Transcendence Through Psilocybin

Hello. So we’re learning today that we don’t die well in America. We don’t end well in America.

National polls and Gallup surveys show repeatedly that we die with what we in palliative care call bad deaths, marked by needless suffering. One area I want to talk about today that is a primary source of this suffering is the existential, spiritual and psychological distress that many people experience as they end their lives, as we end our lives.

Twenty years ago, remarkably, the Institute of Medicine called for a change in how we treat the dying, to change how we approach the end of life. Sadly, 20 years later, in a recent study, we found that depression in the final year of life increased by 26 percent. Things aren’t changing.

Depression and hopelessness are strong predictors of a desire for a hastened death in end-of-life patients. We know that spiritual well-being can buffer against these incredible experiences of hopelessness and depression.

Cicely Saunders, the co-founder of hospice, wrote wonderfully, “You can find a degree of wholeness as a person, whether you get better or not, whether you are suffering or not. I’ve seen people find wholeness as they die.”

The word “heal” means to restore to wholeness, to make whole. It comes from the root “holy,” spiritually pure. Research shows that enhancing spiritual well-being can foster these experiences of wholeness.

Wholeness involves all human experiences, independent of suffering. Healing is independent of cure or dying. Even in death, we can be healed and we can become whole.

Elisabeth Kübler-Ross wrote, “If you become whole again, you’re healed, no matter where along the spectrum.”

Viktor Frankl, the great Holocaust survivor, wrote, “Meaning can be found in life literally up to the last moment, up to the last breath, in the face of death.”

So I’m thrilled to speak with you today about some novel research that addresses, mitigates and treats this awful existential suffering that some people have. That involves the use of psilocybin and government-approved psychedelic research.

Now, I know I’m in San Francisco, and I know I’m among experts and a lot of independent researchers, so if I get something wrong, feel free to correct me.

For almost a decade, my colleagues at NYU, along with the team at Johns Hopkins, have been investigating the efficacy of psilocybin, the psychoactive compound in many species of mushrooms, to mitigate end-of-life suffering, this existential despair that is so crippling for so many people, and feelings of demoralization.

These mushrooms have been used for millennia by Indigenous cultures for healing. What many people don’t know, though you guys know, is that from the ’50s to the early ’70s, there was a large body of scientific literature documenting their clinical benefits for addiction and end-of-life distress.

These are meaning-making medicines, meaning-making molecules.

What strikes me and is remarkable is that we’re wired for these experiences, these incredible mystical experiences that one dose can generate. At the heart of the world’s religions lies what the great Aldous Huxley called the perennial philosophy.

Mystics and ordinary people have had these incredible peak or mystical experiences for millennia. We now know that if we can harness them in a scientific and safe setting, we can use them to mitigate the end-of-life distress that is so common. These experiences of transcendence are wired into our nature.

While it involves a drug, psilocybin, it is not a drug study per se. It’s about these experiences, these naturally occurring experiences throughout history that we can reliably generate with this incredible medicine.

I’m going to read you some quotes from people who were in our study. These are quotes about their experience with psilocybin after their session and in the months and years after the session. All of these people had cancer, and some have since passed away.

“This changed my life.”

“I can’t even imagine the fear of cancer.”

“I felt this constant state of becoming.”

“I felt gratitude like I’ve never felt before in my life.”

“I feel totally whole.”

“Death doesn’t matter.”

From a person approaching death: “Death doesn’t matter.”

As we just heard, life and death are a continuum. Where does one end and where does the other begin?

“I’m less afraid of death.”

“Death is part of life.”

“No fear of recurrence.”

From a person crippled with fear: “I experienced that everything is eternal and that all of existence happens in every moment.”

And finally, “Everything is love.”

We’re going to speak about love a little later on because most people in these experiences talk about this incredible sense of love that changes how they live in the moment and changes how they approach death. It was quite striking to hear over and over again.

So what is this mystical experience? These are the criteria that we use for these studies.

The sense of unity, a profound sense of the interconnectedness of all people and things. Everything is one.

