بخش 89

“Okay, then, but what about the miracle that we are conscious? Just think about that for a second, that we are aware and that we are aware that we are aware! How unlikely is that?” How can we be certain, he was suggesting, that our experience of consciousness is “authentic”? The answer is we can’t; it is beyond the reach of our science, and yet who doubts its reality? In fact, the evidence for the existence of consciousness is much like the evidence for the reality of the mystical experience: we believe it exists not because science can independently verify it but because a great many people have been convinced of its reality; here, too, all we have to go on is the phenomenology. Griffiths was suggesting that insofar as I was on board for one “miracle” well beyond the reach of materialist science—“the marvel of consciousness,” as Vladimir Nabokov once called it, “that sudden window swinging open on a sunlit landscape amidst the night of non-being”—maybe I needed to keep a more open mind to the possibility of others.

• • • IN DECEMBER 2016, a front-page story in the New York Times reported on the dramatic results of the Johns Hopkins and NYU psilocybin cancer studies, which were published together in a special issue of the Journal of Psychopharmacology, along with nearly a dozen commentaries from prominent voices in the mental health establishment—including two past presidents of the American Psychiatric Association—hailing the findings.

In both the NYU and the Hopkins trials, some 80 percent of cancer patients showed clinically significant reductions in standard measures of anxiety and depression, an effect that endured for at least six months after their psilocybin session. In both trials, the intensity of the mystical experience volunteers reported closely correlated with the degree to which their symptoms subsided. Few if any psychiatric interventions of any kind have demonstrated such dramatic and sustained results.*

The trials were small—eighty subjects in all—and will have to be repeated on a larger scale before the government will consider rescheduling psilocybin and approving the treatment.* But the results were encouraging enough to win the attention and cautious support of the mental health community, which has called for more research. Dozens of medical schools have asked to participate in future trials, and funders have stepped forward to underwrite those trials. After decades in the shadows, psychedelic therapy is suddenly respectable again, or nearly so. New York University, which proudly promoted the results of a trial it had once only tolerated somewhat grudgingly, invited Stephen Ross to move his treatment room from the dental college into the main hospital. Even the NYU cancer center, which had initially been reluctant to refer patients to the psilocybin trial, asked Ross to set up a treatment room on its premises for an upcoming trial.

The papers offered little in the way of a theory to explain the effects of psilocybin, except to point out that the patients with the best outcomes were the ones who had the most complete mystical experience. But exactly why should that experience translate into relief from anxiety and depression? Is it the intimation of some kind of immortality that accounts for the effect? This seems too simple and fails to account for the variety of experiences people had, many of which did not dwell on an afterlife. And some of the ones that did conceived of what happens after death in naturalistic terms, as when the anonymous volunteer imagined herself as “part of the earth,” molecules of matter being taken up by the roots of trees. This really happens.

Of course the mystical experience consists of several components, most of which don’t require a supernatural explanation. The dissolution of the sense of self, for example, can be understood in either psychological or neurobiological terms (as possibly the disintegration of the default mode network) and may explain many of the benefits people experienced during their journeys without resort to any spiritual conception of “oneness.” Likewise, the sense of “sacredness” that classically accompanies the mystical experience can be understood in more secular terms as simply a heightened sense of meaning or purpose. It’s still early days in our understanding of consciousness, and no single one of our vocabularies for approaching the subject—the biological, the psychological, the philosophical, or the spiritual—has yet earned the right to claim it has the final word. It may be that by layering these different perspectives one upon the other, we can gain the richest picture of what might be going on.

In a follow-up study to the NYU trial, “Patient Experiences of Psilocybin-Assisted Psychotherapy,” published in the Journal of Humanistic Psychology in 2017, Alexander Belser, a member of the NYU team, interviewed volunteers to better understand the psychological mechanisms underlying the transformations they experienced. I read the study as a subtle attempt to move beyond the mystical experience paradigm to a more humanistic one and at the same time to underscore the importance of the psychotherapist in the psychedelic experience. (Note the use of the term “psilocybin-assisted psychotherapy” in the title; neither of the papers in Psychopharmacology mentioned psychotherapy in its title, only the drug.)

A few key themes emerged. All of the patients interviewed described powerful feelings of connection to loved ones (“relational embeddedness” is the term the authors used) and, more generally, a shift “from feelings of separateness to interconnectedness.” In most cases, this shift was accompanied by a repertoire of powerful emotions, including “exalted feelings of joy, bliss, and love.” Difficult passages during the journey were typically followed by positive feelings of surrender and acceptance (even of their cancers) as people’s fears fell away.

Jeffrey Guss, a coauthor on the paper and a psychiatrist, interprets what happens during the session in terms of the psilocybin’s “egolytic” effects—the drug’s ability to either silence or at least muffle the voice of the ego. In his view, which is informed by his psychoanalytic training, the ego is a mental construct that performs certain functions on behalf of the self. Chief among these are maintaining the boundary between the conscious and the unconscious realms of the mind and the boundary between self and other, or subject and object. It is only when these boundaries fade or disappear, as they seem to do under the influence of psychedelics, that we can “let go of rigid patterns of thought, allowing us to perceive new meanings with less fear.”

The whole question of meaning is central to the approach of the NYU therapists,* and is perhaps especially helpful in understanding the experience of the cancer patients on psilocybin. For many of these patients, a diagnosis of terminal cancer constitutes, among other things, a crisis of meaning. Why me? Why have I been singled out for this fate? Is there any sense to life and the universe? Under the weight of this existential crisis, one’s horizon shrinks, one’s emotional repertoire contracts, and one’s focus narrows as the mind turns in on itself, shutting out the world. Loops of rumination and worry come to occupy more of one’s mental time and space, reinforcing habits of thought it becomes ever more difficult to escape.

Existential distress at the end of life bears many of the hallmarks of a hyperactive default network, including obsessive self-reflection and an inability to jump the deepening grooves of negative thinking. The ego, faced with the prospect of its own extinction, turns inward and becomes hypervigilant, withdrawing its investment in the world and other people. The cancer patients I interviewed spoke of feeling closed off from loved ones, from the world, and from the full range of emotions; they felt, as one put it, “existentially alone.”