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Jeffrey Guss, a Manhattan psychiatrist and a coinvestigator on the NYU trial, thinks the moment could be ripe for psychotherapy to entertain a completely new paradigm. Guss points out that for many years now “we’ve had this conflict between the biologically based treatments and psychodynamic treatments. They’ve been fighting one another for legitimacy and resources. Is mental illness a disorder of chemistry, or is it a loss of meaning in one’s life? Psychedelic therapy is the wedding of those two approaches.”

In recent years, “psychiatry has gone from being brainless to being mindless,” as one psychoanalyst has put it. If psychedelic therapy proves successful, it will be because it succeeds in rejoining the brain and the mind in the practice of psychotherapy. At least that’s the promise.

For the therapists working with people approaching the end of life, these questions are of more than academic interest. As I chatted with Stephen Ross and Tony Bossis in the NYU treatment room, I was struck by their excitement, verging on giddiness, at the results they were observing in their cancer patients—after a single guided psilocybin session. At first, Ross couldn’t believe what he was seeing: “I thought the first ten or twenty people were plants—that they must be faking it. They were saying things like ‘I understand love is the most powerful force on the planet’ or ‘I had an encounter with my cancer, this black cloud of smoke.’ People were journeying to early parts of their lives and coming back with a profound new sense of things, new priorities. People who had been palpably scared of death—they lost their fear. The fact that a drug given once could have such an effect for so long is an unprecedented finding. We have never had anything like that in the psychiatric field.”

This is when Tony Bossis first told me about his experience sitting with Patrick Mettes as he journeyed to a place in his mind that, somehow, lifted the siege of his terror.

“You’re in this room, but you’re in the presence of something large. I remember how, after two hours of silence, Patrick began to cry softly and say, twice, ‘Birth and death is a lot of work.’ It’s humbling to sit there. It’s the most rewarding day of your career.”

As a palliative care specialist, Bossis spends a lot of his time with the dying. “People don’t realize how few tools we have in psychiatry to address existential distress.” Existential distress is what psychologists call the complex of depression, anxiety, and fear common in people confronting a terminal diagnosis. “Xanax isn’t the answer.” If there is an answer, Bossis believes, it is going to be more spiritual in nature than pharmacological.

“So how do we not explore this,” he asks, “if it can recalibrate how we die?”

• • • IT WAS ON AN APRIL MONDAY in 2010 that Patrick Mettes, a fifty-three-year-old television news director being treated for a cancer of his bile ducts, read the article on the front page of the New York Times that would change his death. His diagnosis had come three years earlier, shortly after his wife, Lisa Callaghan, noticed that the whites of his eyes had suddenly turned yellow. By 2010, the cancer had spread to Patrick’s lungs, and he was buckling under the weight of an especially debilitating chemotherapy regime and the dawning realization that he might not survive. The article, headlined “Hallucinogens Have Doctors Tuning In Again,” briefly mentioned research at NYU, where psilocybin was being tested to relieve existential distress in cancer patients. According to Lisa, Patrick had no experience with psychedelics, but he immediately determined to call NYU and volunteer.

Lisa was against the idea. “I didn’t want there to be an easy way out,” she told me. “I wanted him to fight.”

Patrick placed the call anyway and, after filling out some forms and answering a long list of questions, was accepted into the trial. He was assigned to Tony Bossis. Tony was roughly the same age as Patrick; he is also a soulful man of uncommon warmth and compassion, and the two immediately hit it off.

At their first meeting, Bossis told Patrick what to expect. After three or four preparatory sessions of talking therapy, Patrick would be scheduled for two dosings—one of them an “active placebo” (in this case a high dose of niacin, which produces a tingling sensation), and the other a capsule containing twenty-five milligrams of psilocybin. Both sessions would take place in the treatment room where I met Bossis and Ross. During each session, which would last the better part of a day, Patrick would lie on the couch wearing eyeshades and listening through headphones to a playlist of carefully curated music—Brian Eno, Philip Glass, Pat Metheny, and Ravi Shankar, as well as some classical and New Age compositions. Two sitters—one of them male (Bossis) and the other female (Krystallia Kalliontzi)—would be in attendance for the duration, saying very little but available to help should he run into any trouble. In preparation, the two shared with Patrick the set of “flight instructions” written by the Hopkins researcher Bill Richards.

Bossis suggested that Patrick use the phrase “Trust and let go” as a kind of mantra for his journey. Go wherever it takes you, he advised: “Climb staircases, open doors, explore paths, fly over landscapes.” But the most important advice for the journey he offered is always to move toward, rather than try to flee, anything truly threatening or monstrous you encounter—look it straight in the eyes. “Dig in your heels and ask, ‘What are you doing in my mind?’ Or, ‘What can I learn from you?’”

• • • THE IDEA OF GIVING a psychedelic drug to the dying was first broached not by a therapist or scientist but by Aldous Huxley in a letter to Humphry Osmond, proposing a research project involving “the administration of LSD to terminal cancer cases, in the hope that it would make dying a more spiritual, less strictly physiological process.” Huxley himself had his wife, Laura, give him an injection of LSD when he was on his own deathbed, on November 22, 1963.

By then, Huxley’s idea had been tested on a number of cancer patients in North America. In 1965, Sidney Cohen wrote an essay for Harper’s (“LSD and the Anguish of Dying”) exploring the potential of psychedelics to “alter[] the experience of dying.” He described treatment with LSD as “therapy by self-transcendence.” The premise behind the approach was that our fear of death is a function of our egos, which burden us with a sense of separateness that can become unbearable as we approach death. “We are born into an egoless world,” Cohen wrote, “but we live and die imprisoned within ourselves.”

The idea was to use psychedelics to escape the prison of self. “We wanted to provide a brief, lucid interval of complete egolessness to demonstrate that personal intactness was not absolutely necessary, and that perhaps there was something ‘out there’”—something greater than our individual selves that might survive our demise. Cohen quoted a patient, a woman dying of ovarian cancer, describing the shift in her perspective following an LSD session:

My extinction is not of great consequence at this moment, not even for me. It’s just another turn in the swing of existence and non-existence. I feel it has little to do with the church or talk of death. I suppose that I’m detached—that’s it—away from myself and my pain and my decaying. I could die nicely now—if it should be so. I do not invite it, nor do I put it off.

In 1972, Stanislav Grof and Bill Richards, who were working together at Spring Grove, wrote that LSD gave patients an experience “of cosmic unity” such that death, “instead of being seen as the absolute end of everything and a step into nothingness, appears suddenly as a transition into another type of existence . . . The idea of possible continuity of consciousness beyond physical death becomes much more plausible than the opposite.”

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