaning and transcendence. Those better outcomes we talked about, depression, anxiety, demoralization, and hopelessness, being diminished were correlated when someone had the mystical experience.

- [Steve] You need to have the mystical experience to have this powerful effect, this powerful benefit.

- [Tony] I'm gonna hold back from saying they need to, but in this trial and other trials like it, the higher the score and the mystical experience, when that was endorsed, that seemed to be a mediating factor or a predictor of these better outcomes. Again, that comes down to what is the mystical experience? It's a cluster of features and it's ineffability, beyond words. It's a unity, we're all connected, we're literally connected. It's a sense of sacredness, transcendence being a key feature. You know, Abraham Maslow, the great American psychologist, called them peak experiences. And there's plenty of names for them. So we're using the word mystical and some people think mystical, I thought this was a science. But it's a scientific study of the mystical experience. Carl Jung and Rudolph Adel called it luminous. Again, language falls short.

- [Steve] There's also something a little counterintuitive about all of this, because you're talking about people who are scared to death of dying. And we also, of course, know that a psychedelic experience itself can be terrifying.

- Yep.

- [Steve] For anyone, not just people who are dying. And so you would think it might have just the opposite effect. It might trigger incredible anxiety. Not only are you worried about dying, but you're taking this very powerful drug that can be terrifying in itself. And yet somehow you're saying, for a lot of people, it has absolutely the opposite effect. It makes people feel much better, wonderful often.

- [Tony] That's an important point. But it also is wildly frightening, it can be. There's a Greek word, I like to quote the Greeks when I can, called hanime lippi. It's defined as a joyful sorrow or joyful mourning, M-O-U-R-N-I-N. And it's used during Easter week to characterize and kind of conceptualize there is this incredible suffering in death and then transcendence. The more and more I think about these incredible experiences, it seems, in part, they're about recalibrating our suffering. And that in every minute, in getting back to the cancer patients, or for all of us, every moment is filled with potential unspeakable suffering, but also unspeakable joy. There is terror in this. There can be horror in these experiences as well.

- [Steve] Is that important? Do people who go through the terror, I mean, can they get a better result in the end? They're starting being frightened of dying and they might have a, at least at the beginning of the experience, a frightening response to the psychedelics, you know, losing your ego, losing your control. Is it partly going through that terror that gets you to the other side? That gets you to this feeling of it's gonna be okay?

- [Tony] It is for many people. There isn't one experience. Everyone has their own experience, clearly. But there is a whole set of experiences around what you just mentioned. But part of the narrative seems to be, well you take these and this complete knowledge of how things go. A person may feel that. But you come back into ordinary consciousness and doubt creeps in. But what does stick around is that the acceptance of not knowing. And that's been very striking to me. 'Cause you and I know where we don't know what's gonna happen exactly. Maybe in moments as, oh, I know this continues in some way. I feel it. Whatever people may say. And then doubt creeps in, which I think is an essential spiritual value to have that.

- [Steve] Why would the acceptance of not knowing be comforting for people who are dying?

- [Tony] Well, this experience generates that experience of letting go into whatever it is, and they'll say the mystery a lot. But that being okay with it, it's gonna be all right. There's a great line from Thomas Merton, the great Christian mystic, asked Aldous Huxley, who was a great proponent of psychedelics back in the 1950s, he asks him, "What are you doing with this? Why do you discuss religion and psychedelics? What are they doing for you?" At that point, it was primarily LSD and mescalin was Huxley's, what he had done. And Huxley writes him in a beautiful letter this gorgeous paragraph about spirituality. And he says, but in the end, despite all the suffering, and he uses the word evil, and Huxley didn't use words carelessly, he used the all the evil of the world and all the incredible difficulties in being a human being, that the message comes across that somehow it's gonna be all right, despite not knowing. And then he says, "And it's all love." And he says, "God is love." Somehow this experience allows us to be okay with not knowing. And that's something else, that's really incredible, especially if one's body's beginning to fail.

- [Steve] Oh yeah.

- [Tony] Because the terror of death, of course, in part, is my body. Body's beginning to not function. It will stop working in a day, a week, a month, a year. So despite some insights that consciousness may continue, they're also more accepting of this is the way it is.

- [Steve] So I wanna come back to your role in the clinical setting, working with people who are dying, who have a psychedelic experience. And I'm wondering what you do. I'm assuming you've been a therapist in those situations.

