Barry Blechman Takes a Journey

Cold Open

Barry Blechman and I have at least one thing in common.

Barry: Cancer is my family's middle name. My mother had six cancers, my grandfather had cancer. My grandmother had cancer. It’s in the genes.

Shoshana: You know what mine too. So I understand what you're saying.

In the mid 80s, Barry was diagnosed with cancer for the first time. It was in his bowel. He went in for surgery to have it removed.

Barry: Oh, it was one of these, well, there's only a 2% risk that could go wrong. Well, sure enough it went wrong. The surgeon messed up and it didn't come out as supposed to.

Barry was given a procedure called a colostomy. That’s where surgeons bring a portion of the bowel to the surface of the abdomen, where stool’s collected in a bag. For Barry, it was his worst nightmare.

My grandfather had a colostomy. So back in those days the technology was terrible and one of my early trial memories was of him screaming in pain, trying to deal with the thing. By the time I had one in the mid eighties, things have much improved. But it was only for two years and then I was able to get it reversed and everything was great till about five years ago.

Barry was cancer free for roughly three decades. But in the back of his mind he always

figured that cancer would re-enter his life one day. When it did, it was in his bladder.

Shoshana: I'm curious, was it like a routine exam that they found it, did you have symptoms?

Barry: I had a symptom, which I recognized what it was. I could tell I could, I could smell it. I knew it.

Shoshana: You could smell it.

Barry: Yeah. I don't want to get into the gory details, but I knew it was there, my hope was that it could be dealt with easily.

So when Barry's doctor brought him into the office to deliver the news that he had cancer, Barry wasn't surprised by the diagnosis. But the prognosis was not what Barry had hoped for.

Barry: It had spread pretty widely. That was the problem. The first thing he said was, I can't deal with this. This is too big a case for me.

Because of his prior surgeries, the procedure to remove his bladder was complicated. And this all happened right at the beginning of Covid, so Barry was stuck in a locked down

hospital room with no visitors for six weeks.

Even worse, surgeons found that his cancer had spread and there were suspicious nodes in multiple places in his abdomen. That meant more surgical procedures and immunotherapy to kill the cancer cells.

Barry: It knocked the cancer out of my lungs, of my liver and most places in my abdomen.

Shoshana: Wow.

There were a few suspicious spots, but they were quite quiet. They were sleeping. Everyone said, well, they'll probably wake up one day, but go forth and have a good time in the meantime.

But Barry didn’t feel much like having a good time. Since his cancer diagnosis, he had been anxious and depressed.

And that’s when he came across an idea that I encouraged my dad to pursue when he was dealing with the anxiety and depression that can sometimes accompany a cancer diagnosis: psilocybin assisted therapy.

Barry: I had been reading a lot about it. There was a book by the man – he ran the Johns Hopkins experiment on psilocybin.

Shoshana: Roland Griffiths.

Barry: Yes. Roland Griffiths.

Psilocybin is the active ingredient in “magic mushrooms”. And in 2016, Roland Griffiths published a study that showed significant decreases in symptoms of depression AND anxiety… in patients with cancer who’d undergone a single session of psilocybin assisted therapy. And 80-percent of those patients reported still feeling the positive effects of the treatment six months later.

Barry’s daughter encouraged him to try it out.

I have three daughters. The oldest one, Jennifer, is a palliative care doctor. Jenny put me in touch with a psychiatric social worker out in Oregon where she lives. Betty is her name, Betty Warden.

Psilocybin assisted therapy is legal in Oregon, but it can only be used at licensed facilities with trained facilitators. Colorado passed a law making psilocybin treatments legal in May of 2023, and a number of US states are considering laws of their own.

But back when Barry was seeking therapy, Oregon was his only option. Jenny introduced him to a state-certified psilocybin facilitator, and they did preparation sessions over zoom.

Barry: We talked once a month. And it was like having a psychiatric session. Talking about, you know, what I was hoping to get out of it and what's bothering me. And then decided to go out there and do a journey. We don't say trip, that's trivial. We do journeys when it's under medical supervision.

