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INVITED EDITORIAL
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 3-5

The metaphysical combat with death in the terminally ill and the psychedelic trail


Department Consultant Clinical Neuropsychologist ACRO and Clinical Neurosciences, Dr. Balabhai Nanavati Hospital, Vile Parle, Mumbai, India

Date of Web Publication23-Apr-2014

Correspondence Address:
Varsha Dutta
Clinical Neuropsychologist Clinical Neurosciences Division and Radiation Oncology, Dr. Balabhai Nanavati Hospital, S.V. Road, Vile Parle, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131326

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How to cite this article:
Dutta V. The metaphysical combat with death in the terminally ill and the psychedelic trail. J Can Res Ther 2014;10:3-5

How to cite this URL:
Dutta V. The metaphysical combat with death in the terminally ill and the psychedelic trail. J Can Res Ther [serial online] 2014 [cited 2019 Jan 22];10:3-5. Available from: http://www.cancerjournal.net/text.asp?2014/10/1/3/131326

The North Wind of My Mind….

It was in a reverie when I was made that green offering,

that spilled opened the floodgates to a tempest, innermost, inchoate,

a spasm from which I will not recover

from there flew three pigeons, beguiling with beaks in hands,

and strange gesticulations they made

blinded by a colorless hysteria that soon would follow

Each hand out a bay leaf, cut in transverse throwing out a hint at some life that had been cornered;

vast and unfilled

from there appeared the umbilical wound concealed with dirt years of earth

An attempt to brood over it would be sacrilegious, I must say

The odds are at stake, a convulsive possession it would be without an ambition,

or a goal that cannot feed itself

And now that I know I have to relinquish what I know of these dirt years at best,

my morsel of life

my morning and afternoon cups of meaningless hysteria I am infatuated with

siestas filled with evening stars that I just cannot forsake

they all seem a taunt, a jibe I cannot get over

and then… all at once I am accosted by the north wind of my mind from where I know not surrender

from who I seek paltry refuge

and for which I will not apologize

Not that I am impervious to this earth, which in all probability is a construct of my repetitive doing

agonizing and brutal, hinged to the doors of solitude like a craggy beast to its tail

and at all times striving to exhale from some other form of life less mundane, less ordinary

so why should I be condemned for wanting to give up this phony tenure

So here I am walking through these scorching gates

as I shake the earth and vomit up a torrent of mad dust

(From the loose pages of AH who is TI and on a psychedelic jaunt)

After reading this it can perhaps be said with some alacrity that nowhere else does the situational act of being becomes more confrontational than in the terminally ill. After all, this is where one is in direct combat with existence itself; so when certain decisions about one's imminent death have to be made against the odds of having to prolong the therapeutic sentence then the ethical demands entrenched with it comes under immense speculation. The recent surge of allowing psychedelic drugs to be used with the terminal cancer patient has reopened the hot gates of ethical queries; and being under the hammer gives it an urgency that 'the act of being' should itself be considered for all its philosophical deliberations. Psychedelic drug use in this matter is trying to cajole open a position where a place that is concrete can be granted to the patient, something that is soothing and transparent rather than be a beat in the midst of repeated analysis. It is in this very reflection of 'analogia entis' (the very analogy of being) [1] that demands an answer to the lurking obviousness of the unknown.

While the research community is busy jamming up its heels for its quick revival as a therapy drug, some countries have already been at ease by trying to rescue it from the prodigality of the 1960s and giving it a legal prominence for private use. In the early phase of psychedelic research (1950s and 1960s), most of the work getting published was anecdotal, research was largely based on a low dose psycholytic and a high dose psychedelic paradigm that had poor scientific implications. [2] Modern psychedelic research demands that researchers adhere to a more rigorous scientific attitude. What makes studying the effects of these drugs more difficult is the subjective nature of the experience it induces. [3] The sensations experienced by the person are privy to his world alone, impenetrable and unrepeatable, something that collides with a severe scientific temper. Moreover, the inner psychological state of the user determines the course or the path it will take; so little can be accessed in terms of quantifying such subjective experiences. Alexander Shulgin in his book PiHKAL (Phenethylamines i Have Known and Loved) was polemic about the uncertainties involved in objectifying the experiences of such psychoactive drugs drawing from his own experiences that such experiential states are always confined to the sensorium of the individual experiencing it alone, and therefore, cannot be bound by the laws of rigorous science. [3]

Psychedelic drugs have the propensity to a mystical realm that has been associated with reducing the death angst. The numinous healing powers of psychedelic plants have long been associated with ancient cultures; it was rooted in their cultural mores and an integral part of important communal rituals like death. This is before the West forayed and sought it out like a medical enterprise. In the 1970s, Grof and his colleagues, [4] found that when psychotherapy was combined with the psychedelic drug Lysergicacid diethelamyde (LSD), it had the immense potential to mitigate physical pain, depressed, and anxiety-related feelings associated with death in the terminally-ill cancer patient. A recent study by Grobs et al., 2011 [5] used psilocybin, another potent psychedelic drug, but better tolerated than LSD and studied its effects on patients who had advanced cancer. The team followed up with these patients 6 months after they had taken psilocybin and found that this group reportedly had less depressed feelings along with it a dip in their trait anxiety measure too was noticed at 3 months after treatment suggesting that psilocybin could perhaps bring about a long-term positive change in one's personality; but this is still very speculative since these personality traits were not measured prior to the diagnosis of cancer. Positive effects of this drug were also seen in studies where healthy volunteers participated and reported a sense of 'death transcendence' after just a single dose of psilocybin, along with this a positive outlook towards life, enhanced spirituality and general feelings of altruism too were reported that lasted for months after the drug therapy (Griffiths et al., 2011 and 2006). [6,7]