The noetic quality, coined by William James, a profound sense of encountering ultimate reality, whatever you want to call it, or incredible ultimate knowledge.

Sacredness, feelings of awe, humility, holiness and wonder.

Deeply felt positive mood, peace, love and joy to overwhelming degrees. People in these experiences are weeping from the incredible intensity of what they are experiencing.

Ineffability. It’s impossible to describe. Words truly fall short. Though I have to say, they describe it beautifully, as mystics and others have throughout the centuries. But it does seem to transcend words.

And what I think is the most important feature, or likely the most important feature, is this sense of transcendence. People experience a sense of transcending past, present and future, space and time as we know it. That sounds wild, transcending this consensus reality we share today.

Elisabeth Kübler-Ross wrote, “Healing is the personal experience of the transcendence of suffering.”

For people in this cancer study, some approaching death, this one dose generated this experience as if they could pull the lens back on their experience and see themselves, their suffering, their cancer, their bodies and their very existence from a much broader perspective, this timeless dimension.

This timeless dimension can foster nonattachment to this body and to this suffering, and can cultivate a connection to something more enduring within us. What does persist?

Some people report a connection to something outside ourselves. Some see even outside biology and outside consciousness.

For someone who is dying and whose body is beginning to fail, whose body is beginning to cease to work, the insight that, “I’m not only this body, but I’m something more enduring. I’m not this cancer,” is a profound gift to anyone approaching death.

They report incredible experiences of gratitude, equanimity and compassion, and a deep appreciation of being alive in the very moment they have.

Albert Einstein, who I think was a modern mystic, wrote, “The most beautiful and profound emotion we can experience is the sensation of the mystical.”

Last year, our group at NYU, along with a team at Johns Hopkins, published findings never seen before in the history of medicine. One dose of psilocybin produced remarkable changes in anxiety, depression and other measures that I’m going to show in a few moments. We published this in December of last year.

A pioneer of this early research was the wonderful Aldous Huxley. I know you all know him. He wrote The Doors of Perception, which is about his mescaline trip in the early ’50s.

But Aldous Huxley went on to really explore and write about the end of life and how we treat the dying. He said, “The dying face increasing pain, increasing anxiety, increasing morphine, with the ultimate disintegration of personality and the loss of the opportunity to die with dignity.”

This is a picture of Aldous Huxley in Los Angeles during his 1953 mescaline trip, an actual picture of his first psychedelic trip. I love this photograph because it’s historic, Aldous Huxley on his first psychedelic journey.

But I also love it because only a classy, elegant English literary writer would come to his first trip in a tweed jacket and cuffed pants. Classy stuff. No tie-dye stuff. He dressed well for the trip.

We did the studies, and people came in. We prepared them for weeks for what to expect, or what they might possibly expect. We gave them guidelines.

They took the capsule. They lay down, wore eye shades and headphones to encourage them to go into their interior, to go into their internal world and be with the unfolding changes.

We gave them some guidelines. The most important guideline: trust.

Trust the guides you’re working with. Trust the medicine. Trust consciousness. Trust wisdom. Let go into the unfolding changes and experiences, and be open to all that arises, even suffering.

We’ve seen over and over again that when people move directly into suffering, into the face of death, and some actually say they experience death, those moments become teachable moments with incredible insights. They report incredible insights about life, death and the nature of self.

Some brief findings: Anxiety and depression dropped remarkably one day after the psilocybin session. Pink is psilocybin, blue is placebo. It was mitigated in incredible ways and sustained at the six-month mark, when we were still following them.

Depression again dropped remarkably compared with the placebo. It improved spiritual well-being remarkably.

Demoralization and hopelessness, two awful experiences linked to end-of-life suffering, were dramatically reduced in the weeks following the one psilocybin-generated mystical experience.

People experienced transcendence of death, defined as connecting with something more enduring than death itself. Again, you see the pink being the psilocybin and the blue being the placebo. Incredible experiences to see.

So many people spoke about love, which was remarkable. They spoke about love and kindness toward themselves as they approached the end of their lives.