Shoshana: Can you tell us what you wanted? Like what were you dealing with that you really wanted to get out of it?

Barry: Well, one thing is I tend not to be in the moment. I tend to clutter my thoughts, my life with trivial things. I'll be at a concert enjoying it, but I'm not lost in the music because I'll have, then tomorrow you have to make sure that the patio gets washed. Things like that, dumb things like that. So I, one thing I wanted to do was to try to get more in the moment. Another one was to deal with some old griefs instances where I'd been wronged. And I did all those things. Amazing.

I’m Dr. Shoshana Ungerleider and this is Before We Go. This season, we’re in conversation with people from all walks of life, exploring how we live alongside mortality.

Today’s episode: Barry Blechman Takes a Journey.

<theme music ends.

AD BREAK I: 6:23

Act I

In the winter of 2023, Barry Blechman drove to the airport in Washington, DC, and boarded a plane for Bend, Oregon. He was scheduled for a full day of psilocybin assisted therapy to address the anxiety and depression that had followed him since his second cancer diagnosis.

Shoshana: I wanna take you back to that journey of getting to Oregon. As you're walking through the airport, getting on the plane, how are you feeling about what you're about to do?

Barry: Good, enthusiastic, raring to go.

The day before his journey, Barry met with Betty in person. She encouraged him to think about what he wanted to get out of his session – to really focus on specific goals.

Shoshana: So you get to the clinic. What was it like? Did it look like a doctor's office? Was it more spa-like?

Barry: Yeah, not neither. It was more like, uh. almost like a child care place. It was a carpeted floor, low furniture, some blankets, colored things on the walls.

Barry: They can't give you the drug. So they give you a package with the drug. You can either eat the mushrooms or turn it into a tea, which I did.

After a half hour or so, the journey began.

Barry: I had this vision that I was in a Christmas sled on, stuck on a roof, and I couldn't get off the roof and there was things up in the sky I wanted to see it's important. And Betty said, you haven't had anywhere near the what we're allowed to give you. Would you like more tea? And so I took some more tea and that got me, cut the sled flying into the sky there.

Barry: Another time I saw, this black cloud coming. Threatening black cloud. And I was scared. It was scary. And Betty kind of, you know, rubbed my shoulder, said there, there you're safe here. Why don't you go see what's scaring you over there. So with that reassurance I went over and it was that fucking surgeon that messed me up the first time in the eighties. The guy that made the mistakes that set off all this bad surgery. And so I screamed at him. I yelled at him, I beat him up and I was very therapeutic. I felt very good about that. I've been known to have anger, which a lot of anger in me, which comes out at inappropriate times. And something trivial, fierce anger will come out. That doesn't happen so much anymore.

For many people who undergo this therapy, like Barry, the effects can be long-lasting and far-reaching.

Shoshana: I'm so glad that you were able to face him in this, in this way.

Barry: Yeah, it was very therapeutic and it's had lasting effects on my attitude.

Barry: My overall being, being my bearing just changed very substantially. It just became less worried about things, unimportant things. More able to appreciate nice things.

After six months or so, Barry wanted to try it again. So he went back for a second journey.

Barry: I had trouble getting into it when I initially went under, you know, it comes in waves. It's like the tide. You're like lying on the beach and the tide will come and you go, oh, oh, I'm leaving. Okay. The first wave came, it brought me to a bad place. It was a dark cavern. It's ugly. There was surgical things and IVs hanging down. This was my personal nightmares. So I was in a nightmare. So finally I called to Betty and said, get me outta here. And then the rest of the, that journey was fine, although shorter than the first one.

Shoshana: So even though that second session was maybe harder for you, it sounds like, or just different than the first, did the experience shift your thinking about the end of your life at all and facing and facing, dying?

Barry: It certainly did. It's hard to describe. I don't want to die.

But Barry says he can recognize, without falling apart, that it’s going to happen.

Barry: I have some hope that it'll be not, uh, imminent. But I can accept it.

LOTS OF MUSIC HERE!

I wanted to dig into the science behind Barry’s journey, so I called my good friend, Dr. Anthony Back.

