Emma Shackleton, one of the book’s co-authors, answered a few of my questions over email; the accompanying slide show offers a whirlwind tour of the past few hundred years of medical imagery.

Roughly how many of the images featured in the book do you think were originally conceived by their creators as “art”? How much of the material was intended simply to be instructional?

For the historic works, we often do not know what the creators’ original intentions were. In making the images, they each would have been working within their own stylistic and cultural traditions. So, for example, anatomical representations made in Persia and Asia would have been created in line with particular traditions, in contrast to those of, say, 15th-century Europe, where the artists of “The Apocalypse” would have drawn on existing images in order to create the Organ Man [slide 1], and his accompanying anatomical figures.

There are many images in this gallery that do instruct and inform, yet, even where this is their primary role, they were often made by highly skilled artists and were valued for their artistic qualities too. In the 16th century, for example, Charles Estienne wrote of the aesthetic pleasure to be gained from studying the human anatomy, while Andreas Vesalius commissioned the engravings of his revolutionary book, “On the Fabric of the Human Body,” to be made in the great artistic center of Venice. Their work was appreciated not only by practitioners, but by lay people, too.

However, art relating to medicine has been made for many audiences, and it is the breadth of these perspectives that we were keen to explore and bring together to offer a compelling journey into the landscape of medicine. Some objects and images played a role within spiritual ritual or religious practice; others were made as artifacts intended to protect health or cure disease, as caricatures, as narrative paintings or as contemplative pieces that reflect on personal experiences or medical developments.

Do scientists and doctors today go to the same efforts as their forebears to make graphics, charts, tools and records aesthetically pleasing? How have values changed in this regard?

There is a strong tradition of the sciences and art being intertwined, and this continues. The artist Annie Cavanagh has said of the work she creates with microscopist David McCarthy [slide 9]: “It makes an idea concrete or solid, whereas interpretation of literature can go many ways.” Perhaps their extraordinary micrographs highlight one of the major changes in the visual images that are created today.

In the hands of scientists and practitioners like Annie Cavanagh and David McCarthy, we now have remarkable insights at a microscopic level into the body (so we can gain, say, a view of a blood vessel rupturing or neurons in the brain), of the appearance and actions of viruses and diseases, and the structure of medication. Such images can instruct and inform, yet they also give an aesthetic pleasure and reward the curiosity of a lay viewer.

What do you think is the single most powerful thing the collection says about the progress of medicine over the course of the periods it covers? What’s the most powerful thing it says about the progress of art?

It is interesting that you ask about progress. For me, the most powerful message the collection came to say was one about continuity. This eclectic collection does span major developments in medicine, diverse art practices and many perspectives from different cultures. Yet at the heart of it is the human body, and while we are each individuals across time and location, personally and within our cultures we have had to find ways to understand our bodies and ourselves in sickness and health. So, for me, at the core is a message about the human condition — and that is a thread connecting the past, present and future.

Do you have a single favorite image (or a favorite section) from the book? Is there something in particular you think readers might be surprised by?

I hope you don’t mind if I choose a favorite quality. It is that the images allow us to go on fascinating journeys to explore many strands of medicine across time and place, be they anatomy, medical or surgical practice, disease or medication. Follow the trail of herbal medicine, for example, and the images take us from 15th-century Europe to Japan and 19th-century Tibet, or explore astrology in medicine, and we can see visions of its practice across Europe, in Persia, Asia and Mexico.

View the slide show

Luckily, I have one very helpful friend, let’s call her Phyllis, who lives just a few blocks away. We have been friends for close to 20 years now and when my illness began to progress, she really stepped up to the plate. She delivered groceries to my house when I was too ill to go shopping. She drove me to medical appointments when I was too sick to drive. You get the picture. She has really helped out a lot and I am truly grateful. We have a long history and I truly care for her.