- Correct.

- What we might call a guide.

- [Tony] Right.

- [Steve] So people who have had this amazing experience, this transformative experience, and then you talk to them about it. And I'm wondering, what, how do you talk about that? I mean, this is what is called the integration piece of the whole process. How do you talk about transcendent experience? I mean, is it kind of just revealed to themselves or do they need you, someone like you, to help make sense of it?

- [Tony] Important question. So yes, I have not a good word for what we do. Guide isn't great 'cause guide implies you're guiding someone up the hill and I don't know where we're going, so I can't, guide is not quite accurate. Therapist is not, you know, so all different kinds of people use monitor, sitter. But I've been whatever that's called in these studies. And the preparation phase, we get to know them very well, and that's crucial. So the sense of trust and rapport that is cultivated in the pre-medication sessions is not just to get to know their life, which is important. Because during the experience, which can be six hours in length, in totality, if very complicated and difficult things are arising with some person, some figure in their life from 30 years ago, it's important that we know how that person was in advance. So if they needed help in some way, we're there to reassure them and understand a bit about the space they're in. Then on the medication day, when they go into this dramatically altered state that can be quite frightening, to know that we're there reassuring them in the medication session, which is very little talking if it goes very well. So ideally, if they're in it, they were told in advance, don't feel a need to report to us what you're having and experiencing unless you need us. You're in trouble, you're anxious, you're worried. But as you're referring to the integration sessions, then there's a period of time to talk about it.

- [Steve] How can you help in that stage? Because I think for a lot of people, it just would be self-evident that, oh my god, you know, they saw this entirely different way of being in the world. They experienced that. But maybe for other people it's not so obvious.

- [Tony] Right, for some it is the former. Wow, I just had this thing and we're just, was that real? I mean, what the hell? And, you know, addressing those features. But then there is the more, the other side you're referring to, where complicated past relationships came up. Things that weren't so clear, including dark images or such. I think an important part of integration is so you had these insights or experiences, but to apply it to your life. So if you've had a insight where, regarding some relationship or well go make that real. And people will change their lives. People have often asked, usually ask at the end of the trial, how do I stay in touch with that experience? I'm afraid it's gonna leave me. So part of integration can be helping them find ways to develop some kind of practice, it need not be spiritual. But whatever they can do to maintain it. Having a meditation practice, reading certain things. We send them the music list when it's done. And many say, when I play that music, I kind of revisit that experience. If it's just a one-off... well, Houston Smith, the great comparative religion scholar who had this experience and it really amplified his understanding of religion. He said, and I'm paraphrasing him, a spiritual experience doesn't necessarily make a spiritual person. It's what you do with it.

- Yeah.

- [Tony] So I think part of integration is not just I had this wild, bad, good, whatever it was on this pill, and no, it wasn't a one-off. How do you make that part of your life going forward? What changes? What doesn't change? Because that could just be a drug effect and I don't think these are drug studies. They're more like experience studies and we seem to have found the key to open the door to those experiences sometimes, not all the time. The hope is, Steve, that in the future where those who have a life-threatening illness or at the end of life could go to these centers, have their preparation, have the experience, have integration in a safe, supportive setting. And that's our hope.

- [Steve] Tony Bossis is a Clinical Assistant Professor of Psychiatry at the NYU School of Medicine. He was the Director of Palliative Care on the Landmark 2016 clinical trial with cancer patients using a single dose of psilocybin.

- [Anne] And that's it for this hour. No matter what stage of life you're in, I hope every day feels like a gift. Take a minute and be grateful for this time we share.

- [Steve] This is the first episode of Luminous, our new series on psychedelics. You'll find more interviews on the science and history of psychedelics on our website at ttbook.org/luminous. And I hope you'll subscribe to our Luminous podcast feed, where you'll also find bonus episodes.

- [Steve] To the Best of Our Knowledge is produced in Madison, Wisconsin by Shannon Henry Kliber, Charles Monroe Cain, Mark Rickers, Angela Bautista, and our sound designer and technical director, Joe Hartke, with additional help from Sarah Hopeful.

- [Steve] Additional music this week comes from Arastu, Nanima, Maida, Ketsa, and Lagos Disco Machine.

- [Anne] I'm Anne Strainchamps.

- [Steve] And I'm Steve Paulson. Thanks for listening. PRX.

Last modified: 
April 08, 2023