Hallucinogens and delusions

The New York Times finds a reporter who doesn’t know the difference beween a stoned party and a mystical initiation.

Timothy Leary once said jokingly that the psychedelics are such powerful chemicals that they induce delusions in people who don’t even take them. Unlike most of what he said and did, that wisecrack embodied considerable wisdom, and remains valid forty years later.

Two recently approved studies, one at UCLA and one at Harvard, explore the use of hallucinogens to help dying people deal with their impending dates with the Grim Reaper. At least two other human studies involving possible useful applications of hallucinogens (that’s “psychedelics” if you’re my age and not a pharmacologist) are also underway in the United States, reflecting the re-opening of a research tradition that flourished in the 1960s but has been largely shut down since.

The New York Times, having been beaten on the story by the Washington Post and AP, decided to weigh in with a Sunday piece of more than usual obtuseness. It’s worth reading through; while getting most of the facts more or less right, it manages to get the story entirely wrong by making a single invalid (and of course unstated) assumption.

January 16, 2005


Going High Into That Good Night


If there’s a drug for social phobia, maybe there could be one to help us relax in the company of death.

Last month, the Food and Drug Administration gave the go-ahead to a Harvard University plan to study the recreational drug “ecstasy” as a treatment for anxiety in terminal cancer patients. Elsewhere, researchers in California are studying the effect of psilocybin – the active ingredient in hallucinogenic mushrooms – in similar patients. Both teams hope to learn whether the drugs, which can induce effusiveness and heightened awareness, will help people express and manage their fears in a therapeutic setting.

Although these illegal drugs are controversial, their use is a natural outgrowth of the medicalization of all emotional difficulty, from childhood shyness to adult phobias and depression. Doctors already prescribe antidepressants widely to dying patients, as well as anti-anxiety medications, like Valium, which can be emotionally numbing.

The possibility of using potent consciousness-altering agents raises a question: At what point do the theological, cultural and personal significance of mortality become altered, or lost? Does going high into that good night risk mocking end-of-life customs – prompting rave flashbacks rather than life review, rude jokes rather than amends?

“I see death not only as an opportunity to reflect on the meaning of your own existence, but to offer your life as a gift to others,” said the Rev. Donald Moore, a professor of theology at Fordham University. The end presents us with a time to ponder – and discuss, if possible – what life has meant and might continue to mean for others. Any drug that interferes with that experience comes at a steep cost, he said.

“If I never ponder these things,” Father Moore said, “if I never face up to these questions intellectually, if I’m so spaced out it doesn’t make any difference, then I think the experience is pretty empty and meaningless. In death we can become more a part of others’ lives, and if I have decided simply to escape, I may have missed that opportunity.”

From the sixth-century politician Boethius, who turned to philosophy for consolation at the end, to Mozart, who plunged into his requiem Mass, history is filled with examples of those who faced the unknown unaided, and apparently shared in some universal reckoning with their purpose.

But there is no philosophical or psychological reason why existential questions should wait to the end of life. Death itself hardly respects concerns about meaning or timing. It strikes friends and loved ones often without warning. Moreover, it casts a deepening psychological shadow starting in middle age, which gives most people ample opportunity to contemplate the purpose and content of their lives simply by virtue of living to adulthood, psychologists say.

If a drug taken at the end can help them simply reflect on the pleasure of having lived, that in itself might provide comfort and meaning to those left behind, said Dr. Simon Blackburn, professor of philosophy at the University of Cambridge.

“If you look at what people envy as opposed to what they say they like, I think we envy people who go out on a high,” he said. “An old don in my college, he had a stroke at the end of college dinner, and died on the spot, sitting in his suspenders, in candlelight, holding a wine glass. It was the perfect end for him, just incredible, and I think it struck people as very admirable.”

The insistence on making amends, on finding or declaring meaning, stems as much from cultural expectations of a good death as it does from the needs or the psychological state of a dying person, psychiatrists say. Some people have an anguished need to talk with loved ones, but cannot bring themselves to do so; others simply want to say goodbye and laugh their way out. And the effect of even a strong drug may not alter those desires much.

Researchers tested LSD in terminal patients in the 1960’s, and heroin in the 1980, and neither drug made much difference in the emotional or family experience at the end of life, said Dr. David F. Musto, a professor of psychiatry and medical history at Yale University School of Medicine.

“The larger danger is that we try to manage a death along the lines of what we consider the right way of doing it,” Dr. Musto said. “Some want to leave peacefully, and others are anxious to find some meaning and get things taken care of,” and new drug treatments may help both.

Not to mention those who want simply to laugh, and trust their maker to understand their choice. “There was some one thing that was too great for God to show us when He walked upon our earth,” wrote the Catholic philosopher and commentator G. K. Chesterton, in his classic “Orthodoxy,” “and I have sometimes fancied it was His mirth.”

The central assumption of the article is that all “drugs” are alike, and that “drugs” have the property of dulling perception and cognition, making people less present to what is happening to them. From this perspective, if “drugs” could be useful for dying people at all, it could only be by serving as anodynes for physical or psychic pain.

The author notes, without apparent irony, that the benzodiazepine minor tranquilizers (the class that includes Valium, Xanax, and Ativan) are already used in precisely that way as part of what is now the normal dying process. (He omits mention of the heavy use of opiates and opioids to deal with not only terminal pain but also terminal fear.)

He then goes on, in his own voice and in the voices of those he quotes, to paint a picture of the new research as involving getting people too stoned to know what’s happening to them. (Note all the loaded language: “raves,” “flashbacks,” “high,” “recreational drug,” “illegal drugs,” “spaced out,” and of course “escape.”)

That picture is just about exactly the opposite of the truth. The actual intended use of the hallucinogens with the dying is precisely to make them more aware, not less aware, of what they are undergoing. (The reporter notes that “heightened awareness” is a common effect of the hallucinogens, but doesn’t seem to notice the contradicton between that fact and his main thesis.)

By contrast with the opiates and the tranquilizers, which are given constantly (and, for the opiates, in escalating doses), the hallucinogens would be used on no more than a handful of occasions; I think the protocols now being studied involve only one or two administrations.

The experiences the experimenters are hoping to facilitate resemble moments of mystical insight more than they do drunken binges. One standard “endpoint” of such studies is reduced use of sedatives and pain-killers, leading to a more conscious dying.

Whether this will turn out to work or not I don’t know; that’s why they call it “research.” And the reporter is clearly right about one thing: if using the hallucinogens to address the fear of death is a good idea, there’s no reason to wait until people are actually dying to start the process. After all, none of us is getting out of here alive.

But the reporter, who doesn’t seem to have bothered to talk with anyone working on the current studies or anyone who worked on the previous studies, or to read any of the voluminous literature, seems to have worked from the principle that a sneer always makes a good story. Or perhaps he simply doesn’t grasp the possibility that a chemical, used under the right conditions and with the right intentions, might facilitate something closely resembling a major religious experience, though that possibility is illustrated by traditions from the Eleusinian Brotherhood to the Native American Church.

Whatever the explanation, his trivializing, moralizing, condescending tone in talking about something of which, on the evidence of the story, he appears to be entirely ignorant is really pretty contemptible. Presumably the copy editor who wrote the silly-clever headlines didn’t know any better.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

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