The problem is, Phyllis has no respect for personal boundaries. For example, I had an accident a few months ago and was taken by ambulance to the emergency room. After I had been checked out, I phoned Phyllis to tell her what happened and to ask for a ride home. I knew that I would need to change from my hospital gown into my street clothes, so I told her I would meet her in the waiting area when I was finished. But when Phyllis arrived, she walked straight into my room in the E.R. This is sort of understandable. She was probably worried and wanted to lay eyes on me to make sure I was safe. I can’t say I wouldn’t have done the same thing. When the nurse said I could get dressed and go home, I asked Phyllis if she would mind waiting outside until I finished getting dressed. Her response was, “Well, it’s nothing that I haven’t seen before.” She not only dismissed my request to step out of the room, but she didn’t even divert her eyes! This was very embarrassing for me. I didn’t want to seem ungrateful for her help by forcing the issue, but I believe it is my decision who sees my body and when. I don’t think it was too much to ask for her to step outside, but she clearly had no respect for my wishes. I was so shaken by the day’s events that I didn’t argue and just got dressed, but I felt very angry and violated.

Another example is when she helped me move into my new house a few years ago. The move took place over the course of several days and I loaned her a key to my front door so she could move boxes in at her convenience. I had forgotten that I had given her a key until a few weeks later when I invited her over for a visit. When she arrived, she didn’t knock on the door. She just let herself in using the borrowed key. I thought it was an awfully bold move. I hadn’t meant for her to keep the key and I certainly didn’t mean for her to use it so casually. I didn’t mention how her use of the key made me uncomfortable, but I did ask for the key back. She suggested that she hold on to it in case of an emergency, which I couldn’t really argue with.  For someone in my condition, it is important to have someone who can access you quickly in an emergency. But I just don’t trust that she won’t take advantage of the situation. It’s not just the casual use of the key that bothers me. There’s a combination of her words and actions, something that’s difficult to explain, that sends the message that she has a right to have full access to my home and life because she helps me out. She becomes bossy and tells me what to do. “Stop talking and take your medicine,” was uttered most recently. The really interesting part of this is that she never treated me this way before I became so ill. Or at least I never noticed.

Let me be clear that I don’t think there is any malice at play here. Phyllis is a very kind person and I think her intentions are pure. She is just socially awkward. She just doesn’t seem to understand the unspoken rules that the rest of us understand. A few days ago, she walked into my kitchen, took all the items out of my refrigerator, rearranged the shelves, and put the items back in where she thought they should go. She did not ask my permission and we hadn’t discussed the order of my refrigerator shelves. Most people would know that that is completely unacceptable behavior, but I think Phyllis just has no clue. It may be difficult for her to comprehend how painful it is for me to lose my independence and how important it is to maintain my privacy, dignity and autonomy whenever possible. But I sometimes feel like a child with no power or voice to control my own environment. If I speak up, I may lose the only help I have to survive.

Cary, how can I set boundaries with Phyllis without threatening our friendship and my lifeline?

Sincerely,

Becoming Helpless and Nearly Hopeless

Dear Becoming Helpless,

Most everyone knows that you’re supposed to leave the hospital room when someone has to get dressed, and you’re not supposed to rearrange their refrigerator without permission. Still, for some reason, your friend does not seem to know that or does not seem to care. I wonder why that is.

I put myself in people’s shoes. I imagine what they believe and how they feel. I imagine that this friend of yours who is helping you out is doing her best. She may be anxious and self-conscious about her role. She probably believes that her take-charge, no-nonsense approach is what is required. This may have been taught to her; she may be reveling in it; she may be secretly trying to show you, finally, how things are done; she may be getting a charge out of it. She may know that she is pushing your boundaries and feel that that is the right and necessary thing.

Still, she is helping you. It is understandable that you would fear saying a word of protest. It might drive her away. But I think you can strengthen your relationship by taking her into your confidence.

Our preferences are just preferences; they do not raise us above anyone else or solidify our moral standing. We may have been taught certain manners but they are just manners. They are not central to who we are.

