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Project Overview Psychedelic Research Implications for Palliative Care & End-of-Life Existential Distress Anthony P. Bossis, Ph.D. New York University School of Medicine Psilocybin Psilocybin ❖ Naturally occurring compound in many species of mushrooms ❖ Called “Flesh of the Gods” by the ancient Aztecs ❖ Long history of ceremonial use by indigenous cultures for religious insight and healing ❖ Psilocybin possesses a chemical structure similar to the neurotransmitter serotonin ❖ Rapidly metabolized to psilocin, an agonist at serotonin 5-HT-2A (primary receptor) and 5-HT-2C receptors ❖ Psychedelics do not lead to addiction / dependence (O’Brien, 2001); no evidence of association between lifetime use and increase in mental disorders (Krebs & Johansen 2013). Lifetime use of psychedelics was associated with a reduced likelihood of suicidal thinking, planning and attempts (Hendricks et al. 2015; Johansen & Krebs 2015) Psilocybin in the Mayan Culture (1000 B.C. - 600 A.D.) The Eleusinian Mysteries Ancient Greece ❖1600 BC – 392 CE. Annual festival celebrated the myth of Demeter and Persephone. ❖Participants included Plato and Cicero ❖Sacred Way from Athens. ❖κυκεών - believed to be entheogen ergot -grew on wild grass (Paspalum distichum) Entheogens in Ancient Greece Eleusinian Mysteries (1500 B.C. - 392 A.D.) Seeking The Magic Mushroom by R. Gordon Wasson Brief History of Psychedelics 1938 - Present Albert Hoffman Good Friday Study Recent & Ongoing Research: synthesizes Marsh Chapel Psilocybin, LSD, MDMA: LSD-25 Cancer anxiety, alcoholism, tobacco - Alan Watts / Joyous cessation, PTSD, meditators, Cosmology depression, religious leaders First LSD psychiatric Strassman treatment: DMT Studies H. Osmond LSD w Alcoholics Sandoz Swiss Archives 1953 Produces of Neurology UCLA psilocybin on LSD Psilocybin Cancer 1960 Controlled 1947 Substances Act Anxiety Published June 1, 1967 1970 2011 1938 1962 1990-1995 1953 1943 1960 2006 Hoffman Aldous Huxley uses Harvard 1953-1977 Johns Hopkins ingests LSD mescaline Psilocybin Project 2016 •1000 clinical & research reports Psilocybin Mystical Leary, Alpert, NYU – JHU 1954 • 40,000 subjects Experience Published Metzner Psilocybin Cancer Doors of Perception • End of life distress and alcoholism 1957 Distress Published Gordon Wasson • Spring Grove Research: • Used in psychoanalysis 1964 Eric Kast LSD EOL study “To the extent that all mystical or peak- experiences are the same in their essence and have always been the same, all religions are the same in their essence and have always been the same. This something common, this something which is left over after we peel away all the localisms, all the accidents of particular languages or particular philosophies, we may call the ‘core- religious experience’ or the ‘transcendent experience’” Psychedelic ψυχή δηλείν (psyche meaning soul or mind and delos meaning “make visible, manifest, or reveal”) Entheogen ἔνθεος and γενέσθαι (“becoming divine within” or “becoming god within”) Characteristics of Mystical States of Consciousness (MEQ) (W. Pahnke, 1963; Pahnke & Richards, 1966) Unity A strong sense of the interconnectedness of all people and things – All is One. Sense of oneness achieved through self transcendence. The Noetic Quality Named by William James - a feeling of profound insight or intuitive knowledge with a tremendous force of certainty - of encountering ultimate reality. Sacredness Intuitive response of awe, humility, holiness, reverence and wonder in the presence of inspiring reality. Deeply Felt Positive Mood Joy, blessedness, peace and love to an overwhelming degree of intensity, often accompanied by tears. Ineffability and Paradoxicality Experience is felt to be beyond words, non-verbal, and impossible to describe. A sense of reconciliation of opposites Transcendence of Time/Space A sense of timelessness- transcending past, present, and future, and beyond ordinary three-dimension space in a realm of eternity or infinity. A sense of past and future collapse into the present moment—an infinite realm with no time/space boundaries . Healing is the personal experience of the transcendence of suffering E.Cassell, C.Hammersclag, E. Kubler-Ross, C. Saunders, B. Seigel, G. Stephens Egnew, T. (2005). “The most beautiful and profound emotion we can experience is the sensation of the mystical. It is the fundamental emotion that stands at the cradle of true art and true science” Albert Einstein Research on Entheogens and Mystical Experience 1962: Marsh Chapel Experiment (“The Good Friday Experiment”) Walter Pahnke, Harvard Medical and Divinity School • Psilocybin subjects “experienced phenomena which were indistinguishable from, if not identical with” the categories of naturally occurring mystical experience” • Majority of subjects who received psilocybin scored highly on most or all mystical experience measures • Conclusion: ‘the results of our experiment would indicate that psilocybin is important tools for the study of mystical state of consciousness”. 