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By temporarily disabling the ego, psilocybin seems to open a new field of psychological possibility, symbolized by the death and rebirth reported by many of the patients I interviewed. At first, the falling away of the self feels threatening, but if one can let go and surrender, powerful and usually positive emotions flow in—along with formerly inaccessible memories and sense impressions and meanings. No longer defended by the ego, the gate between self and other—Huxley’s reducing valve—is thrown wide open. And what comes through that opening for many people, in a great flood, is love. Love for specific individuals, yes, but also, as Patrick Mettes came to feel (to know!), love for everyone and everything—love as the meaning and purpose of life, the key to the universe, and the ultimate truth.

So it may be that the loss of self leads to a gain in meaning. Can this be explained biologically? Probably not yet, but recent neuroscience offers a few intriguing clues. Recall that the Imperial College team found that when the default mode network disintegrates (taking with it the sense of self), the brain’s overall connectivity increases, allowing brain regions that don’t ordinarily communicate to form new lines of connection. Is it possible that some of these new connections in the brain manifest in the mind as new meanings or perspectives? The connecting of formerly far-flung dots?

It may also be that psychedelics can directly imbue otherwise irrelevant sensory information with meaning. A recent paper in Current Biology* described an experiment in which pieces of music that held no personal relevance for volunteers were played for them while on LSD. Under the influence of the psychedelic, however, volunteers attributed marked and lasting personal meaning to the same songs.These medicines may help us construct meaning, if not discover it.

No doubt the suggestibility of the mind on psychedelics and the guiding presence of psychotherapists also play a role in attributing meaning to the experience. In preparing volunteers for their journeys, Jeffrey Guss speaks explicitly about the acquisition of meaning, telling his patients “that the medicine will show you hidden or unknown shadow parts of yourself; that you will gain insight into yourself, and come to learn about the meaning of life and existence.” (He also tells them they may have a mystical or transcendent experience but carefully refrains from defining it.) “As a result of this molecule being in your body, you’ll understand more about yourself and life and the universe.” And more often than not this happens. Replace the science-y word “molecule” with “sacred mushroom” or “plant teacher,” and you have the incantations of a shaman at the start of a ceremonial healing.

But however it works, and whatever vocabulary we use to explain it, this seems to me the great gift of the psychedelic journey, especially to the dying: its power to imbue everything in our field of experience with a heightened sense of purpose and consequence. Depending on one’s orientation, this can be understood either in humanistic or in spiritual terms—for what is the Sacred but a capitalized version of significance? Even for atheists like Dinah Bazer—like me!—psychedelics can charge a world from which the gods long ago departed with the pulse of meaning, the immanence with which they once infused it. The sense of a cold and arbitrary universe governed purely by chance is banished. Especially in the absence of faith, these medicines, in the right hands, may offer powerful antidotes for the existential terrors that afflict not only the dying.

To believe that life has any meaning at all is of course a large presumption, requiring in some a leap of faith, but surely it is a helpful one, and never more so than at the approach of death. To situate the self in a larger context of meaning, whatever it is—a sense of oneness with nature or universal love—can make extinction of the self somewhat easier to contemplate. Religion has always understood this wager, but why should religion enjoy a monopoly? Bertrand Russell wrote that the best way to overcome one’s fear of death “is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life.” He goes on:

An individual human existence should be like a river: small at first, narrowly contained within its banks, and rushing passionately past rocks and over waterfalls. Gradually, the river grows wider, the banks recede, the waters flow more quietly, and in the end, without any visible break, they become merged in the sea, and painlessly lose their individual being.

• • • PATRICK METTES lived seventeen months after his psilocybin session, and according to Lisa those months were filled with a great many unexpected satisfactions, alongside Patrick’s dawning acceptance that he was going to die.

Lisa had initially been wary of the NYU trial, interpreting Patrick’s desire to participate as a sign he’d given up the fight. In the event, he came away convinced he still had much to do in this life—much love to give and receive—and wasn’t yet ready to leave it and, especially, his wife. Patrick’s psychedelic journey had shifted his perspective, from a narrow lens trained on the prospect of dying to a renewed focus on how best to live the time left to him. “He had a new resolve. That there was a point to his life, that he got it, and was moving with it.

“We still had our arguments,” Lisa recalled, “and we had a very trying summer” as they endured a calamitous apartment renovation in Brooklyn. “That was hell on earth,” Lisa recalled, but Patrick “had changed. He had a sense of patience he had never had before, and with me he had real joy about things. It was as if he had been relieved of the duty of caring about the details of life, and he could let all that go. Now it was about being with people, enjoying his sandwich and the walk on the promenade. It was as if we lived a lifetime in a year.”

After the psilocybin session, Lisa somehow convinced herself that Patrick was not going to die after all. He continued with his chemo and his spirits improved, but she now thinks all this time “he knew very well he wasn’t going to make it.” Lisa continued to work, and Patrick spent his good days walking the city. “He would walk everywhere, try every restaurant for lunch, and tell me about all the great places he discovered. But his good days got fewer and fewer.” Then, in March 2012, he told her he wanted to stop chemo.

“He didn’t want to die,” Lisa says, “but I think he just decided that this is not how he wanted to live.”

That fall his lungs began to fail, and Patrick wound up in the hospital. “He gathered everyone together and said good-bye and explained that this is how he wanted to die. He had a very conscious death.” Patrick’s seeming equanimity in the face of death exerted a powerful influence on everyone around him, Lisa said, and his room in the palliative care unit at Mount Sinai became a center of gravity in the hospital. “Everyone, the nurses and the doctors, wanted to hang out in our room; they just didn’t want to leave. Patrick would talk and talk. It was like he was a yogi. He put out so much love.” When Tony Bossis visited Patrick a week before he died, he was struck by the mood in the room and by Patrick’s serenity.

“He was consoling me. He said his biggest sadness was leaving his wife. But he was not afraid.”

Lisa e-mailed me a photograph of Patrick she had taken a few days before he died, and when the image popped open on my screen, it momentarily took my breath away. Here was an emaciated man in a hospital gown, an oxygen clip in his nose, but with bright, shining blue eyes and a broad smile. On the eve of death, the man was beaming.

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