Shoshana: And do you want me to, is it okay if I call you Tony?

Tony: Please, please, please call me Tony. We're old friends. You've gotta call me Tony.

Shoshana: Of course. I, you know, I just like to be respectful.

Tony is a medical oncologist and palliative care doctor at the University of Washington who is now focused on doing clinical trials with psychedelic medicines.

Shoshana: Tell me the story of how you first started thinking about using psychedelic assisted therapy to help patients.

Tony: Well it really goes back to how I got into this field altogether, right? My mother had pre-leukemia and died, uh, of it while I was a sophomore in college, right?

Losing his mother led Tony to ask some big questions. And he kept asking those questions, through medical school and beyond.

Tony: A whole bunch of that was this process of coming to terms with what it means to be present in the face of something really awful. Right. Um, because despite all the technology that I had as an oncologist, there were still moments where you get to a place where the patient and you think, oh my God, this is just, this is not what anyone was hoping for. Right. Like this is everybody's nightmare.

Tony was one of the early researchers in the field of medical aid in dying. His patients were asking about it, even though it was not yet legal anywhere in the US. And Tony realized something important.

Tony: People were not asking because of symptoms or pain. They were asking because they thought they were losing dignity. They thought they didn't see a way forward. They didn't want to be taken care of. Right. And of course, you know, I'm a gay man. Who came of age during the AIDS crisis, right? The bad part. When everyone was dying. And I had seen all that in spades and basically the AIDS communities in Seattle and San Francisco, as you know, they pioneered this whole hastening your death thing. You know, people were saving up their meds, they were taking them, they were trying it out. They were sharing all that information pre-internet. And so I was kind of in this culture of, is there a way to take control of your death?

That’s when Tony heard about the psilocybin studies, like the one published by Roland Griffiths in 2016. And he thought psilocybin might offer his patients something different.

Tony: Like a whole way of looking from a 10,000 foot level at all these issues.

Tony: I practiced in Seattle and I, I knew my patients would be asking for this. They'd already been asking me about death with dignity. I knew they would be asking about this. And I thought, how am I ever going to look them in the eye and say, I think this is a good idea or a bad idea. Right. And so I arranged to have my own trip.

It took Tony three months to find a guide – a trained psychologist who would shepherd him through the experience.

Tony: It turns out this is not a do it yourself kind of thing.

You actually need to have somebody with you who has been in that territory before. Otherwise you can really get stuck. You can really go down a rabbit hole. You can really have, you know, be re-traumatized by the experience. So you really need somebody with experience.

So Tony found someone who would guide him through a number of prep sessions, a full day with psilocybin and a couple of integration sessions. And in 2017, he traveled to California to try psilocybin assisted therapy for himself.

Tony: And I had a profound trip. 'Cause my whole thing was, you know, is this really something or is it really just, you know, people having these other experiences? And I was like, holy cow, this is profound. Like I'm a very intellectual, kind of thinky person, right? And, and, and part of the a, a huge part of the trip was, you need to pay attention to people that you are not paying attention to. So all these older grandmotherly age women came up to me and they were all looking at me like, you are not paying attention to us. And they were right. Of course.

Tony: And then the other part was you, there are things in your body that you have to learn and you just have to stop thinking. And I had all this energy coming through my body and I would be thinking, you know, I've got this, now I understand. And boom, it would happen again. It like just literally shook it out of me for like three hours. And the guide was like, are you okay? Do you need me to rub your legs or something? And I was like, I was actually like, you know what? I think I'm just supposed to feel all this. It's not. It doesn't, it's not bad, but I just am like, I'm having this experience. So it was this very profound, embodied experience for me. And then I came away with the sense that, you know, there were ways of looking at, our existence and our being on this planet that were just much different than what I had ever learned in medical school.

Tony wrote about his experience in the Journal of Palliative Medicine.

Shoshana: What do we understand about how and why this treatment works? And, and to the extent that you can, tell us about what's actually happening in the brain.

Tony: Yeah, so when you take psilocybin, it gets absorbed in the gut and then converted into this other compound psilocin.