2006 -Johns Hopkins University School of Medicine 2006 • 61% of psilocybin group vs 11% placebo complete mystical experience • 14 month follow-up: 67% top 5 most significant spiritually experience; 58% most meaningful Long-Term Follow-Up of Good Friday Experiment (Doblin, 1991) Category Experimentals Controls Six month Long-term Six months Long-term 1. Unity A. Internal 60 (77) 5 (5) B-External 39 (51) 1 (6) 2. Transcendence of Time and Space 78 (73) 7 (9) 3. Deeply Felt Positive Mood 54 (56) 23 (21) 4. Sacredness 58 (68) 25 (29) 5. Objectivity and Reality 71 (82) 18 (24) 6. Paradoxicality 34 (48) 3 (4) 7. Alleged Ineffability 77 (71) 15 (3) 8. Transiency 76 (75) 9 (9) Average for the Categories 60.8 (66.8) 11.8 (12.2) 9. Persisting Positive changes in Altitude and Behavior 48 (50) 15 (15) 10. Persisting Negative Changes in Attitude and Behavior 6 (6) 2 (4) Psilocybin Participant Verbatim Comments / 14 Month Follow-Up Study Griffiths, R., Richards, W. et al., (2008. Journal of Psychopharmacology.) The sense that all is One, that I experienced the essence of the Universe and the knowing that God asks nothing of us except to receive love. The part thatI [experienced] continues to astick reality out thatfor me was was clear, knowing beautiful, and bright seeing and experiencing with every sense and fiber of my being that andall things joyful... are In connected. short, this experience opened me up (gave To cease to be, as Ime understand a tangible it, vision) was not of frightening.what I think Itis wasattainable safe every day. and much greater than I have words for or understanding of. Whatever is larger than the state of being is what was holding me. The profound grief I experienced as if all of the pain and sadness of the world were passing through me cell by cell tearing apart my being. Religious and Mystical Experiences Half of Americans (49%) say they have had “a religious or mystical experience – that is, a moment of religious or spiritual awakening.” Similarities Between Naturally Occurring and Entheogenic God Encounters (Johns Hopkins University) • 70% participants reported the experience to be more real than everyday normal consciousness • 75% described communication with something described as sacred, 75% benevolent, 75% eternal • 75% rated the experience as among the the most personally meaningful and spiritually significant of their life • More than two-thirds identified as atheist before the experience no longer identified as atheist afterwards “I assert that the cosmic religious sense is the strongest and noblest driving force behind scientific research” Albert Einstein Where and How Do Americans Die? Despite Gallup polls finding that 9 out of 10 terminally ill patients with less than six months to live would choose to die at home, a majority of Americans today die in institutions, surrounded by medical equipment and medical staff.1,2,3 Research reveals that in general, Americans are dying not “good deaths”, but “bad deaths” marked by needless suffering and disregard for patients’ and families’ wishes or values. 4 1Foreman (1996). 70% would pick hospice, poll finds. Boston Globe. October. 2National Hospice Organization. (1996). New findings address escalating end-of-life debate (press release). October. 3Seidlitz et al. (1995). Attitudes of older people toward suicide and assisted suicide: an analysis of Gallup poll findings. J American Geriatric Society. 43:993-998 4 Breitbart, W., Gibson., C., & Chochinov, H. (2005). Palliative care. In: Textbook of Psychosomatic Medicine. Institute of Medicine (1997) Approaching Death: Improving Care at the End of Life Depression in the last year of life has increased 26 percent A. Singer, . et al. Annals of Internal Medicine. (2015). Demoralization Syndrome Depression and hopelessness strong predictors for desire for a “a state in whichhastened hopelessness, death inmeaninglessness, end-of-life patients. and existential distress are the core phenomena” Breitbart et al., 2000. Kissane et al., 2001 A Call for Addressing Existential and Psycho-Spiritual and for Effective Therapies Identified by: World Health Organization (WHO) Institute of Medicine (IOM) National Comprehensive Cancer Network (NCCN) Joint Commission (JC) National Consensus Project (NCP) National Quality Forum (NQF)] Key Components of Palliative Care ❖ Affirms life and regards dying as a normal process ❖ Neither hastens nor postpones death ❖ Integrates the psychological and spiritual aspects of patient care ❖ Encouraging life review to help recognize purpose, value, and meaning Spirituality at the End of
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