Medicine

Kossut had no idea, but in the spring of last year, he was looking for something, anything, that might improve his mental state. In 2008, he was diagnosed with cancer of the tonsils and put on a biweekly chemo and radiation regimen. He quickly lost his appetite, dropped weight and sank into a deep depression. When a friend sent him a news brief about the experimental NYU study, he applied.

Shortly before Kossut’s arrival on the morning of his session, two clinic employees entered a high-security storage room, which just happens to face a painting of a white rabbit. From a massive steel combination safe they removed a bottle containing one gram of synthesized psilocybin, the psychoactive agent animating the 200-member fungus family commonly known as “magic mushrooms.” The duo carefully measured the small container against the previous day’s weight, as if securing a store of weapons-grade plutonium. They then pill-pressed an amount of powder containing 20 milligrams of the molecule, first identified in 1958 by the Swiss chemist Albert Hoffman, most famous for his other psychedelic synthesis, LSD-25.

They delivered the pill to a converted exam room gutted of its dental chair and refitted for comfort with holistic panache: plush pillow-strewn sofa, Persian carpet, Buddha statuettes, books on spirituality and mysticism, a high-performance sound system. Only the ceiling lighting track betrays the former identity of New York City’s federally sanctioned psilocybin room.

Receiving the pill is Dr. Stephen Ross, a 40-year-old assistant professor of psychiatry at NYU Medical School and the cancer study’s principal investigator. Ross has a precise scientific manner softened by an upbringing in Southern California, where his mother (also a doctor) took him to hospice centers as a child, sparking an interest in end-of-life issues. Now director of the addiction division at Bellevue, Ross is among the youngest of a new generation of psychedelic researchers. With his cancer study still two years away from publishing results, he is already looking ahead to testing psychedelic treatments for drug addiction and alcoholism.

For now, Ross is fully focused on treating existential anxiety in people like Kossut, who lies on the couch, ready for his initiation into the psychedelic mysteries. In the research jargon, Kossut is “psychedelic naive.” After swallowing the pill Ross presents — in the cap of a ceremonial ceramic mushroom — all he can do is close his eyes, lose himself in the preselected tabla drum and sitar music, and try to remember the advice to not fight it, to move ever deeper into the light, to let go …

“It was absolutely incredible,” remembers Kossut. “The first rush was a little scary as I realized it wasn’t the placebo. That passed and next I was crossing boundaries of time and space and reality. I felt this weightlessness, this sense of being close to an unspeakable beauty that was unlike anything in my experience. For the first time since my diagnosis, I was not afraid of anything. The wall of depression that was building up day by day, the fear that I was going to die soon, that my daughter is only 8 — all those things disappeared. I wanted to stay there. I wanted it to last longer.”

It did. More than one year after his psilocybin session, Kossut reports greatly improved states of emotional and psychological well-being. “I walked out of the session happy, unafraid of death,” he says. “I don’t know why, but a transformation took place after being in that peaceful place. I relaxed. I started enjoying food again and was able to gain weight. The session taught me to be fully in the present. I’m optimistic. Mentally and physically, just better.”

This glowing report — based on a single dose of a naturally occurring, non-addictive, low-toxicity substance — sounds impossible. Surely one pill can’t succeed where months of traditional psychotherapy and antidepressants usually fail. According to science, that’s not how drugs work. It’s foreign to the model. But high success rates in ongoing concurrent studies at NYU and Johns Hopkins strongly suggest that Kossut’s psilocybin-assisted psychological rebound is no fluke. So do the findings of a pilot project conducted by Dr. Charles Grob at UCLA. Between 2004 and 2008, Grob administered psilocybin to 12 cancer patients suffering fear, anxiety and depression. His data, published last year in the Archives of General Psychiatry, showed long-term diminished anxiety and improved mood in every subject. The NYU and Johns Hopkins studies build on Grob’s pilot program with more subjects and higher doses. Midway through the research, their results are just as strong, signaling larger, multi-site trials to come.

“What appears to be going on with the psilocybin studies is a model system for creating ‘quantum change,’” says Dr. Roland Griffiths, the behavioral biologist who oversees the Johns Hopkins study. “We’ve shown we can safely produce replicable effects.”

This is the subdued, clinical language of a psychedelic science renaissance quietly entering its third decade. If its practitioners and advocates avoid the utopian claims and liberationist rhetoric that defined the LSD gospel of the 1960s, this is no accident. A new generation of psychedelic researchers understands that public and official support depends on exorcising the ghost of Timothy Leary, whose democratic acid crusade grew out of and ultimately helped destroy the first wave of psychedelic science in the 1950s and ’60s. Their goal is not to promote the legalization of these drugs or tout their value for everyone, but to revive the once-great and now largely forgotten promise of psychedelic science. And that just might, among other things, change the way we confront and think about death.