Psilocyn binds to serotonin receptors in the brain, and changes the way that different parts of the brain communicate with each other.

Tony: So for example, you'll remember things that you didn't even know you remembered. Experiences will come back to you that you didn't realize had so much emotional impact, but in fact, were like pivotal and you've been repressing them. Connections between parts of your life about how you've developed, and how that has shaped your decisions. Those will become clear to you. Your receptors get stimulated for actually kind of a short period of time. It's like half an hour or something like that. But the subjective effect of that and what happens in your brain continues to play out for hours.

Tony: It changes how you are with your sense of self during the experience. So the part of your brain that is responsible for. I am Tony, I like coffee in the morning. I am a doctor who cares about that. All that stuff kind of gets dissolved. And you can see on people's brain scans on their functional MRI scans that that part of your brain that is responsible for the ego, it actually becomes less active. So it's like less of the I, more of everything else.

Shoshana: So this kind of therapy is still only available in a few states. Why is that?

Tony: The federal government has continued to classify psilocybin as a schedule one drug, meaning there is no known beneficial use. And so it's highly restricted. And so the people who have been accessing this treatment now are really early adopters who've been very interested, highly motivated, able to spend some time and resources their way to this.

For the past few years, Tony has been leading FDA approved clinical trials at the University of Washington. He wanted to take the treatment out of clinics, like the one Barry visited, and into nature. So he brought a small group of patients with incurable cancer to a retreat.

Tony: I mean, this is the way it's traditionally been done in traditional practices, right, in groups. And I also wanted to make a place where people with cancer could listen to each other. And that it turns out, I think, has been the most profound part of this. They talk to each other, they tell their stories to each other. They support each other during the three day retreat. And I think that is as powerful as anything I say as the doctor.

After one session, one of the participants asked Tony if he could write a thank you note to the manufacturers of the drug.

Tony: This, so this is from his email. This was my first experience and it was a truly mystical experience for me. I felt what it feels like to feel everything all at once. I felt my bones dissolve and my body become liquid, and the whole world was liquid and full of color. I felt and visualized my jaw dissolve on several occasions and realized I was clenching my jaw and I let go. And the first time I felt like what it means. To let go.

Tony: Then dot, dot, dot. He said time became limitless and I felt like what it feels like to be infinite. During the session, I had to pee and went to the bathroom, and when I was peeing the toilet was full of jellyfish and I realized I could pee jellyfish.

Tony: And here's where he gets to the nub of it. For a period of time, nothing made sense. And it was so funny to realize how absurd it was to make sense of things. I felt like a billion colors and I felt love. So much love, like I've never felt before. I objectified my cancer and wanted to be angry at it and yell and scream, and then started laughing at how absurd that was. So I gave it a hug and loved and forgave. I wrestled with the idea of death and it didn't seem possible to die. It felt like my body could die, but my feelings could never die. And I know this sounds silly, but I realize that death is love.

Shoshana: Whoa.

Tony: Right. So I, as an oncologist, right, who had practiced for 30 years, right? I had never heard anything like this. What he's doing there is he is detaching himself from all his stories about how cancer should work or how it should act, or what he deserves, and he's able to look at it from this 50,000 foot view and go, this is really all about love and death is actually about love too.

Tony: And I have seen versions of that now in many, in many people who've had a psilocybin experience. Some of them have smaller versions of it, some of them have medium sized versions. He had a big version of it. But, I think that experience, what changes people.

But Tony is the first to admit. This kind of therapy is not always rainbows and jellyfish.

Tony: There was a person in my first study. She had a, a rough first trip. And she came out of it later and said, what I realized is how I'm trying to control everything and I, I have to stop doing that. Like the, this is not a viable strategy for me. And so it was a profound realization for her, and she said, and I would never do that again, right? Like, it's too hard.

And while psilocybin assisted therapy has been shown to have lasting effects, it shouldn’t be seen as some kind of miracle treatment.

