The Explorer’s Edge is a monthly community series hosted by the Synthesis Institute. This December we explored the potential of Palliative Psychedelics and the ways in which these experiences encourage us to question what it might mean to live or die ‘well’.
What Psilocybin Taught Me About Dying
Death shepherds us all through life. Yet Palliative Care is still a source of controversy, being mired in nuance and complexity. Cultural responses to dying and bereavement vary widely, both at individual and societal levels. This presents practical, ethical, legal, and socio-culturally sensitive challenges when discerning the indications and contraindications of an intervention, the timing of treatment, and how we hold space for a diverse array of perspectives within our shared existential container.
As psychedelic substances gain mainstream acceptance, the evidence-based guidelines for professional clinicians are still being defined. Clinicians have a legal responsibility and a Hippocratic moral duty to ‘do no harm.’ But psychedelics are an emerging industry where long-term and large-scale clinical trials are still relatively sparse, instigating extrapolation and speculation around clinical outcomes – which already hold a unique set of criteria within the Palliative Care context.
Patients with a terminal diagnosis are often too physically and psychologically frail to be included in clinical trials, further limiting the scope of insights that may be gained from our traditional approaches to evidence-based research. Equally, the subject prompts us as a collective to holistically reconsider what it might mean to live or die ‘well.’
Psychedelics can instigate ineffable processes that share many parallels with near-death experiences, prompting us to contemplate how we might prepare for the end of life before a terminal diagnosis. Panellist Dr. Stephanie Van Hope describes this evolution of perspective as a shift from focusing on cure, to comfort, to consciousness; where a greater consideration of the uncertainty of our wider context can facilitate a deeper appreciation of the historical and modern practices that foster integration.
Hosted by Daan Keiman, Buddhist chaplain, psychedelic educator and Synthesis Content Advisor, the panel consisted of Dr. Stephanie Van Hope, a holistic Nurse practitioner, Anthony Back MD, physician and Author of What Psilocybin Taught Me About Dying, and Lou Lukas MD, graduate of the Synthesis Psychedelic Practitioner Training Program and Associate Professor of Palliative Medicine and Neurological Sciences at the University of Nebraska Medical Centre.
This 90-minute community gathering including panel conversation and interactive Q&A, was for anyone that wished to deepen their inquiry into the topics of life and death; Whether they were a patient that felt called to investigate psychedelic perspectives on palliative care, a clinician interested in the potential applications of the space, or a practitioner navigating the nuances of cultural context. However while this event aimed to share insights from research, case studies, and experiences, it was not designed to offer clinical guidelines or advice. The agenda for the session included:
- Sharing front-line experiences of the hospice process and case studies from the panellists’ clinical practice, as well as discussing how this may differ from available academic data due to the limitations that science and researchers face.
- Exploring the latest evidence-base around psychedelic use in retreat and clinical settings, and extrapolating how this might be empathetically and holistically applied to palliative care.
- Addressing the ethical, legal, and socio-cultural challenges facing patients, clinicians, and researchers, especially in an end-of-life context.
- Exploring how we might navigate the concept of unity in diversity when it comes to acknowledging the need for a diverse array of existential containers.
- Discussing how to be individually and collectively open to this deeper level of existential inquiry while further developing our emotional and cultural sensitivity and stability. This involves exploring the ways in which we might compassionately encourage fear and frantic activity to transform into openness and curiosity.
Key Takeaways From Psychedelic Perspectives
Almost 200 members took part in the event which will be made available to watch via the Synthesis Institute platform. Opening reflections from Daan’s experience in Hospice care acknowledged that those working within the palliative field often have a strong emotional capacity to be present with whatever arises, as well as a humanising sense of humour.
Participants were reminded that these insights were in no way established best practices, or an instruction to start working with psychedelics in underground, hospice, or palliative care settings, but were simply conjectures, experiences, and considerations rooted in intuition and potential. No expert or panellist sought to speak in a definitive way – but aimed to share from a place of curiosity, mystery and humility, especially with regards to a topic as sensitive and complex as End-Of-Life Care. Based on the discussion and questions received from our final community event of 2023, these are 5 key points that emerged:
- The Price of Progress: Rapid advances in medicine and technology have delivered tangible benefits to us as a species, but they have also had hidden costs. We are less connected to the wider ecosystem and to its natural cycles; The medicalisation of natural processes including death and birth has often placed them in a binary, pathological context. Instead of being seen as a potential rite of passage, death is always viewed as a failure of care. Although it will not remove many of the emotional difficulties and challenges, shifting the cultural focus from cure to consciousness could help us to view these processes as design features, as much as design flaws.
- Panoramic Perspectives: Paradigmatic shifts that allow us to holistically reintegrate into the cycles of life and death collectively re-humanise us, allowing us to grieve together in an embodied way. Demand for this shift is occurring at a point in time when the prevailing culture has become increasingly neoliberal and materialist. This has affected access to timely, qualitative end-of-life care, and altered our perspective of what a ‘good death’ might look like. There is evidence to suggest that the current cultural container does not have the capacity or resilience to work with the complexity of these intangible mental, emotional and spiritual dimensions.
- Nature and Nurture: The reorientation towards consciousness that is encouraged by psychedelic medicines is relevant to us all, not just those facing an end-of-life diagnosis. Transcendent experiences take time and preparation to integrate, with lessons that can be brought back into life. Neither are these benefits limited to the medicines themselves, as they are synergised by the warmth and care received within an environment of greater empathy, patience and connection. ‘Set and Setting’ needs to be re-evaluated on a systemic level beyond the scope of psychedelic intervention, especially if we are to avoid such medicines becoming just another thing on the conveyor belt of routinised care.
- Conscious of Contraindications: When it comes to screening, individuals must have the mental and physical capacity to cope with such treatments. This involves evaluating metabolic and cardiac functions, symptomatic management, and assessing degrees of psychological openness and resilience. When mitigating the risks of potentially challenging or overwhelming experiences, some factors to consider include levels of neuroticism, dose, relational background and previous experiences, embodied practices, and access to a like-minded religious, spiritual or existential community support network. An individual’s willingness and ability to lean into these questions and perspectives also has to come from within, and cannot be externally encouraged or enforced. However while the current environment predominantly leans towards a modus operandi of striving and control, such processes often benefit from an ability to accept and to let go.
- Quality and Quantity: Finally, it may be that access to psychedelic medicines cannot be scaled in the traditional way. In spite of the demand, there is evidence to suggest that psychedelic-assisted care should not be rushed and rolled out en masse. In a society heavily focused on theoretical technicalities and qualifications – to have guides, practitioners or supervisors without any degree of personal experience is something that could present cause for concern; Sympathy is from the sidelines, but empathy is from experience. To medicalise and professionalise the nature of ritual, ceremony and community would take away from it, by transforming the nature of the question into something that it is not. For example, this could be akin to reducing an intangible holistic process like ‘love’ to its constituent hormones and molecules.
“In the words of Trevor Hall – You Can’t Rush Your Healing.”