Who Will Benefit from Psychedelic Medicine?
An essay based on my May 27 NIH/NCI talk: A Breast Cancer Patient’s Perspectives on the Uses of Psychedelics in Medicine
My psychedelic story began in 2012, when I was a subject in a clinical trial at Johns Hopkins University School of Medicine’s Behavioral Pharmacology Research Unit. I was given doses of psilocybin – the active ingredient in “magic mushrooms” to treat my cancer-related depression.
I’d become depressed after I’d moved to the UK following my breast cancer diagnosis, in 2009. From August of that year, I no longer had health insurance in the US, and I wasn’t able to find a job. I was able to obtain ongoing treatment in the UK through the National Health Service.
When my first session day arrived, I was brought into a softly lit, comfortably decorated lounge, invited to lie down on a sofa and listen to music. Then I swallowed a capsule of psilocybin.
I was by turns cold, hot, and shivering. Then three violin notes lit strands of deep red light, which trickled like water in my right visual field. Deeper tones poured from above in huge blue clouds.
Another violin flourish turned the sky yellow and brought with it a comet’s tail of body parts. Standing in the middle of a cyclone of arms, legs, heads, and breasts, I was at once my embodied self and an observer outside my body, watching an astral trail of limbs disappear into the distance behind me.
Some time later I found myself inside a steel industrial space. I became aware of my feelings toward my two remaining siblings. A woman seated at the end of a long table, wearing a net cap and white clothes and working busily, turned and handed me a Dixie cup.
“You can put that in here,” she said. The cup filled itself with my bilious, sibling-directed feelings. “We’ll put it over here,” she said, and placed it on a table at the back of the room. Then she went matter-of-factly back to work, along with now numerous busy women who occupied this space.
My guide asked me what was happening. As I recounted the scene, I began to laugh out loud, and my own laughter appeared to me in a midnight blue, cloud-dark sky as an effusion of twinkling gemstones, glittering in time with my peals of laughter, like a metronome.
During the session, I underwent a series of emotional transitions, ranging from sadness about what I had lost in my life, to perplexity, to joy, to fear, to amusement.
My life has changed since that day.
Both in the UK where I received follow-up care and in the US where I had my surgery and radiation therapy, medicine excels at finding cures for disease and saving lives.
All that excellence has created a kind of void, wherein treatment of the disease has outflanked the emotional and existential needs of patients. My demoralization is common among cancer patients. We obsess about survival and what the future holds for us.
Modern medical care isn’t designed to manage end-of-life or even life-threatening illness issues, from pain relief, to family worries, to existential anxiety.
“Existential terror in the dying is the most taboo conversation in medicine,” said Anthony Bossis, Clinical Assistant Professor of Psychiatry at NYU. “You can count on clearing the room of internists the moment you mention death.”
Care givers and doctors fall back on what they’re good at doing: biological medicine and technological interventions. Forget the human being, she’s way too complicated.
Psychedelic medicine, properly done, is the opposite of modern medicine. It is the answer to psychiatry. The diagnosis as a central feature falls away. What matters is the human being and her experience during the session, and how she integrates the it afterwards.
In indigenous groups, where the psychedelic ritual originated, the experience has more to do with shared values and cultural symbolism than it does with biochemistry. The fetishisation of medical cures underscores the central falsehood of pharmacological medicine: that social and relational factors are subsidiary to swallowing a daily pill.
What happens during effective psychedelic treatment with the necessary preparatory and integration sessions is not a drug treatment. It is a hero’s journey.
There’s the voyage out; barriers and obstacles encountered; signposts and guideposts recognized; lessons learned from overcoming challenges; the integration of the experiences, and then, finally their meaning and messages incorporated into everyday life.
The failure of the psychotherapeutic process as it has existed for the last century and a half is located at its epicenter: the power disparity in the therapeutic dyad. Merely walking through the consulting room door, the patient subordinates herself to the therapist, who, by virtue of a title, is presumed to know more about her than she does herself.
Psychedelic therapy subverts the timeworn patriarchal hierarchy by creating an atmosphere of cooperation and trust rather than competition and domination. Or, to state it more bluntly, what women do in structured settings rather than what men do; women create cooperatives, men create hierarchies.
