The Trip Treatment – The New Yorker

Psilocybin may be useful in treating anxiety, addiction, and depression, and in studying the neurobiology of mystical experience.

Extract from The Trip Treatment – The New Yorker

On an April Monday in 2010, Patrick Mettes, a fifty-four-year-old television news director being treated for a cancer of the bile ducts, read an article on the front page of the Times that would change his death. His diagnosis had come three years earlier, shortly after his wife, Lisa, noticed that the whites of his eyes had turned yellow. By 2010, the cancer had spread to Patrick’s lungs and he was buckling under the weight of a debilitating chemotherapy regimen and the growing fear that he might not survive. The article, headlined “Hallucinogens Have Doctors Tuning in Again,” mentioned clinical trials at several universities, including N.Y.U., in which psilocybin—the active ingredient in so-called magic mushrooms—was being administered to cancer patients in an effort to relieve their anxiety and “existential distress.” One of the researchers was quoted as saying that, under the influence of the hallucinogen, “individuals transcend their primary identification with their bodies and experience ego-free states . . . and return with a new perspective and profound acceptance.” Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

The revival of psychedelic research today owes much to the respectability of its new advocates. At sixty-eight, Roland Griffiths, who was trained as a behaviorist and holds senior appointments in psychiatry and neuroscience at Hopkins, is one of the nation’s leading drug-addiction researchers. More than six feet tall, he is rail-thin and stands bolt upright; the only undisciplined thing about him is a thatch of white hair so dense that it appears to have held his comb to a draw. His long, productive relationship with nida has resulted in some three hundred and fifty papers, with titles such as “Reduction of Heroin Self-Administration in Baboons by Manipulation of Behavioral and Pharmacological Conditions.” Tom Insel, the director of the N.I.M.H., described Griffiths as “a very careful, thoughtful scientist” with “a reputation for meticulous data analysis. So it’s fascinating that he’s now involved in an area that other people might view as pushing the edge.”

The lab at Hopkins is currently conducting a study of particular interest to Griffiths: examining the effect of psilocybin on long-term meditators. The study plans to use fMRI—functional magnetic-resonance imaging—to study the brains of forty meditators before, during, and after they have taken psilocybin, to measure changes in brain activity and connectivity and to see what these “trained contemplatives can tell us about the experience.” Griffiths’s lab is also launching a study in collaboration with N.Y.U. that will give the drug to religious professionals in a number of faiths to see how the experience might contribute to their work. “I feel like a kid in a candy shop,” Griffiths told me. “There are so many directions to take this research. It’s a Rip Van Winkle effect—after three decades of no research, we’re rubbing the sleep from our eyes.”

“Ineffability” is a hallmark of the mystical experience. Many struggle to describe the bizarre events going on in their minds during a guided psychedelic journey without sounding like either a New Age guru or a lunatic. The available vocabulary isn’t always up to the task of recounting an experience that seemingly can take someone out of body, across vast stretches of time and space, and include face-to-face encounters with divinities and demons and previews of their own death.

Volunteers in the N.Y.U. psilocybin trial were required to write a narrative of their experience soon after the treatment, and Patrick Mettes, having worked in journalism, took the assignment seriously. His wife, Lisa, said that, after his Friday session, he worked all weekend to make sense of the experience and write it down.

When Mettes arrived at the treatment room, at First Avenue and Twenty-fifth Street, Tony Bossis and Krystallia Kalliontzi, his guides, greeted him, reviewed the day’s plan, and, at 9 A.M., presented him with a small chalice containing the pill. None of them knew whether it contained psilocybin or the placebo. Asked to state his intention, Mettes said that he wanted to learn to cope better with the anxiety and the fear that he felt about his cancer. As the researchers had suggested, he’d brought a few photographs along—of Lisa and him on their wedding day, and of their dog, Arlo—and placed them around the room.

At nine-thirty, Mettes lay down on the couch, put on the headphones and eye mask, and fell silent. In his account, he likened the start of the journey to the launch of a space shuttle, “a physically violent and rather clunky liftoff which eventually gave way to the blissful serenity of weightlessness.”

 

The “same force that takes you deep within will, of its own impetus, return you safely to the everyday world,” the manual offers at one point. Guides are instructed to remind subjects that they’ll never be left alone and not to worry about their bodies while journeying, since the guides will keep an eye on them. If you feel like you’re “dying, melting, dissolving, exploding, going crazy etc.—go ahead,” embrace it: “Climb staircases, open doors, explore paths, fly over landscapes.” And if you confront anything frightening, “look the monster in the eye and move towards it. . . . Dig in your heels; ask, ‘What are you doing in my mind?’ Or, ‘What can I learn from you?’ Look for the darkest corner in the basement, and shine your light there.” This training may help explain why the darker experiences that sometimes accompany the recreational use of psychedelics have not surfaced in the N.Y.U. and Hopkins trials.

