A clinical psychologist and Clinical Assistant Professor of Psychiatry at the NYU School of Medicine, Anthony Bossis, PhD will be at McGill University in Montreal on September 12, 2019 to deliver a talk titled “Psychedelic Research: Implications for Palliative Care and End-of-Life Existential Distress.” 
The lecture, hosted by the McGill Institute for Health and Social Policy and co-hosted by Palliative Care McGill, the Division of Social and Transcultural Psychiatry, and the Culture, Mind and Brain program, will be held from 6:00 to 7:00 pm in the Palmer Amphitheatre on the sixth floor of the McIntyre Medical Building. 
Professor Bossis took some time to answer some questions for us ahead of his visit. 
Why has research on psychedelic drugs in psychiatry been slow to develop despite their promise? What sorts of experiences do people have when taking these drugs?

Medical research with psychedelics has a very interesting history. What some may not know is that psychedelic research began in the 1950s and was conducted through the mid- 1970s at respected academic medical centres with over a thousand clinical and research papers written on their therapeutic applications. Psychedelics were a respected part of conventional academic psychiatry. The two primary clinical indications to come out of that period were for the treatment of alcoholism and for the emotional and existential distress in end-of-life cancer patients. The early findings were encouraging until the passage of the Controlled Substance Act in 1970 that placed serotonergic psychedelics such as LSD and psilocybin into a category characterized as having no therapeutic value. Regrettably, decades passed with no further clinical research until the 2000s. Much time was lost researching these promising substances.

The recent reemergence of the research is focusing on safety and efficacy while looking at clinical applications such as end-of-life distress. It’s challenging to describe the variety of experiences in just a few minutes. The type of subjective experiences people have varies greatly and are largely dependent on what is called set and setting, the set being the mindset, personal history, and intentions of the person taking the drug and the setting being the social, cultural, and physical context in which the agents are taken. Experiences can be aesthetic in nature, psychodynamically or autobiographically oriented, and what has been the most interesting, is the category of peak or mystical experience which has been shown since the early research to be an integral and mediating factor of positive therapeutic outcomes.  Subjective features of a mystical or peak experience are a sense of unity, transcendence, sacredness, ineffability, deeply felt positive emotions, and the noetic quality – a term coined by William James defined as the sense that one is encountering ultimate reality.

Why are psychedelics used with advanced cancer or end-of-life patients?  What are the implications for their use in palliative care?  Are there other disorders they might be used for?

This is an important area to address.  In our healthcare systems, there have been a paucity of treatment modalities to address the psychological, spiritual, and existential distress that many people experience at the end of life.  More broadly speaking, there continues to be a cultural resistance to address death and dying. Dying has unfortunately become medicalized and seems to be one of our final taboos.  In recent years however, there have been positive developments in improving this conversation in our culture. Emotional distress at the end of life may be evidenced by depression, anxiety, hopelessness, and meaninglessness.

Dating back to the early psychedelic research and through the present studies, a single psychedelic-generated experience has been shown to mitigate this end-of-life suffering largely through the peak or mystical experience.  The current research with cancer patients builds upon the earlier research when psychedelics were legal and notable figures like Aldous Huxley spoke out on the promise of psychedelics with dying patients. Recent randomized double-blind clinical trials using psilocybin – a natural compound found in specific species of mushrooms – at NYU and Johns Hopkins found that approximately 80% of persons with cancer demonstrated decreases in anxiety, depression, and measures of spiritual and existential distress along with enhanced spiritual well-being after a single experience.

Remarkably, the results demonstrated that the mystical experience was a mediating factor of positive outcome measures including anxiety and depression. The experience of meaning-making and of transcendence – of not solely identifying the experience of self with the dying body – can be a profound gift to a dying patient. These mystical and transpersonal experiences can offer insights regarding new possibilities of understanding the nature of self and may challenge prior assumptions on the nature of death. The implications for helping enhance the end -of-life experience and for palliative care are significant. Other clinical indications for the therapeutic use of psilocybin and other psychedelics include addiction, PTSD, and depression.

How much of the effects of psychedelics depend on the context of use and the people working with the patient? Does culture play any role? Could psychedelics be used anywhere?

The psychedelic experience is largely dependent on the context or set and setting. In many ways, it amplifies aspects of the person’s interior.  It’s not about the drug per se, but the experience that only one session can generate. Historically, these substances were used for healing purposes within indigenous and ancient cultures where the guides or shamans were well familiar with the shifts in consciousness they can produce. In our research, when the individual is carefully screened and the experience is embedded within an interpersonally supportive psychotherapeutic period of preparation and integration, there have been no serious adverse effects.  That can’t be said when taken recreationally without proper screening.  The risk of panic, anxiety, and other adverse effects are heightened when done in those settings.

What does your work teach us about human psychology more generally? What do you think your research tells us about some of the “big questions” concerning the meaning of life and the nature of spirituality? 

Great questions. Apart from the clinical applications of psychedelics, it seems this may pose the most fascinating implication for psychedelics. Can these compounds contribute to consciousness research? What is consciousness? Where is consciousness? Can psychedelics help us understand the nature of consciousness and what is called the “hard problem’ and other big questions?  How or why does consciousness arise from complex brain function? Is it possibly more remarkable than that? What is the source of consciousness?

This really seems like the final frontier of science. Can mystical experience and other non-ordinary states of consciousness from near-death experiences or meditation shed light on the complexities of mind?  Mystical or peak experiences have occurred naturally and cross-culturally throughout history and recent surveys show nearly half the population report these types of experiences. These experiences are also found at the foundations of our religious traditions which Huxley called the perennial philosophy.  Do these experiences have pro-social and pro-ethical implications? It seems humans are wired for meaning.  Why is that? Science and religion were not always separate avenues of inquiry.  At their essence, both attempt to understand the nature of self and existence. Is the mystical experience in some way linked to the foundations of consciousness? Many individuals who’ve had mystical experiences report the primacy of love and interconnectedness as the most important or transformative feature which is what we also see at the mystic core of the religious traditions. How can both science and the study of the sacred help us? I’m sorry, I’ve just answered your question with many more questions!

September 5, 2019