 - – - – - – - – - -

Dosing anxious cancer patients with psychedelics may sound counterintuitive, to put it mildly. The hallmarks of the psychedelic experience — the loss of bearings in time and space, the breaking up and slipping away of the sense of self — can themselves produce acute anxiety and panic. Everyone has heard stories, most of them apocryphal, of psychedelic experiments gone wrong; of kids on acid jumping off of 12-story buildings, or showing up in emergency rooms a twitching, psychotic mess, requiring enough Thorazine to sedate a horse.

But the current studies are not self-experiments. They are carefully designed and professionally guided therapy sessions crafted to minimize anxiety and avoid so-called bad trips. Subjects are screened and prepared before ingesting the psilocybin in a plush environment overseen by two specially trained therapists. Even the dose employed is the result of trial and error: The Johns Hopkins team has identified the golden mean — between 20 and 30 milligrams, roughly equal to a good fistful of strong ‘shrooms — to maximize peak experience while minimizing transitory anxiety.

Which is not to say that subjects don’t sometimes get scared. Clark Martin, a retired psychologist who suffers recurrent kidney cancer, panicked during the onset of his first psilocybin session at Johns Hopkins. “Initially it was like falling off a sailboat,” he remembers. “You turn around, the boat is gone. Then the water’s gone. Then you’re gone. I wanted things to make sense again. My urge was to run outside.”

But his guides calmed him and the anxiety passed. Today what Martin remembers best is what came next.

“Everything became tranquil and calm, and I had the sense that I was floating on a giant bubble,” says Martin, who spent the next several hours in this peaceful place meditating on life, death, the nature of human relationships and consciousness. “I left the session animated and intellectually stimulated. Today I don’t have a sense of death like I used to. I see it as part of the flow of nature. There’s grieving and sadness, of course, but what’s being lost is this false sense of separateness we create. I don’t get too worked up about my illness anymore. My relationship with my daughter is better. I’m also more fully present and empathic when I spend time with my elderly father, who has dementia.”

What’s going on here? How does psilocybin induce states of consciousness capable of dramatically reorienting one’s mental frame? The beginnings of an answer may be found in the morning mists of recorded history. In the ancient world, disparate cultures from the Amazon to Siberia consumed psychedelic mushrooms and plants in sacred rituals they viewed as openings into spirit worlds where mysteries were revealed and ineffable wisdom communicated. Often these rituals were conducted by “medicine men” and focused on themes of disease, death and healing, as in the case of Amazonian cultures where doctors still engage in ritualized use of the “healing plant” Ayahuasca.

No one is claiming that psychedelics cure disease. But around the time Western science discovered psychedelics in the 1890s, psychology of religion scholars began to notice a recurring cross-cultural motif — the psychic salving power of what American psychiatrist Richard Maurice Bucke called “cosmic consciousness.” To research his landmark 1902 study “Varieties of Religious Experience,” the psychologist and philosopher William James surveyed a vast global record of spiritual literature. Again and again, he encountered reports of death anxiety evaporating upon the direct experience of mystical states of consciousness. The reports of Kristof Kossut and Clark Martin overlay neatly with James’ description of the afterglow provided by mystical consciousness, “of which the central [characteristic] is the loss of all the worry, the sense that all is ultimately well with one, the peace, the harmony, the willingness to be, even though our outer conditions should remain the same.” Throughout history and in every culture, James found, those who experience “the full flood of ecstatic liberation” tend to benefit afterward from “a new zest which adds itself like a gift to life … and a temper of peace.”

This insight led James to advocate for experimental mysticism, which helped him treat his own bouts with severe depression. In the 1870s, James began using nitrous oxide (a hallucinogen that shares characteristics with ketamine and PCP) as a shortcut to the experiences cataloged in “Varieties.” He found the practice salutary. Mind-blowingly so. But nitrous is just laughing gas compared to the classical hallucinogens that concerned James’ heir in the annals of chemical mystics.

In the middle of the otherwise staid 1950s, the writer Aldous Huxley emerged as a muscular advocate for psychedelics. His conversion followed his first mescaline trip, immortalized in the slim but influential 1954 work “The Doors of Perception.” Like James, Huxley’s  experiments built on a lifelong interest in mystical states. His cross-cultural examination of mystical testimony, “The Perennial Philosophy,” found the same aspects to the experience as recorded in today’s psilocybin studies: a sense of access to ineffable and intuitive knowledge; a sense of unity, transcendence and sacredness; overwhelming, ecstatic positivity felt as joy, love and peace.