Central to who we are, are deeper things. We are creatures who have suffered; we are creatures who feel fear in the night and who feel pain, who have had dreams and purposes sometimes met and sometimes thwarted; we are helpless and proud and we carry with us into old age much of the vanity of youth. We are simply human, no better and no worse than anyone else.

To be simply human in need of care and understanding is not just a misfortune. It is a kind of gift. It forces us to accept this basic fact, that we are just flawed humans encountering our physical limitations, encountering our physicalness in all its messy, confounding, stubborn physicality. This is all we are, finally, on the physical plane: this jumble of weak limbs struggling to support each other; this tangle of twitching fingers stitching an agonized weave, patching some jeans, stirring some tea, grating lemon zest for a pound cake, sewing on a button. This is what the body comes to. This is what we all come to.

In yet another sense your illness is a gift: You are being slowly carried down a river that for others is a terrifying torrent of rapids approaching a falls. You are being given time; millions of others are snatched away instantly on the highways and on battlefields and in sleep; they go without any preparation. You are being granted time to ponder your life and prepare.

We all are going, so how would you prefer to go? Would you prefer that suddenly in the night your body would seize up like an engine that has burned its oil and thrown a rod? Or would you prefer to have some time to see where this all is headed, even though it is painful and sad?

I know only a little about this kind of struggle but I know enough to prefer the warning signal of illness to the smack of a bus or a gunshot or cardiac arrest. (Given the universe’s ironic sense of humor, I’ll probably die under a speeding bus.) I’m just saying, having had cancer and having thought about death, I cherish the idea of knowing when death might be coming and having a chance to prepare. This last bout was just a warning; it’s gone and is not expected back. But it taught me a lot.

As to your friend Phyllis, it’s my observation that knowledgeable caregivers ask before they do things. They pay attention to the emotional needs and wishes of the person they are caring for. Your friend is not a professional caregiver. She may not know. She may really think that her take-charge way is the best way.

I think you need to risk showing her, with love, who you really are. Ask her for understanding. At the same time, loosen your grip on these preferences. As you open your heart to her, and as she tries to accommodate you, you may find your need for modesty and control slowly begins to release its grip on you, as well.

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. 

Over the last few decades in the U.S., the paternalism of the medical establishment has begun to crumble and patients have been given more and more power in deciding their own treatment for everything from cancer to disk pain. As a result, it’s increasingly becoming important to understand why certain people make, for example, the choice to eschew chemotherapy in their cancer treatment while others make it their first choice.

According to “Your Medical Mind,” a new book by Dr. Jerome Groopman, New Yorker staff writer and author of “How Doctors Think,” and his wife, Dr. Pamela Hartzband, an endocrinologist and educator at Harvard Medical School, the decisions we make as patients have a lot to do with our personalities and personal history. Using a combination of case studies, including Brody’s, and medical data, the book divides patients into four groups — believers, doubters, maximalists and minimalists. Understanding which of those groups we belong to, they argue, goes a long way toward helping us take control of our own healthcare.

Salon spoke with Groopman and Hartzband over the phone, about the disappearance of doctor paternalism, the real meaning of medical statistics and the problem with “House.”

Why is it important that we figure out why some people make different treatment choices than others?

Dr. Jerome Groopman: In a great deal of medicine, there is no one right answer. It’s a gray zone. Each of us has a different set of values with regard to risk and benefit, so choices are made on a very individual basis. As the patient, you are the one who is going to live with the decision, and you want to have confidence that you made a decision that was right for you as an individual.

Dr. Pamela Hartzband: We don’t adopt or endorse the old model of paternalism, but if you want to advocate for yourself, in order to do it effectively, you need to understand why one choice appeals to you rather than another and sometimes there are subtle or hidden forces that are trying to influence you one way or another. We point out in the book that the average American spends more time being exposed to drug ads on television than they spend with their doctors. You spend 16 hours a year watching those ads. You don’t spend 16 hours a year with your doctor.

There’s been this shift in the American health care system toward giving more control to patients in their relationships with their doctors. Why?