They spoke about love toward other people in their lives and throughout their lifespans. They spoke of what I find stunning, this incredible, larger, broader kind of cosmic love, that love is the ground of all being.

I like to use the Greek word agape, a kind of divine love.

I want to read you a quote from one of the patients. His name was Patrick. He was in his 50s. He had an awful metastatic cancer. He passed away a year and a half after the study was over.

I had the complete privilege of working with him. He was an incredible, incredible person. He wrote this about his experience there on the couch for three or four hours in this altered state of consciousness.

He later wrote, “From here on, love was the only consideration. Everything that happened, anything and everything that was seen and heard, centered on love. It wasn’t just the only purpose. It was so pure that sheer joy was indescribable, and the bliss and the fact there are no words to actually capture my experience, my state or this place.

“I know I’ve had no earthly pleasures come close to this incredible feeling, thought, sensation or image of beauty. Nothing during my time on Earth has felt as pure and joyful and glorious as the height of this journey.”

He had a great life. He was a journalist, a musician, he owned restaurants. He had a great, full life.

“I took a tour of my lungs,” he wrote.

So in his experience, he went into his body for part of it. He could see the tumors.

He wrote, “There were nodules there, but they seemed rather unimportant. I was being informed not to worry about the cancer. It’s minor in the scheme of things. The more important work is love.

“My life has changed in a way that I may never fully understand, but I have an understanding and awareness that is beyond intellect, that my life, that every life and all that is the universe equals one thing: love.”

Patrick rated this experience as the single most spiritually significant experience of his lifetime and among the five most meaningful experiences of his lifetime.

Thich Nhat Hanh, the Zen monk, wrote, “Our true nature is the nature of no birth and no death. Only when we touch our true nature can we transcend the fear of nonbeing or of annihilation.”

Is that what these people are experiencing? It sure sounds like it.

We’re currently conducting another clinical trial with psilocybin. If that one mirrors the results of this incredible study, I think we’re on track in the coming years to have psilocybin rescheduled for people at the end of life who are suffering.

That will be a remarkable advancement in how we treat the end of life. The end of life has become medicalized. It needs to be humanized, brought from behind closed doors back into the culture where it belongs, because death is here every day.

The implications are incredible. Improving how we die with peace and dignity. It provides clues as to what consciousness is. Where is consciousness? Are we wired for meaning, and if so, why?

Many people here say it’s because of love, and that’s the enduring element.

There are prosocial implications. People report, “We’re all connected. It’s an illusion that we’re separate.” And if that’s true, how do we hurt one another?

In closing, when Patrick had that session that day, he took the capsule. He lay down on the couch, and for two hours he said nothing.

We were right there, the guides, two people, as we watched him. He had eye shades and headphones, and he lay quietly for five or six hours while the experience happened internally.

Two hours after it began, with tears coming down his face, he said, “Birth and death is a lot of work.”

It was quite stunning.

He later said that was the start of his journey within and that this consciousness really shaped how he died and recalibrated his death. His wife, Lisa, and he both attributed his ending with no fear to this experience.

He didn’t want to leave this incredible miracle we have called life, but he wasn’t afraid.

Patrick and others in these studies have been the true teachers, showing us what is possible, that we’re wired for these incredible meaning-making, transcendent experiences. Nature has wired us that way, and these medicines reliably generate that experience under the right conditions.

They’ve confirmed for me what we use in palliative care, the term we use, that a good death is indeed possible.

And that maybe the ground of being, the very nature of consciousness, is something of a substance that the mystics and the people in these studies describe as a type of great liberation or love.

That we’re all indeed connected, that perhaps this is our true nature and that it’s available to us all. With it, we can live well and we can end well.

When Patrick said those words, I thought of a Zen saying that is sung in monasteries at the end of the day. I want to close with this saying today:

“Let me respectfully remind you: Life and death are of supreme importance. Time swiftly passes by and opportunity is lost. Each of us should strive to awaken. Awaken. Take heed. Do not squander your life.”

Thank you