Bossis noted that Mettes was crying and breathing heavily. Mettes said, “Birth and death is a lot of work,” and appeared to be convulsing. Then he reached out and clutched Kalliontzi’s hand while pulling his knees up and pushing, as if he were delivering a baby.

“Oh God,” he said, “it all makes sense now, so simple and beautiful.”

Around noon, Mettes asked to take a break. “It was getting too intense,” he wrote. They helped him to the bathroom. “Even the germs were beautiful, as was everything in our world and universe.” Afterward, he was reluctant to “go back in.” He wrote, “The work was considerable but I loved the sense of adventure.” He put on his eye mask and headphones and lay back down.

“From here on, love was the only consideration. It was and is the only purpose. Love seemed to emanate from a single point of light. And it vibrated.” He wrote that “no sensation, no image of beauty, nothing during my time on earth has felt as pure and joyful and glorious as the height of this journey.”

Every guided psychedelic journey is different, but a few themes seem to recur. Several of the cancer patients I interviewed at N.Y.U. and Hopkins described an experience of either giving birth or being born. Many also described an encounter with their cancer that had the effect of diminishing its power over them. Dinah Bazer, a shy woman in her sixties who had been given a diagnosis of ovarian cancer in 2010, screamed at the black mass of fear she encountered while peering into her rib cage: “Fuck you, I won’t be eaten alive!” Since her session, she says, she has stopped worrying about a recurrence—one of the objectives of the trial.

Great secrets of the universe often become clear during the journey, such as “We are all one” or “Love is all that matters.” The usual ratio of wonder to banality in the adult mind is overturned, and such ideas acquire the force of revealed truth. The result is a kind of conversion experience, and the researchers believe that this is what is responsible for the therapeutic effect.

Subjects revelled in their sudden ability to travel seemingly at will through space and time, using it to visit Elizabethan England, the banks of the Ganges, or Wordsworthian scenes from their childhood. The impediment of a body is gone, as is one’s identity, yet, paradoxically, a perceiving and recording “I” still exists. Several volunteers used the metaphor of a camera being pulled back on the scene of their lives, to a point where matters that had once seemed daunting now appeared manageable—smoking, cancer, even death. Their accounts are reminiscent of the “overview effect” described by astronauts who have glimpsed the earth from a great distance, an experience that some of them say permanently altered their priorities. Roland Griffiths likens the therapeutic experience of psilocybin to a kind of “inverse P.T.S.D.”—“a discrete event that produces persisting positive changes in attitudes, moods, and behavior, and presumably in the brain.”

Death looms large in the journeys taken by the cancer patients. A woman I’ll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space as if in a video game until she arrived at the wall of a crematorium and realized, with a fright, “I’ve died and now I’m going to be cremated. The next thing I know, I’m below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I’m seeing the trees growing, and I’m part of them. It didn’t feel sad or happy, just natural, contented, peaceful. I wasn’t gone. I was part of the earth.” Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across “the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I’d ever known. When my time came, that’s where my life would go once it left me and that was O.K.”

I was struck by how the descriptions of psychedelic journeys differed from the typical accounts of dreams. For one thing, most people’s recall of their journey is not just vivid but comprehensive, the narratives they reconstruct seamless and fully accessible, even years later. They don’t regard these narratives as “just a dream,” the evanescent products of fantasy or wish fulfillment, but, rather, as genuine and sturdy experiences. This is the “noetic” quality that students of mysticism often describe: the unmistakable sense that whatever has been learned or witnessed has the authority and the durability of objective truth. “You don’t get that on other drugs,” as Roland Griffiths points out; after the fact, we’re fully aware of, and often embarrassed by, the inauthenticity of the drug experience.

This might help explain why so many cancer patients in the trials reported that their fear of death had lifted or at least abated: they had stared directly at death and come to know something about it, in a kind of dress rehearsal. “A high-dose psychedelic experience is death practice,” Katherine MacLean, the former Hopkins psychologist, said. “You’re losing everything you know to be real, letting go of your ego and your body, and that process can feel like dying.” And yet you don’t die; in fact, some volunteers become convinced by the experience that consciousness may somehow survive the death of their bodies.

In follow-up discussions with Bossis, Patrick Mettes spoke of his body and his cancer as a “type of illusion” and how there might be “something beyond this physical body.” It also became clear that, psychologically, at least, Mettes was doing remarkably well: he was meditating regularly, felt he had become better able to live in the present, and described loving his wife “even more.” In a session in March, two months after his journey, Bossis noted that Mettes “reports feeling the happiest in his life.”

How are we to judge the veracity of the insights gleaned during a psychedelic journey? It’s one thing to conclude that love is all that matters, but quite another to come away from a therapy convinced that “there is another reality” awaiting us after death, as one volunteer put it, or that there is more to the universe—and to consciousness—than a purely materialist world view would have us believe. Is psychedelic therapy simply foisting a comforting delusion on the sick and dying?