Timothy Leary was the first scientist to test the power of psychedelics to trigger these states. In 1963, his last year at Harvard, Leary supervised an experiment in which psilocybin was administered to 10 seminary students attending the Good Friday sermon at Boston University’s St. Marsh Chapel. Of the 10, eight claimed to experience something like mystical consciousness. Forty years later, Roland Griffiths updated the Marsh Chapel experiment at Johns Hopkins by administering psilocybin to healthy individuals with an interest in spiritual states. As he reported in the journal Psychopharmacology, nearly 80 percent of subjects listed their psilocybin session as among the top-five most meaningful experiences of their lives, and described the experience in language straight out of the mystical literature. Follow-up monitoring by the subjects’ families and friends found sustained positive changes in personality, behavior and mood.

The fact that psychedelics act as shortcuts to mystical states provides only one-half of the logic underlying the psilocybin-cancer studies. The young field of palliative care provides the other half with its research into “good deaths.” The palliative-care literature finds that those with a sense of a transcendental force have less depression and anxiety. This can mean belief in a Judeo-Christian god, or a direct memory of the nameless, overwhelming sense of eternal, cosmic love occasioned by the ingestion of 20 or 30 milligrams of psilocybin.

“Psychedelics are a powerful mechanism for forging a connection to a transcendental force, and people with such a connection are protected against end-of-life distress,” says NYU’s Ross. “We all have cognitive illusions that protect us from the knowledge that we will die, and medicine is failing those who have to deal with this abruptly.”

Psilocybin metabolizes quickly, and follow-up doses are not needed to maintain long-term effects. This means that the psilocybin studies are not really drug studies in the traditional sense. They are more like experiential studies, in which the benefit is derived from the memory of something that isn’t easily explained away by reference to serotonin receptors. “Eternity, a state of awareness outside of time, often described as pulsating with love and life, no longer is an abstract concept,” explains Bill Richards, a therapist with the Johns Hopkins team who has been working with psilocybin since 1963. “Rather [it] is a memory of an experience, perhaps more vivid than the memory of visiting a foreign city on a vacation. Typically fear becomes replaced with curiosity and trust in deeper strata of consciousness.”

Among those who have benefited from a new trust in these deeper strata of consciousness is Janeen Delany, a Phoenix woman who flew to Baltimore for psilocybin therapy in 2008 after a leukemia diagnosis.

“I was struggling emotionally with my fear,” she remembers. “No matter how hard I tried to do the work myself, I couldn’t get to that place of acceptance.” More than two years later, Delaney describes her psilocybin experience as the turning point in coming to terms with her illness. “It changed my frame of mind,” she says. “This disease no longer defines me when I wake up in the morning. I understand myself as part of a greater whole made up of energy and frequencies. It’s impossible to put these insights into words, but they were real; are real. It felt like a thousand pounds lifted off my shoulders. I’m now the person I always wanted to be.”

- – - – - – - – - -

Using psychedelics to treat terminal anxiety was popularized in the West in Aldous Huxley’s 1962 utopian novel “Island,” in which the natives of the fictional paradise Pala ingest a psilocybin-like drug called moksha during stages-of-life rituals, including infirmity, sickness and death. Huxley himself would famously request and receive a large intravenous dose of LSD on his own deathbed the following year.

Shortly after Huxley’s passing, Eric Kast of the Chicago Medical School began a four-year study administering LSD to cancer patients in extreme pain. He discovered that along with reorienting the patient’s relationship to death, the psychedelic had an analgesic effect resulting from an “attenuation of anticipation.” Following their LSD treatments, Kast wrote, subjects developed “a peculiar disregard for the gravity of their situations and talked freely about their impending death with an affect considered inappropriate in our Western civilization but most beneficial to their psychic states.”

A former graduate student of Tim Leary’s named Walter Pahnke picked up Kast’s work in 1968 at Spring Grove Hospital in Baltimore. As part of a psychedelic dream team including Stanislav Grof and Bill Richards, Pahnke successfully administered LSD and psilocybin to more than 100 cancer patients between 1968 and 1977. The National Institute of Mental Health funded much of their work.

