Psychedelic Psychotherapy Near the End of Life
CHARLES S. GROB, M.D., AND ALICIA L. DANFORTH
“Death must become a more human experience. To preserve the dignity of death and prevent the living from abandoning or distancing themselves from the dying is one of the great dilemmas of modern medicine.”
--Sidney Cohen, M.D., 1965
For individuals approaching the end of life, severe and persistent spiritual and existential crises are common occurrences. Even though modern medicine has progressed considerably in developing effective treatments for advanced-stage disease, often extending survival time for months or even years, efforts designed to address the psychological distress of terminal illness have often been limited.
Surveys have found that up to 70 percent of individuals with advanced-stage cancer experience heightened and often clinically significant anxiety. Depression and despair in cancer clients is not uncommon and leads to poorer survival rates, suicidal preoccupation and behavior, desire for hastened death, and requests for physician-assisted suicide. Existential anxiety, while a universal phenomena, develops greater intensity and urgency at the end of life along with heightened perception of vulnerability and inevitable death. The profound spiritual suffering often experienced as individuals approach the end of life shares many features of severe depression, including hopelessness, worthlessness, meaninglessness, social isolation, anger, guilt, and remorse. Addressing such conditions of spiritual and existential distress encourages active life review along with a realistic appreciation of current realities and assists in recognizing purpose, value, meaning, forgiveness, and reconciliation.
The great challenge for individuals nearing the end of their lives is often one of sustaining a sense of meaning and purpose. As the physical body declines and approaches death, individuals are often overwhelmed with pain and suffering, psychological as well as physical, and they begin to lose the thread of meaning and coherence that had previously defined their lives. Finding and sustaining meaning and a reason for being alive become the central challenges when faced with life-threatening illness, and serve as a way to help deter end-of-life despair.
Psychedelic psychotherapy is a treatment approach that has been demonstrated to facilitate enhanced states of spiritual transcendence and well-being reliably when conducted under optimal conditions. The passage of time has allowed for a relaxing of restrictions imposed on research as a result of the cultural turmoil of the 1960s and has provided new opportunities to reexamine the range of safety and efficacy of this long neglected treatment model. Both the pioneers of psychedelic research several decades ago along with more recent investigations have made the practical determination that, when conducting hallucinogen-facilitated psychotherapy with advanced-stage cancer clients, adhering to certain structures that will increase the likelihood of positive outcome is important. To begin with, clients must be informed that the treatment will not cure their physical illness but may help them develop the emotional strength to cope with what lies ahead. A period of preparatory work is necessary to establish rapport and trust between the client and therapeutic team and to conduct a thorough life review, including an examination of past and current relationships. Communication issues are addressed, as are attitudes and fears of death and dying and concerns about the future.
The treatment session is conducted in a pleasant and private setting that is decorated with items such as tapestries, art, flowers, or objects that have meaning for the client. During the long psychedelic experience (4 to 6 hours with psilocybin and 8 to 12 hours with LSD), the client is encouraged to lie down wearing an eyeshade and listening to pre-selected music through earphones (the experience of listening to music helps the client to let go of usual ego controls and experience a heightened degree of emotional awareness). Immediately after the session, family and friends may visit as the post-session “afterglow” state often opens up the opportunity for gratifying emotional interchanges. The final element of the treatment process is the integration of the experience, preferably with ongoing support from the research team, which occurs in the days, weeks, and months that follow.
Historical Research Background
Among the most promising areas of study coming out of the “Golden Age” of psychedelic research from the late 1950s to the early 1970s were a series of reports describing the work of investigators exploring the use of a psychedelic treatment model with clients who had been diagnosed with terminal cancer. Although he was not a medical researcher, the English literary figure Aldous Huxley was the first Western intellectual to identify the potential application of psychedelic compounds at the end of life. During the final ten years of his life, Huxley developed a fascination with the range of effects of the newly discovered psychedelics, and particularly their potential to alleviate psychospiritual suffering. In his final work of fiction, Island, Huxley described the use of the moksha (Sanskrit for “enlightenment”) medicine to facilitate the passage of the terminally ill from life into death. True to his beliefs, Huxley arranged for his personal physician to inject him with 100 micrograms of LSD hours before he died.
Huxley was a close friend of Sidney Cohen, a prominent internist at the UCLA School of Medicine who developed the first program designed to examine the use of psychedelics to ameliorate the high levels of emotional distress often observed in patients dying of advanced medical illness. Unfortunately, the details of his findings were never reported. However, Cohen published the rationale for conducting this treatment in Harper’s Magazine in 1965 in an article titled “LSD and the Anguish of Dying.” Cohen fervently called for the development of a more effective intervention for individuals approaching the final stages of life, which he believed would one day alter the experience of dying.