J.G.: There were two factors. The first was the AIDS epidemic, which I had a lot of experience with myself: Starting in 1980, I did a lot of HIV-related work. With gay men being hit disproportionally by the virus, there was a lot of political activism that was linked to it. Gay men wanted to make sure, rightfully, that what was being done was right for them and in their interests. The other was the women’s movement. It took a long time for surgeons to shift from mastectomy to the removal of a lump [in their treatment of breast cancer]. Part of that was the burst of feminism. You had these two groups who were treated in a particularly paternalistic way by the medical establishment and they helped spur the changes [in treatment] in the ’60s and then the ’70s and then full force in the ’80s.

It’s funny. I’m originally from Canada. I only experienced the American healthcare system in the last five years, and one thing I did notice is that here there is a much larger emphasis on my choice. I have problems related to a ruptured disk and the first time I went to the neurologist in the U.S., he laid out  all these options of treatment, and then just paused when he was expecting me to jump in. And I just stood there silently, confused.

P.H.: There was a survey of breast cancer patients, which we talk about in the book, where they were asked whether they wanted to make the decision about their treatment themselves, with their doctor, or have the doctor make the choice. Interestingly, not everyone wanted the same thing. Some people wanted to have the primary role in making the decision and others wanted the doctor to do it, and the largest proportion wanted shared decision-making.

But as you point out in the book, in America, we also stigmatize people who don’t want to take control of their healthcare.

J.G.: This is not just anecdotal. It was first articulated by Carl Schneider from the University of Michigan, that some patients feel that they’re out of sync with the culture because they don’t want to take the burden as they see it of making every decision for themselves. And sometimes they feel stigmatized, that they are not empowered or not advocating and so on.

It’s a personal process, it’s not a fixed process. We wrote about Ms. Brody, a patient who was used to being in control, but when she was faced with so many complicated decisions [about her possible breast cancer], her doctor was completely transparent with her. He said, you know there’s a big debate about radiation here, and she ultimately said, I don’t have the expertise to make a sound decision but he understands my medical mind, he knows what my goals are. When she was found to have a genetic predisposition for breast cancer, she had to revert back and make decisions with some level of autonomy. It’s a dynamic process.

People’s perceptions of doctors are often shaped by TV shows like “House,” where they’re presented as people who can come up with miraculous diagnoses working alone. Given that patients are being given more autonomy in their decision-making, how do you think these kind of pop cultural portrayals affect their perception of the process?

J.G.:  “House” is “Sherlock Holmes,” that’s what it’s modeled on. You have a detective who’s a drug addict. It’s very entertaining and very popular, but frankly it’s not the real world of medicine. A lot of very important diagnoses and decisions are made in group ways in terms of discussing complicated cases in clinical conferences, drawing on colleagues, working as a team. The idea that there’s an idiot savant who goes out and finds something isn’t accurate.

P.H.: You’re trying to get the unusual diagnosis nobody can make, that’s a very dramatic and very entertaining, and a really interesting part of medicine. But once you’ve made the brilliant diagnosis and you’ve got treatment options to consider, a lot of times there are several, and that’s where this all comes into play.

That should be the spinoff show: “House discusses treatment options.” In the book, you explain how the way numbers are presented to patients deeply affect the way they think about their treatment options. How is that?

P.H.: In the book we talk about a 45-year-old woman who has high cholesterol and we show how, if you hear about a relative reduction in risk as opposed to an absolute reduction in risk, it has a big impact on your decisions of treatment. So when her doctor talked to her about her statin medication, he presented its benefits as reducing the risk of a heart attack by 30 percent reduction. This made it sound like she was 100 percent at risk if she didn’t take it.

J.G.: But what she needed to find out was that the chance of something like that happening was actually only one in a hundred. Ninety-nine out of 100 people over 10 years will have no problem if they don’t take statin. So a 30 percent reduction would have a very minimal impact in her personal situation. Just recently I saw an ad for statin that said 80 percent of people who have heart attacks had high cholesterol. That’s true. But it sounded like 80 percent of people with high cholesterol will have a heart attack. The numbers are almost always presented like this in ads, so it looks like you’re in much greater danger and the benefit of the treatment is much larger than it really is.

