Dr. Jeff Spiess

When I was younger, all I knew about psychedelic drugs was that they caused addiction, bad trips, psychosis and a host of other horrible consequences. In the 1960s, researchers and advocates like Timothy Leary believed that the use of psilocybin (the “magic” in magic mushrooms) could have great therapeutic potential in the treatment of mental illness and behavior problems, from alcoholism to criminality. Depending on your point of view and who you listen to, Leary and his colleagues were either visionaries or drug-crazed con artists. This latter view, along with the subsequent “turn on, tune in, drop out” counterculture, led the US government to prohibit the use of psilocybin and the synthetic psychedelic LSD, a status that persists.

          But, in a great example that what goes around comes around, psychedelic agents, psilocybin in particular, are increasingly demonstrating evidence of possible utility. Just last week, for example, the prestigious New England Journal of Medicine published the results suggesting that psilocybin might be as effective as escitalopram (Lexapro^®) in depression. For my money, though, the most exciting findings are in patients with spiritual pain or existential distress in the dying.

          As people approach the end of their lives, unresolved psychological and spiritual needs often produce suffering that can be manifested in a pantheon of ways, from depression and withdrawal to agitation and violence. The usual approaches to alleviating this suffering involve therapeutic presence, counseling, expressive therapies, and sedating medications, all of which can be at least partially effective in most situations, though all of us who work with the dying and thousands of people who have set with a loved relative going through the anguish of an existential crisis know that these techniques are often unsatisfactory and that novel approaches are desperately needed.

          Indigenous cultures worldwide have employed psychoactive substances in spiritual or religious practice to achieve a state of transcendence, like the use of peyote by various First Nations people in the Americas. People with experience using psychedelic agents often describe having experienced expanded states of consciousness, encountering levels of awareness that we have usually called spiritual. Traditional counseling employs interpersonal conversation and work to achieve benefit; psychedelics encourage the patient to go deeper into themselves.

          In the work done so far with psychedelic agents for spiritual distress in the terminally ill, it seems apparent that it is the achievement of the expanded state of consciousness and the memory of what was experienced that drive the therapeutic effect. A commonly described therapeutic benefit is loss of fear of dying coupled with an enhanced desire to live fully until death comes.

          It is critical that psychedelic therapy involve preparation with an expert and trusted therapist who will be present through the experience to provide security as well as to later assist in integration of any insights that occur. Researchers with experience here say that it is critical for patients to be able to trust whatever their mind brings forward, even if it is negative and painful, what once was called a “bad trip”; being able to accept the wisdom of one’s own mind is much of the whole point.

          As an accompanying editorial in the New England Journal of Medicine pointed out, psychedelic research is still finding its place. The traditional medical model of research may or may not be the optimal method of discovering the potential of psychedelic agents in human illness and distress, but I am hopeful and a little bit excited that these substances might be a little bit magic after all.