The cancer anxiety studies of the ‘60s and ‘70s were part of a global postwar flowering of psychedelic science. Researchers published hundreds of peer-reviewed papers, with LSD receiving the bulk of the attention. Psychedelic drugs were considered a revolutionary tool, frequently compared to the invention of the telescope or microscope. They were seen as keys to understanding and finding treatments for everything from alcoholism to autism to schizophrenia. This was not a fringe view, but that of respected researchers backed by the Food and Drug Administration and funded by institutions like the Rockefeller Foundation. There were research grants galore and conferences sponsored by the American Psychiatric Association. (We’d later learn that the CIA funded many psychedelic research projects. But that’s another article.)

The golden age of psychedelic studies proved brief. Even before recreational use exploded in the mid-1960s, the government had begun moving toward the view of the military and intelligence establishments that psychedelics were mere “psychotomimetics” (i.e., they mimicked psychosis) holding no scientific use (let alone spiritual or humanistic value). A series of laws throughout the decade steadily restricted and discouraged scientific access to psychedelics culminating in the 1970 Controlled Substances Act, which grouped psychedelics together with heroin as a Schedule 1 drug. According to the Drug Enforcement Agency, created in 1972, Schedule 1 drugs “have a high potential for abuse [and] have no currently accepted medical use in treatment in the United States.”

The closing of the psychedelic mind involved the weaving of a fine-spun stigma and the application of indistinct professional pressure. “A subtle microphysics of power guided scientists away from further work on these compounds,” says Nicolas Langlitz, an anthropologist at the New School who studies psychedelic science. “The allocation of funding, having to guard one’s reputation, approval of research projects, recruitment of test subjects — it all led to a near-total breakdown of academic hallucinogen research.” Before the end of the ’60s, two leading lights in the field would bemoan the fact that interested and capable scientists were “turning their backs on psychedelics for fear of identification with irresponsible researchers.”

Then as now, “irresponsible researchers” was synonymous with Timothy Leary, the ex-Harvard professor turned self-styled laughing leprechaun and high priest of an everybody-must-get-stoned psychedelic revolution. Among the new generation, resentment of Leary’s legacy remains palpable, as is the determination to avoid the mistakes, indeed the tragedy, of the 1960s.

“Leary so undermined credible scientific use of these compounds that it poisoned research for decades,” says Griffiths of Johns Hopkins. “The iconic scientist goes AWOL and promotes unrestricted recreational use. As a result, I don’t know of any other set of scientific questions that have been banned for decades because it was judged too dangerous to study. Maybe germ or chemical warfare. But I doubt those were actually stopped.”

Bill Richards, the avuncular Hopkins therapist who knew Leary and has overseen thousands of psychedelic sessions over 50 years, has learned to take the long view. “One of our sayings during the sessions is ‘Let go,’ which we needed to do,” he says. “The old fires needed to die down. Leary’s ashes needed to get launched into outer space. Now I’m hopeful. The research proceeds with integrity.”

 - – - – - – - – - -

This quickening psychedelic revival was a long time coming. Activists and scientists began laying the groundwork during the second Reagan administration, when their efforts seemed most futile. In 1986, Rick Doblin founded the Multidisciplinary Association of Psychedelic Studies to advocate and educate the public. Not much happened until 1990, when Rick Strassman of the University of New Mexico Medical School broke ground with a study on the affects of DMT, the so-called nuclear bomb of the psychedelic family. Then, early in the first Clinton administration, the National Institute of Drug Abuse and the Food and Drug Administration quietly signaled a readiness to approve new psychedelic research. Encouraged by the signs, a group of scientists founded the Heffter Research Institute in 1993 to fund projects and hold them to the highest scientific standards.

The early naughts witnessed a further eroding of the psychedelic research taboo. The big foundations and government agencies maintained their distance, but groups like MAPS, Heffter and the Council on Spiritual Practices stepped in to underwrite medical school studies involving Schedule 1 drugs such as Ketamine, MDMA, marijuana and psilocybin. Mid-decade, Harvard’s John Halpren finally exorcised Tim Leary’s Cambridge ghost when he won approval for a small cancer anxiety study employing MDMA. The data from these and other studies is now beginning to appear in medical journals and on professional association conference agendas. This year, a chapter on psilocybin therapy for cancer patients will appear for the first time in a standard psycho-oncology textbook.

Much of this activity is centered at NYU, where a vibrant community of therapists and scientists has emerged around an ongoing speaker’s series called the Psychedelic Research Group. In 2008, Dr. Jeffrey Guss, a Manhattan therapist and co-investigator on the NYU study, taught “Psychedelics and Psychiatry,” the first course on psychedelic therapy offered at a modern medical school. Guss also directs the university’s 12-week psychedelic psychotherapy training program, the only program of its kind in the country. “We’re establishing a conversation across disciplines — oncology, psychiatry, palliative care — to reintroduce psychedelics into the medical discourse,” says Guss. “The field is emerging as a doable career, and I’ve started to mentor people who want to move exclusively in this direction.”