Tony: I think it's not good for us to think of this as, oh, this is going to be the magical cure for all your anxiety and depression, right? Like, after you have psilocybin therapy, even if it works really well, you will still have moments when you're worried. You'll still have moments when you're scared or pissed off or whatever. They're not usually as sticky, and you may have more ways of dealing with them so that they don't, you know, they don't weigh on you and they don't, um, overtake you and they don't turn into these rabbit holes that you go down and get stuck in. But it's, you know, you're still a human with moods, right? You know, it's not gonna mean you're never sad. But it can mean some other big things.

You’re listening to Before We Go. We’ll be right back.

AD BREAK 22:50

Act II

I told Tony all about Barry Blechman and his experience with psilocybin assisted therapy. And I mentioned that one of the things I found really interesting about Barry’s story is that he didn’t go into his journey wanting to become less depressed and less anxious about death. He wanted to be able to stay in the moment – to be able to enjoy listening to music at a concert without worrying about the fact that the patio still needs to be washed.

Tony wasn’t surprised by this at all.

Tony: You know what I see when people come in looking for this kind of experience is that there's kind of a top level thing or a set of top level things and some lower level things, right? So for example, people will say, I'm so mad about my treatment. I'm so angry about the way I was treated. I'm so like frustrated and disappointed that they missed my diagnosis for a while or that something like this. And there are a bunch of people who will come with that as the top level thing that they need to work through. And then they do work through that.

Tony: And then what happens is they get to this lower level of whoa. What is really driving this? What is really driving that anger and frustration and disappointment is this lower layer of what is happening to me? Is it real that I am in the near future, not going to be here in this world? What does that non-existence mean? What kinds of losses does that mean? I face? What kinds of changes in my body and changes in my being, does that mean I face? So I, I see and hear lots of different, top line questions and they often point to this lower level stuff.

I also told Tony about Barry’s second journey – the one that didn’t go as well. And I asked him if there was any scientific evidence about second journeys and whether they were helpful.

Tony: Well, here's the thing is there's hardly any science. So I have just completed the first study of a second experience for people who had a first experience, right?

Tony conducted a clinical trial of 52 patients who either hadn’t responded to their first treatment or who felt like their anxiety went away for a little while, and then it came back.

Tony: And so those people came back for a second experience. And, we're just looking at the data now. I mean, anecdotally, I can tell you there were some real big things that happened, but there's not. Research about, you know, how many treatments do you need or what's the benefit of going through a second treatment? And so that's why I was doing this study was to try to look at that and figure out, you know, is there something to this.

Tony is still sorting through the data, but there’s one thing he’s sure about.

Tony: There was a lot of publicity surrounding the 2016 trials that were, that was like, you know, one treatment and that will do it all. And I have clearly seen that I don't think that's true, but I think the question of how second experiences are handled and how people work through them, that that is clearly a complicated thing that I think we are still learning about.

Tony is looking for funding for follow up studies. And he has high hopes for where all this might lead.

Tony: I am hoping that in the future there will be ways for people to access psychedelic medicines in a way that is completely safe and legal and. With enough supervision and people who know what they're doing. And I'm hoping that that. Kind of experience will be available for people with a life-threatening illness like cancer, you know, for people with mental health issues like, you know, depression, but also for people who are spiritual seekers, for people who are going through some kind of massive life transition. All those kinds of things. I'm hoping that there's some kind of, safe and legal pathway for them.

When I spoke to Barry Blechman in late May, he felt the same way.

Barry: I've had almost three years and I've had with my partner Kitty, the most wonderful experiences went to, Patagonia, which was just extraordinary. Just extraordinary, the most beautiful place on earth.

Shoshana: Beautiful.

Barry: We went to Seyshells and Cape Town. \We, so I had never, I grew up in New York, but I'd never been to Lincoln Center. We saw like an opera at the Met. No idea how beautiful it was much more beautiful than our Kennedy Center. I went to Royal Albert Hall in London for a fabulous concert. Went to Ascot races, which was really nice. Went to Paris. Oh, we went to the Paris Olympics.

Shoshana: Oh my goodness.

Barry: Extraordinary. I mean, we've been on the road for three years.

Barry told me about a spiritual experience he had during a recent trip to Patagonia.