Since the 1990s, research work on psychedelics has been on the rise with academic work being published from labs across different research fields. But looking at it closely, research involving a double-blind, placebo-controlled paradigm had considerably failed to show its competency in studying the effects of these psychedelic drugs for its psychotherapeutic potential. It is but natural to consider studying the psychological state of the psychedelic experience using the most advanced neuroimaging techniques since the physiological reaction often emulates the personal experience. This whole experience would have a significant impact on the neural pathways of the brain, but it would be naïve to think that we could interpret the private experiential state of the person involved or even reduce each aspect of the psychical state to the lowest possible denomination (Kometer and his team, 2012) [8] showed that psilocybin could produce attentional biases in a positive way by acting on the serotonin system, this was part of a study where the effects of the drug were being examined in relieving mood disorders like depression. From their experiences in Spring Grove and MPRC, Yensen and Dryer [9] stated that the context in which a psychedelic experience unfolds is what finally determines the final outcome. So accordingly all the confounding factors need to be observed and conformed to if replication is to take place; but quite clearly there can be no control over such situations and no two sessions can ever be alike, as these experiences are intrinsically unrepeatable. And because the subjective experience here is quintessential for the understanding of how the experiential state unfolds one cannot, but help rely on all the confounding factors there are that will influence the end result.

The question that many will ask is whether the medical model will accommodate everything that comes along with the psychedelic experience. Will the "prescribed psychedelic drug" alleviate this death angst? And is it possible to share or go through the entire range of experience in a situation that is 'doctored'. Psychedelic drugs as means of self-exploration has been studied and documented in healthy adults (Lerner and Lyvers, 2006) [10] and the reason why some people with spiritual leanings or with a certain belief system might be inclined to use these drugs have also been considered (Moro et al., 2011), [11] but this does not obviate the rest who might not lean towards anything. 'Angst' is a state of mind that arises when faced with sheer nothingness, [12] exemplified by death when there is no more to look ahead to, when the usual way of looking at the world loses its obvious meaning. So when one has a time frame to live in the apprehension and the anxiety of living through everyday takes on a new meaning, a new fear; look at the case of 'AH' it is the facticity of his being, [13] his imminent death that eluded him, he was forced to confront what was beyond his control. That aspect of his existence was determinedly becoming less prosaic, he was being dulled with it and he had to come to terms with this 'facticity' that it was banal; and so he had to be quick about his next move; could he exercise his resolve to outdo this situational circumstance, do something instead of merely dissociating himself from all that was going on, perhaps that was when he surrendered in an allegorical way to the guts of his psyche, which he called 'the north wind of my mind' and was least apologetic about. It was the cause and not the penalty that he was paying for, something that had sawed him open and laid bare, it was the prodigality of the situation that was bound to leave anybody unarmored. The question here was of being in existence for which a remedy could never be sought; no one could cure this pathology, brutal as it may appear we cannot undo this umbilical wound. For a brief while from now we will be trudging into a therapeutic realm, but that will not peel open an answer; that something more sacrosanct beyond our earth boundaries has been visited, has been penetrated is all we know for now, that our consciousness has been the construct of our own doing and has opened the gateway to another backstreet spewing up a torrent of mad dust is all we know for now.

 
 > References Top

1.Pryzwara E. Betz JR (translator) Analogia Entis: Metaphysics: Original Structure and Universal Rhythm. Grand Rapids. Eerdmans, 2014.  Back to cited text no. 1
    
2.Sewick B. Psychedelic assisted Psychotherapy for the Terminally ill. MAPS.1997.  Back to cited text no. 2
    
3.Shulgin A, Shulgin A. PiHKAL. A Chemical Love story. 1991.  Back to cited text no. 3
    
4.Grof S, Goodman LE, Richards WA, Kurland AA. LSD-assisted psychotherapy in patients with terminal cancer. Int Pharmacopsychiatry 1973;8:129-44.  Back to cited text no. 4
[PUBMED]    
5.Grob CS, Danforth AL, Chopra GS, Hagerty M, McKay CR, Halberstad AL, et al. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatry 2011;68:71-8.  Back to cited text no. 5
    
6.Griffiths RR, Johnson MW, Richards WA, Richards BD, McCann U, Jesse R. Psilocybin occasioned mystical-type experiences: Immediate and persisting dose-related effects. Psychopharmacology (Berl) 2011;218:649-65.  Back to cited text no. 6
    
7.Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl) 2006;187:268-83.  Back to cited text no. 7
    
8.Kometer M, Schmidt A, Bachmann R, Studerus E, Seifritz E, Vollenweider FX. Psilocybin biases facial recognition, goal directed behavior and mood state toward positive relative to negative emotions through different serotonergic subreceptors. Biol Psychiatry 2012;72:898-906.  Back to cited text no. 8
    
9.Yensen R, Dryer D. Thirty years of psychedelic research: the Spring Grove experiment and its sequels. In: Schlichting M, Leuner H, editors. World of Consciousness. Berlin: GAM-Media GmbH; 1992. p. 141-76.  Back to cited text no. 9
    
10.Lerner M, Lyvers M. Values and beliefs of psychedelic drug users: A cross-cultural study. J Psychoactive Drugs 2006;38:143-7.  Back to cited text no. 10
    
11.Moro L, Simon K, Bard I, Racz J. Voice of the psychonauts: Coping, life purpose and spirituality in psychedelic drug users. J Psychoactive Drugs 2011;43:188-98.  Back to cited text no. 11
    
12.Heidegger M. Being and Time. Sein und Zeit, 1927.  Back to cited text no. 12
    
13.Sartre JP. Being and Nothingness. Kensington Publishing Corporation,1943.  Back to cited text no. 13
    




 

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