For political and scientific reasons, cancer anxiety is the research avenue with the most potential to scale up in the near future. Advocates like MAPS’ Doblin optimistically envision a scenario in which the therapy could be more widely available in a decade. Getting there will require larger trials and a full rescheduling review by the DEA and the Department of Health and Human Services. “Getting a drug rescheduled is very difficult,” says Bill Piper, national director of the Drug Policy Alliance. “But by its charter, the DEA is bound to follow the science.”

Establishing psilocybin-assisted therapy as an accepted option for end-of-life care could have some surprising consequences. Among them is a fundamental reorienting of our culture’s relationship to death. It could move discussion on what constitutes a “good death” and how to better provide them. Because Western medicine focuses narrowly on defeating disease with little consideration for how we die, the sick often spend their last weeks and days surrounded by machinery and hospital staff instead of a comfortable hospice setting surrounded by family.

“There is an increasing understanding that there is a paucity of approaches to psycho-spiritual well-being at end of life,” says Anthony Bossis, a palliative-care expert at NYU and co-investigator of the psilocybin study. “Medicine doesn’t talk about how we die. Palliative care brought psycho-spiritual stress into the conversation, and now psychedelic research is enlarging that conversation by exploring the ontological shifts, like that brought about by psilocybin, which can affect one’s outlook on life, death, disease.”

Adds Griffiths of Johns Hopkins: “So much money gets poured into those last few months of life where people are terrified and grasping at anything to prolong life. It’s heartbreaking to see, but our culture has such a disordered relationship to end-of-life issues. Change that, and people will change their utilization of the medical system. They’ll use it more in some ways, less in others. The result would be a huge net decrease in expensive interventional procedures in the final weeks.”

If and when psilocybin enters the larger healthcare debate, it will trigger the mother and possibly deciding battle of the 1960s culture wars. The prospect of Medicare dollars going to psychedelic therapy would send right-wing opportunists into a stomping rage. Sarah Palin would tweet about Hippie Death Panels. The GOP might revive its 1972 battle cry about liberals marching under a banner of “acid, amnesty and abortion.”

But here the history of the medical marijuana movement is instructive. Drug warriors could only deny the medicinal value of marijuana for so long; soon they were forced to beat a retreat before the combined forces of the medical literature, lobbying and advocacy, and the reality of millions of suffering Americans. If the science is solid, it usually wins, if only in fits and starts. This is especially true when the science is accompanied by the moving testimonies of people like Roy, a 52-year-old television news producer and Stage-4 lung-cancer patient who this summer underwent psilocybin treatment at NYU after three years of chemotherapy. Like Krystof Kossut and dozens of others, Roy had grown increasingly anxious and depressed before his revelatory psilocybin session. Today he describes that session as among the most precious and important experiences of his life. His journal is excerpted in a forthcoming chapter in Springer’s textbook, “Psychological Aspects of Cancer,” co-authored by Bossis and Guss of the NYU study and Charles Grob of UCLA.

“From here on love was the only consideration,” Roy writes of his psilocybin session.

Love seemed to emanate from a single point of light. The bliss was indescribable … I took a tour of my lungs. There were nodules but they seemed rather unimportant … I was being told (without words) to not worry about the cancer … it’s minor in the scheme of things, simply an imperfection of your humanity and that the real work to be done is before you. Again, love … [On the day after the session] I felt spectacular … both physically and mentally! It had been a very long time since I’d felt that good … a serene sense of balance … Undoubtedly, my life has changed in ways I may never fully comprehend. I now have an understanding, an awareness that goes beyond intellect, that my life, that every life, and all that is the universe, equals one thing: Love.

It’s true we don’t know much about psychedelic states of consciousness. Are they merely biochemical carnivals producing internal hallucinations, or are they — as people often describe them — “more real than real”? The psychedelic experience has always been just that — the ultimate subjective experience, ineffable and very difficult to account for when over. But those who doubt its power or “reality” might remember that we also have precious little understanding of the neurological basis of “normal” consciousness. And when it comes to bringing comfort to the ill, of giving the gift of “indescribable bliss,” a case can be made for the irrelevance of ultimate metaphysical and scientific questions. The first psychologist to advocate for experimental mysticism also advocated for that most American of thought systems, pragmatism.

Truth, concluded William James, is what works.