When people are diagnosed with an illness they often put a lot of effort into finding the “best” doctor. Why isn’t that always the best strategy?

J.G.: Now quality report cards are being published, and some of the stuff on that is absolutely important. You don’t want to go to a surgeon who has a very high rate of infections or a hospital that doesn’t give the correct treatment for a heart attack. But a lot of these profiles of doctors — who’s best, who’s highly ranked, who’s not — don’t even agree with each other. Often it depends on the financial interest of the insurer who is backing the study. What’s really important is how does the doctor work with you as an individual to customize the treatment. In the book we follow a woman who is an art dealer, and when she gets sick, she goes to the best of the best and the guy is totally dismissive. He wasn’t a good fit.

Toward the end of the book you write about advanced directives, like Do Not Resuscitate orders, which some very ill people use to guide their treatment in their final days. Increasingly, studies have shown that they’re not ideal. Why?

P.H.: Advanced directives are a starting point. In the book we talk about the woman, Mary Quinn, who had a cancer and at the beginning said, I really don’t want any heroic measures, and yet when it came down to it, she changed her mind. That happens a lot, that people don’t anticipate that they’ll be able to adapt and enjoy their lives in circumstances they’ve never experienced.

J.G.: If someone is on heavy medication or comatose and family members or friends or partners, whatever, are called upon to try to make substituted judgments, that’s very challenging. What does a heroic measure mean in that setting? Trying to understand from the person’s past choices whether they’re a maximalist, minimalist, believer or a doubter, it will help direct you in a way that you can make a judgment which hopefully was in their best interest.

How have your experiences as patients changed the way your practice medicine?

P.H.: I’m a doubter, so I’m basically worried about every treatment. Jerome is a maximalist, which is the opposite point of view. That person is ready to barrel right through treatment without thinking about the downside.

When we present treatment options to patients, we’re very careful not to impose or project our biases on the patient. We try very carefully to elicit the patients’ own sentiments, so they can make the decisions that are right for them. We also try to acknowledge where the patients are coming from, so when we start giving our discussion of treatment options we understand how they’re likely to react.

Frank H. Netter, M.D. (1906-1991) was a physician, and a Fellow of the New York Academy of Medicine, but also a leading medical illustrator. He studied at the National Academy of Design and the Arts Students League while attending NYU and working at Bellevue. He supplemented his studies and income with illustration commissions, sometimes for his professors. Although he soon had his own private practice in NYC, he continued his work as an artist but after a misunderstanding wherein Netter asked for $1,500 for a series of five pictures and an advertising manager agreed to and paid $1,500 each — $7,500 for the series — Netter gave up the practice of medicine. His relationship with CIBA began in 1936 with the depiction he designed of a fold-out human heart used to promote the sale of the medicine Digitalis. His work was also used to market Novocain. He’s best known for illustrating the multiple volume CIBA Medical Illustrations set. In 1989, his “Atlas of Human Anatomy” was published and is considered a staple of medical education.

My fascination with Netter’s work comes from how he’d often employ what feels like a documentary approach to his designed scenarios. These aren’t just clinical depictions or representations, they have a personality and even a warmth that initially stunned me. The individual stamp of Netter’s hand is always there … not what I expected from the world of  medical manuals.

(Nerd note: he also wrote and illustrated, the obscure “Fad Diets Can Be Deadly” in 1975).

Copyright F+W Media Inc. 2011.

Salon is proud to feature content from Imprint, the fastest-growing design community on the web. Brought to you by Print magazine, America’s oldest and most trusted design voice, Imprint features some of the biggest names in the industry covering visual culture from every angle. Imprint advances and expands the design conversation, providing fresh daily content to the community (and now to salon.com!), sparking conversation, competition, criticism, and passion among its members.