Barry: Do you know the books by Castaneda? They were popular in the sixties and seventies.

Shoshana: I don't think so.

Barry: He, uh, used a lot of peyote, preached the use of peyote for spiritual enlightenment and wrote once that the only way to truly appreciate life is to recognize your death and live with it on your shoulder. So just know it's there.

After I got off the call with Barry, I looked this up. Castaneda believed that by recognizing death as a constant companion, even as an advisor, we could all learn to become more present in our everyday lives. He even wrote, quote, "When you need an answer, look over your left shoulder and ask your death."

Barry: So we were in Patagonia at the Fancy Hotel and I had gone e-biking. You know, I'm 82, so I've been reluctant to do anything that might break bones.

Shoshana: I am 45 and I'm reluctant to go on an e-bike, so I hear you.

Barry: I got brave for some reason and went e biking and it was fabulous. I had such a good time, I conquered this fear. My partner said, well, why don't you go get reflexology. They had a spa. I said, yeah, that's a good idea. Top off a perfect day. So I went down to the spa and this nice lady was working on my feet and this nice music was playing and I was totally relaxed. Like I don't think I've ever been that relaxed. And then I felt this Hispanic man walking up behind me, behind my right shoulder. It was real in my mind. And I said, oh, you are my death. You are my death. But I'm not ready. I'm not ready. I'm having a good time. Don't take me now in Patagonia. And he kinda smiled and he stepped back.

Shoshana: Wow.

Barry: That was quite extraordinary.

Barry: You know, then sure enough, that was in March and in, uh, two weeks ago I discovered that my cancer has come back. I'm back in immunotherapy this time with an even newer miracle drug. Take that RFK. Yeah. Science is important.

Shoshana: Indeed.

Barry: And the oncologists are quite optimistic about this new one combined with the old one since the old one worked once.

Shoshana: And when you imagine the time that you have left, however long that may be, what matters most to you now?

Barry: Well, my life is circumscribed right now, because of the illness which keeps me more or less confined to, if not the house, the neighborhood.

Shoshana: Yeah.

Barry: But I try and succeed every day. I invite people to come visit friends so I could talk to them. I listen to a lot of music. Watch the Knicks struggling in basketball. Try to make the most, within my circumscribed life, try to make the most of it,

Barry: I mean, I don't want, I don't want to die, but I'm not afraid of it, and I know it'll be coming. But, it's alright. It's alright. I'm so grateful for the extra years that the, immunotherapy gave me in. All the wonderful things I did. And it wasn't just the doing of the things, but able to appreciate them in ways that I never had been able to appreciate music or art or being outside for that matter. I've listened to, oh, a cello player recently…

[cello music]

Barry: And just gotten completely lost in the music in ways – I could listen to music and appreciate it – but this is different. It's being really a part of it. Becoming a part of it. And that I attribute to psilocybin.

[more cello music]

I spoke to Barry Blechman on May 28. And then I received an email from his daughter, Jenny, letting me know that her father had died in the early morning of June 27th, almost exactly a month after our conversation.

Jenny says that Barry died peacefully, with his three daughters and his partner, Kitty, at his side.

She says it was the ending her father had hoped for.

CREDITS

—

Next time, on the show.

Kirsty Parsons was diagnosed with cystic fibrosis when she was just one day old. She spent her life believing that she would not live to see her 30s. But when she was 24, a new treatment was developed that changed her life.

I was just sitting there and I hadn't even moved. And all of a sudden I just coughed and this plug of phlegm just came up and I was like, where has this come from? I don't know, this sounds like a very sci-fi esque kind of thing, but this monster that had always been in my lungs and holding me back and just being able to cough it all up, was really cool.

But living – when you were told you were going to die – can be complicated. And Kirsty and many others in the CF community now have the opportunity to ask themselves questions they never asked before.

I think it's probably an opportunity to start thinking about what they want a five years out future self, a 10 years out future self to look like. How are they spending their time? Who are they with? What are they doing? Are they working, not working? What do each of those periods look like?

That’s next week on Before We Go.