Psychedelics have a remarkable effect on the therapeutic relationship and the process of psychotherapy. The use of psychedelics in a therapy relationship can allow for a deep amplification of essential elements in the therapy process. This is especially so in a brief intense intervention, one that is designed to alleviate fear, anxiety, and loss of meaning at the end of a life.
People faced with their own death are confronted with the last great mystery of life. What lays beyond this world is unknown and so, shrouded it remains. We have accounts of near-death experiences, and the statements of various religions concerning the afterworld, but no certainty.
The hopes, yearnings, and despairs of the patient nearing death, and their loved ones, are projected on this screen of unknowing. A psychedelic experience can provide a glimpse into the process of death, an opportunity to experience a preview of what it is like to surrender the hard-won image of oneself to the unknown. This ego death, or transcendence, is a central axis of the relief that can be provided by psychedelic drugs in a properly managed milieu.
Ego death can be physically powerful and include physical symptoms such as weak pulse and breathlessness, or it can be more eidetic, involving the extreme modification of the usual sense of self. Or it can be more symbolic and integrative. In this regard, I recall the peak experience of my first psychedelic psychotherapy patient. (Patients discussed in this article have fictitious names to shield their true identities.) Joe was a labor union leader.
Joe called us (therapist and co-therapist) over to the couch. He held our hands. He spoke of being a child, of the difficulties he experienced being poor, of the joys of his profound identification with his father and the struggle that was his father’s. Joe said he was experiencing that his father’s struggle was also his own, and at the same time it was the struggle of all men–the struggle to overcome life’s difficulties; the pain, the disillusionment, and the horror of being alive. He described seeing the American flag, stars and stripes; the stripes he described as blood red. Then Joe said, “I feel like I am becoming the blood that flows through my veins. It’s Irish blood! There is strength here. I feel the strength of the Irish people; the noble strength of working men. I can feel the meaning of the struggle, of my Irish ancestors. They are stubborn and strong.” Joe said he experienced the ideals and dreams that brought his people and others to the U.S. as immigrants. “They wanted to overcome pain, injustice and suffering with their strength–not just for themselves, but for all of us. I share this struggle. It has been my struggle to carry forward these ideals through my work with the union.”
Notice the subtle shifts of identity as he holds our hands, speaks of growing up and gently blends his identity first with his father’s, then with the flag, then with his blood and ancestry, and finally a melding with his life purpose. This ego death is a subtle change in identity, and a shift toward a transcendence of his separateness, yet his strong sense of self prevails through his altruism. Following this, Joe recapitulated his entire life trajectory. We shared his deeply emotional reliving of moments of triumph and defeat.
The outcome of this experience was a paradoxical relief from the emotional component of the pain that he felt. He was able to say that although he still felt considerable physical pain, the meaning had changed now that he fully realized the fact that he was dying. His mood was radiant and the family members who came to collect him after the session basked with us in the golden glow of a peak experience. After this treatment his need for pain medication diminished.
Sharon was a medical professional who was diagnosed with cancer. The LSD session took place in a hospital. She weighed 80 pounds at the time of this session, and was suffering from a lack of red blood cells. Any physical exertion caused panting and an overwhelming anxious feeling that she could not breathe. During the beginning of her LSD session the anguish presented itself in frightening proportions. She screamed out her profound distress! She tossed and turned in the hospital bed while listening to the music we were playing over headphones. She suddenly knelt and said, “For once in my life!” She stood up, we supported her to avoid a fall off the hospital bed. The co-therapist and I, each on opposite sides of the bed, held her hands so she could balance, Sharon bent her knees, to bounce as though riding a moving platform. Her face was radiant! She said, “Finally in the center ring!” “That’s me, I am a real star!” This remarkable tension posture was maintained for several hours! She no longer needed our help, not breathless or frightened, but instead invigorated, enjoying an effortlessly balanced “ride.” After a lifetime of domination by her older sister. and harsh scolding by strict parents, she was able to rescue her own essence.
Sharon was suddenly surrounded by lights, smelled sawdust and heard a cheering crowd of admirers. She rode proudly on the backs of three white horses. Her hands extended, grasping the bridles, her feet resting on the two outer horses. She rode around the ring, profoundly satisfied and connected withher heroic self! This experience was deeply nourishing and healing. She enjoyed a radiant, healing glow that endured months after the session. Her physical condition improved dramatically in the aftermath of the LSD session. She returned to 140 pounds. Her oncologist concluded that this was “among the most dramatic chemotherapy-induced remissions.”
Experiences such as these are not contained within a drug, neither are they defined by the specific effects of a particular psychedelic drug. Instead they are experiences in consciousness that reflect, through psychedelic amplification, the rapport, emotional nurturing and safety that grew out of hours of preparatory therapy. There is a special attunement between a psychedelically-informed therapist and their patient. The therapist knows, through their own personal experience, the healing depths that are possible for the patient. They know as well that there is no certainty. A peak experience is not something that can be forced; it is a spontaneous event in the ongoing consciousness of a well-prepared and supported voyager who is entering the savage and beautiful country of the mind.
Psychedelic medicines are powerful tools that require proper training of therapists for the most effective psychotherapy outcomes to be realized. The nature of training is multidimensional because, in my opinion, it must include a personal psychotherapy occurring within a series of psychedelic sessions for the trainee. The deep experience of psychedelic states, and the effective understanding of one’s own psychodynamics on a personal and transpersonal dimension, is essential for the safe, effective and responsible use of these drugs. A capacity for personal surrender to the effects of psychedelics, including egodeath, is a prerequisite for any effective psychedelic therapist.
The Drug War has created such a repressive political atmosphere that proper training has been eliminated. Perhaps the greatest tragedy of this repression is the loss of lineage: There is no way for mature psychedelic therapists to legally train new therapists in the ego-surrendering processes. A generation of experienced therapists is about to be lost. The Maryland Psychiatric Research Center was the last facility that had financial support and political permission to train its therapists this way. Unfortunately the MPRC closed its doors to psychedelic research in 1977. It is a good thing that MAPS is working toward permission to administer psychedelic training sessions. One can only hope that a mechanism can be found to allow mature therapists, trained as outlined above, to begin the process of passing on their knowledge experientially through training sessions.
How can a psychotherapist have something to offer the dying? It is only the therapist who has lived deep recapitulation of their early years, and a convincing death of their cherished concept of themselves, who can offer solid guidance to a patient in a deep psychedelic session. Through this kind of training a therapist faces death, through the caring assistance of a mentor who has experienced the same depths. By undergoinga convincing personal experience of death “ahead of time” the therapist gains the personal experience necessary to provide compassionate support so patients can fully face the ultimate mystery.