During a psychedelic session, as the ego gradually dissolves, the subject’s feelings emerge and become part of her conscious awareness. The feelings and the images they engender are the center of her journey. There is no psychiatric diagnosis directing her exploration. Sessions have two guides. Unlike conventional therapy, there is not a lot of verbal interchange between guides and subjects. The new model requires facilitators or guides skilled at remaining emotionally present in the emotional present.
Why then, someone asked me a few weeks ago on Twitter “if psychedelics kill the ego, [are] there so many hyper-inflated male egos in the psychedelic scene?”
The tendency for egos to inflate and narcissistic personalities to become amplified during psychedelic sessions has a lot to do with culture and setting.
In the western world, male self-importance is consistently rewarded. Dr Charles Grob, professor of psychiatry and biobehavioral sciences and Director of the Division of Child and Adolescent Psychiatry at the University of California Los Angeles explained it this way: hallucinogens are non specific amplifiers of existing personality traits. For a man (or woman) whose personality is piloted by narcissism and grandiosity, psychedelics will make him moreso. When the experience is undertaken without ego-tempering safeguards, an already grandiose personality emerges fully inflated. The outcomes are universally catastrophic, to the user or to the outside world or both.
Cultures where psychedelics were part of a ritual process confined these highly charged experiences to sacred settings where context and meaning were understood. Knowledgeable priests or elders acted as guides and teachers.
Narcissism and grandiosity tend to diminish as an outcome when the psychedelic journey is part of a guided ritual experience, incorporating integration and re-assimilation into daily life. In this context, a trip-bloated ego can safely be deflated.
With the reemergence of psychedelics on the medical and cultural scene, the grandiose tendency is asserting itself, this time in venture capitalists’ conference rooms.
During the Covid lockdown, one of the world’s largest psychedelic pharmaceutical investors, Christian Angermayer, suggested public health could be sacrificed for the sake of “the economy.” Complete shut downs were, he said were “violating civil rights we fought for.”
In psychedelic medicine, civil rights will mean treatment is available to anyone who needs it: women, persons of color, persons living on the reservation, and in the inner city.
Now, though, even as the drugs themselves remain illegal, corporations are taking the field. They’re developing proprietary formulations using naturally-occurring and out-of-patent compounds, like psilocybin and MDMA. In patent filing after patent filing, they’re in a race to lock psychedelics behind paywalls. They’re even trying to patent treatment space specifications. Protecting intellectual property based on original research – the intent of patent law – has nothing to do with this attempt to pre-emptively capture the market. To date there are no anti-monopoly laws protecting psychedelics; there is no administrative or regulatory or legal oversight, and there are no ethical guard rails.
The last thing on the minds of these men is the raison d’être, ostensibly, of medicine: the relief of human suffering.
If commercial development proceeds the way investors would like, ordinary persons will not be able to afford a course of two psychedelic sessions priced at $10,000 to $15,000. The choice for government becomes either regulating the pharmaceutical industry and medical delivery system so that prices and access are done in a controlled and democratic matter or accept the underground as a fact of life.
Here in France, where I’ve lived for the past seven years, clinical trials with psychedelics and MDMA haven’t gotten off the ground, despite the efforts of a dedicated group of doctors. Cancer patients’ only access to psychedelics for relief from anxiety and existential distress is by way of the underground. The underground are the most meticulous, safety, oriented, set and setting abiding, research-following drug providers imaginable. They’ve read more scientific papers than most of the doctors I’ve tangled with over the last twenty years. I have found them to be an invaluable resource. For those who are struggling with terminal cancer diagnoses, they are essential.
One young man I spoke with, a cancer patient in his mid-thirties, who suffers from metastatic thyroid cancer, used LSD to help him weather his anxiety. He’s read almost every paper about psychedelic medicine ever published.
In a pre-surgery interview for one of his many surgical interventions, he disclosed to the anesthestist he’d used LSD to help him with his mood. She halted the process until she could order liver function tests prior to surgery, tests normally ordered when a patient is a known intravenous drug user. She believed LSD was an injectable drug. Her ignorance was emblematic of many doctors’ lack of knowledge about how psychedelics are used effectively and safely to treat the anxiety of those suffering from life-threatening disease.
In the near future, the medical establishment must come to terms with the failure of reductive diagnostic and treatment models. The psychotherapeutic world is changing. The daily pill is a relic, the legacy of a century's worth of institutional failures. Psychedelic medicine has introduced a fundamental shift. The medical, psychiatric and public health fields will either adapt or else they will left behind as a new archetype of healing emerges.