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What psilocybin taught me about living and dying 

Written by Dr Lauren Macdonald (Integrative Medicine Specialist and Psychiatry Doctor)

Underneath my eye mask the colours and geometric shapes swirl and shift as I begin to surrender to the experience unfolding before me. I gently rest one hand across my chest, the other on my belly and remind myself to breathe. I feel my torso rise and fall beneath my hands as it slowly starts to dawn on me; there is no backing out now. I have just finished sipping what is known as a ‘hero’s dose’ of psilocybin truffles, akin to magic mushrooms, dissolved in ginger tea.

I am lying on a mattress in a room at a legal psilocybin retreat in The Netherlands attempting to process and resolve the psychological impacts of a succession of traumas I have experienced over recent years. In February 2014 I was diagnosed with malignant melanoma, the deadliest known skin cancer. Despite multiple surgeries and treatments, 18 months later, the cancer had progressed to stage IV; tumours were rapidly spreading and growing in my lymph nodes, pectoral muscles, lung and adrenal glands. At 31 years old, with a prognosis of approximately 12 months, I plunged into a deep existential dread. At 4am, when the rest of the house was quiet and the feeling of aloneness was overwhelming, I would lie awake, desperately scouring the internet, looking for anything that could bring me hope, hunting for anti-cancer foods and supplements, or for stories of anyone with stage IV metastatic melanoma who had survived beyond my prognosis.

As a doctor, I was trained to diagnose depression and anxiety yet I was in no way prepared for the overwhelming hopelessness and dissociation that could accompany a life-threatening illness. Effectively, having been handed a death sentence, I found myself navigating immense grief and loss. Then during my darkest period, approximately two years after my initial diagnosis, there was suddenly a glimmer of hope on the horizon; a cutting-edge new treatment. In the initial trials immunotherapy was found to be effective in 20-30% of patients with metastatic melanoma and at the beginning of 2016 I was incredibly fortunate to be able to access this treatment through the NHS. Miraculously, just 6-months after starting the treatment, my scans showed No Evidence of Disease (N.E.D). It was wonderful news and yet I was left with a lingering fear of recurrence and, ultimately, death. Every ache and pain an unwelcome reminder that I was only one scan away from being plunged back into a world of tests, surgeries and treatment.

I was still reeling from the physical and psychological impact of the cancer when I was hit by a vehicle as a pedestrian in 2018. This crushed my right tibia and left me recovering in a wheelchair for several months. At a time when I was trying to get my life back on track, the accident only further pushed me into survival mode. I found myself in a constant state of ‘fight or flight’. I tried meditation, yoga, breathwork, journaling, talk-therapy, even cold water swimming yet I could not help but feel that although I had potentially survived cancer, here I was, still shut down and only half alive.

It was not until I was faced with these hugely challenging life events that I became aware of the new research highlighting psychedelics as a potential tool to support healing from trauma. Like many, I used to be incredibly wary of psychedelics. I had heard horror stories about bad trips, even of psychosis, and I had no reason to suspect that the fearful narrative I had heard during my youth might have been deliberately peddled by the American Government and worldwide media.

For decades, research into the use of psychedelic medicine has stalled and stagnated, obstructed by the hangover from Nixon’s ‘War on Drugs’ and its associated propaganda, misinformation and legislative red tape. But these are fast-moving times, and a renaissance in research is gathering pace. Along with psilocybin, other psychedelic compounds such as LSD, ketamine, DMT, MDMA and ibogaine are currently being tested in clinical trials around the world, with promising results emerging for a range of medical conditions, from depression, post-traumatic-stress-disorder (PTSD), addiction disorders, eating disorders, to Alzheimer’s disease and migraines. I was curious about the vast array of research but it was the studies reporting that psilocybin, alongside psychotherapy, could be used to successfully reduce end-of-life anxiety that really caught my eye. In a study by Johns Hopkins University in 2016, 80% of patients reported a reduction in end-of-life distress following psilocybin-assisted psychotherapy. Another study shared by the NYU Grossman School of Medicine in 2020 reported that the improvements in emotional and existential distress in people with cancer remained for years after receiving psilocybin treatment.

Inspired by the studies, and a must-watch TED talk by Professor Roland Griffiths (Johns Hopkins University), in October 2019 I travelled to a retreat in The Netherlands in the hope that a psilocybin experience might help me process the trauma of both my cancer and the accident. During the first few days we were encouraged to dance, sing, meditate, sit in sharing circles, spend time in the garden, and listen to fireside stories. I felt increasingly relaxed, less self-consciousness and much more present in my body. The day of the ceremony itself, I joined the group in singing beautiful folk songs as we crushed the truffles, preparing them for our tea. We added personal items to an alter and set our intentions for the journey ahead. Then it was time to sip the blue-tinged tea.

I lie down, cover my eyes and pull the blanket up to my chin. Geometric shapes and colours. Breathtakingly beautiful. Like nothing I’ve seen before. Then music; ethereal, tribal, sometimes electronic. It has somehow taken up residence inside my skull, directing the geometric patterns dancing in front of my eyelids, guiding the quality and intensity of my emotions. I lose track of time. And then, there is nothing. Or something? No patterns. No physical body. No ‘me’. Instead, there is only energy. People from my past are present but not in human form; instead, they exist as beautiful coloured swirling energies. Somehow they share the insight that dying is not final, simply the end of our physical form. I am finally at peace, surrounded by love. In the distance, I hear the quiet sound of mournful crying. I sense a presence by my side – a facilitator has come to comfort me – and I realise that I am crying. I am supported and safe as my tears start to flow. Years of pain released at last. The music shifts and my sadness slowly dissipates. I sense my hands on my chest and belly and take another deep breath. The music, now tribal drumming and a lady singing an unrecognisable language, transports me into the pumping muscles of my own heart. Within my own body, I find my ancestors, shaped as wolves. They are waiting to guide me through the next chapter of my journey.