“That’s above my pay grade,” Bossis said, with a shrug, when I asked him. Bill Richards cited William James, who suggested that we judge the mystical experience not by its veracity, which is unknowable, but by its fruits: does it turn someone’s life in a positive direction?

Many researchers acknowledge that the power of suggestion may play a role when a drug like psilocybin is administered by medical professionals with legal and institutional sanction: under such conditions, the expectations of the therapist are much more likely to be fulfilled by the patient. (And bad trips are much less likely to occur.) But who cares, some argue, as long as it helps? David Nichols, an emeritus professor of pharmacology at Purdue University—and a founder, in 1993, of the Heffter Research Institute, a key funder of psychedelic research—put the pragmatic case most baldly in a recent interview with Science: “If it gives them peace, if it helps people to die peacefully with their friends and their family at their side, I don’t care if it’s real or an illusion.”

Roland Griffiths is willing to consider the challenge that the mystical experience poses to the prevailing scientific paradigm. He conceded that “authenticity is a scientific question not yet answered” and that all that scientists have to go by is what people tell them about their experiences. But he pointed out that the same is true for much more familiar mental phenomena.

“What about the miracle that we are conscious? Just think about that for a second, that we are aware we’re aware!” Insofar as I was on board for one miracle well beyond the reach of materialist science, Griffiths was suggesting, I should remain open to the possibility of others.

“I’m willing to hold that there’s a mystery here we don’t understand, that these experiences may or may not be ‘true,’ ” he said. “What’s exciting is to use the tools we have to explore and pick apart this mystery.”

Perhaps the most ambitious attempt to pick apart the scientific mystery of the psychedelic experience has been taking place in a lab based at Imperial College, in London. There a thirty-four-year-old neuroscientist named Robin Carhart-Harris has been injecting healthy volunteers with psilocybin and LSD and then using a variety of scanning tools—including fMRI and magnetoencephalography (MEG)—to observe what happens in their brains.

Carhart-Harris works in the laboratory of David Nutt, a prominent English psychopharmacologist. Nutt served as the drug-policy adviser to the Labour Government until 2011, when he was fired for arguing that psychedelic drugs should be rescheduled on the ground that they are safer than alcohol or tobacco and potentially invaluable to neuroscience. Carhart-Harris’s own path to neuroscience was an eccentric one. First, he took a graduate course in psychoanalysis—a field that few neuroscientists take seriously, regarding it less as a science than as a set of untestable beliefs. Carhart-Harris was fascinated by psychoanalytic theory but frustrated by the paucity of its tools for exploring what it deemed most important about the mind: the unconscious.

“If the only way we can access the unconscious mind is via dreams and free association, we aren’t going to get anywhere,” he said. “Surely there must be something else.” One day, he asked his seminar leader if that might be a drug. She was intrigued. He set off to search the library catalogue for “LSD and the Unconscious” and found “Realms of the Human Unconscious,” by Stanislav Grof. “I read the book cover to cover. That set the course for the rest of my young life.”

Carhart-Harris, who is slender and intense, with large pale-blue eyes that seldom blink, decided that he would use psychedelic drugs and modern brain-imaging techniques to put a foundation of hard science beneath psychoanalysis. “Freud said dreams were the royal road to the unconscious,” he said in our first interview. “LSD may turn out to be the superhighway.” Nutt agreed to let him follow this hunch in his lab. He ran bureaucratic interference and helped secure funding (from the Beckley Foundation, which supports psychedelic research).

When, in 2010, Carhart-Harris first began studying the brains of volunteers on psychedelics, neuroscientists assumed that the drugs somehow excited brain activity—hence the vivid hallucinations and powerful emotions that people report. But when Carhart-Harris looked at the results of the first set of fMRI scans—which pinpoint areas of brain activity by mapping local blood flow and oxygen consumption—he discovered that the drug appeared to substantially reduce brain activity in one particular region: the “default-mode network.”

If the default-mode network functions as the conductor of the symphony of brain activity, we might expect its temporary disappearance from the stage to lead to an increase in dissonance and mental disorder—as appears to happen during the psychedelic journey. Carhart-Harris has found evidence in scans of brain waves that, when the default-mode network shuts down, other brain regions “are let off the leash.” Mental contents hidden from view (or suppressed) during normal waking consciousness come to the fore: emotions, memories, wishes and fears. Regions that don’t ordinarily communicate directly with one another strike up conversations (neuroscientists sometimes call this “crosstalk”), often with bizarre results. Carhart-Harris thinks that hallucinations occur when the visual-processing centers of the brain, left to their own devices, become more susceptible to the influence of our beliefs and emotions.

Video: A participant in N.Y.U.’s Psilocybin Cancer Anxiety Study describes his healing psychedelic trip.

The Trip Treatment – The New Yorker.

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