‘Psychedelics’ (the word derived from the Greek for “mind-manifesting”) are a hallucinogenic class of drug in which the primary effect is to trigger an expanded or altered state of consciousness. This means that after ingesting the substance you will typically experience a combination of visual and auditory changes that are not possible in the typical conscious state. The exact brain mechanism by which psychedelics work remains unclear but research suggests they influence the receptors for the neurotransmitter serotonin whilst also reducing activity in structural areas of the brain such as the default mode network. In doing so, they increase communication in remote parts of the brain, breaking down rigid patterns of thinking whilst also offering new insights. At the psychological level, it has been proposed that the often reported mystical experience and sense of oneness is a key part of the transformative process.

Most psychologists believe that our mind creates barriers to prevent access to memories of traumatising events and experiences in an effort to protect us from the pain. Yet these barriers can prevent us from processing our past traumas, leaving us with unexplainable and often untreatable depression, anxiety and PTSD. It can take years of talk therapy or advanced meditation to access and address these memories, a feat that psychedelics can often achieve in a matter of hours.

Reflecting on my own psychedelic journey, I am aware how much I wish that every terminally ill patient could be offered a similar experience. I often think about my uncle who died from motor neurone disease and of how this medicine could potentially have alleviated some of his distress in his final months. I also think about the suffering of other cancer patients; those I’ve known, those who have died, and those that are still in my life.

As someone who has been active in the online cancer community for years, I am regularly contacted by patients looking for advice and, ultimately, hope. Often, alongside their medical team, they are doing everything they can to support their healing and yet the cancer is still progressing. Receiving these emails, often leaves me feeling helpless and frustrated. This is because rather than suggesting yet another diet or supplement to these patients, what I want to be able to offer them is the gift of surrender and peace. Tragically, despite initial research strongly supporting psychedelic-assisted psychotherapy for end of life distress, palliative patients in the UK are still unable to legally access this treatment. Fortunately, we are starting to see a shift internationally. In August 2020, in response to Therapsil’s advocacy efforts, Canada’s Health Minister, Patty Hajdu, approved psilocybin-assisted psychotherapy for four Canadian’s with terminal diagnoses. More recently Health Canada has approved 25 more applications from cancer patients for treatment of end-of-life distress and also granted exemptions to 19 healthcare workers (doctors, nurses, psychologists, psychiatrists, counsellors and social workers) for professional training purposes.

Alongside Canada, the USA and Australia are also leading the way with legislative and regulatory changes that will help better support a range of patient groups to access these medicines. In my opinion, these changes can’t come soon enough. Even before the COVID-19 pandemic, rates of depression and anxiety were on the rise and more people than ever reported feeling lonely and disconnected. As a Psychiatry doctor I know that the number of people needing psychological support now threatens to drastically overwhelm our services, and our need for new and better interventions to support our mental health is greater now than ever. Psychedelics are by no means going to be a panacea to all of our worldly problems but they may offer a new mode of healing, provided they are consumed in a safe, supported environment. Furthermore, the ripples of any healing at an individual level can often be felt by immediate friends and family and the wider community, even generations to come, allowing an opportunity for collective healing (socioeconomic, racial, cultural, environmental etc) beyond just the individual.

Assisted by the media’s current enthusiasm to inform on psychedelic research, I have no doubt that increasing numbers of people will be interested in the use of psychedelics over the coming years. This is why we urgently require a structured and legal approach to psychedelic-assisted psychotherapy to allow for careful screening and appropriate delivery in the UK and overseas. There will still be the issues of cost, training of facilitators and sourcing of substances to manage but a policy reform would mean we would be one major step closer to providing much-needed healing. The challenges for our future will be whether we can progress beyond outdated government policy, shift public perception, and ensure that treatments are affordable and accessible to those in need.

As a result of my own experience, I now consider myself an advocate for the therapeutic use of psychedelics and view them as a potential gateway to cathartic experiences akin to rebirth. However, we must also recognise these are powerful substances that can be destabilising if used inappropriately, something that has been understood by Indigenous cultures who have used these medicines responsibly for centuries. This is why Set (the right mindset), Setting (the right physical space) and Integration (the process of making sense of the lessons and insights gained during the experience) is crucial.

Both my perception of psilocybin and my life as a whole has been forever changed by my experience at the retreat in The Netherlands. I was hoping the experience would help me feel less fearful of dying, but it has given me so much more than that; it has helped me come back to life. I feel more connected to myself, friends, family and our beautiful, fragile planet. Whilst I have always appreciated spending time in nature I now see how alive and awe-inspiring the world around us is. I have also learned that it is through connection – with oneself, with Spirit, with nature, and with each other – that healing and transformation happens. It’s my hope that sharing my experience with you might help alleviate any remaining negative opinion regarding these substances and instead leave you curious, hopeful and grateful that the psychedelic renaissance is finally here.

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