Existential Medicine

Earlier in the year I posted about the use of psychedelic drugs, particularly psilocybin (the active ingredient in “magic mushrooms”), to treat the clinically depressed. I’ve just finished reading a recent piece in the New York Times on a growing number of psychiatrists nationwide who are currently conducting studies on the merits of psilocybin in mitigating fears of death in terminally ill patients. Rather than discuss neural basis for psilocybin’s potential psychiatric benefits (about which very little is known), I feel compelled to write about the ethics of such drug administration, which I have been struggling with since my initial post on the subject.

The New York Times piece describes two patients, suffering from a cancer, who were told they had very little time left to live. Initially, both patients struggled immensely with their respective diagnoses, but each found refuge in experimental studies in which psilocybin was administered, followed by prolonged sessions of meditation and introspection. At the end of their studies, each performed much better on a battery of depression and anxiety tests, and each reported a completely different world view, one in which death was not the end of life, but part of “…a process, a way of moving into a different sphere, a different way of being.”

Although psilocybin appears to be effective in mitigating anxiety in depressed or anxious patients, there is something very unsettling about the idea of administering a compound that effects the brain so drastically (in ways yet to be fully understood), so as to convert a state of near panic to one of placidity and tranquility.

While the ends of such administration may be appreciated by the patient, are the means ethical? Perhaps, with death so near, a patient deserves to die in peace, regardless of the ethical implications. But, every time I read about psilocybin as a clinical drug, I cannot help but think about Aldous Huxley’s A Brave New World. True, there is a big difference between recreational use of a powerful psychedelic (as was the case in A Brace New World or 1960’s America) and prescribed use by terminally ill patients, but once the ball gets rolling, I fear it will be hard to stop. As Lauren Slater, author of the New York Time piece writes, “If, say, end-stage cancer patients can have it, then why not all individuals over the age of, say, 75? If treatment-resistant depressives can have it, then why not their dysthymic counterparts, who suffer in a lower key but whose lives are clearly compromised by their chronic pain? And if dysthymic individuals can have it, then why not those suffering from agoraphobia, shut up day and night in cramped quarters, Xanax bottles littered everywhere?” While some may say that such hypothetical scenarios will never come to be if psilocybin use is strictly regulated for terminally ill patients, people like Rick Doblin and his group MAPS (Multidisciplinary Association for Psychedelic Study) have already started petitioning for the legalization of psychedelics for use in a “wide range of clinical indications.”

Psychedelics, such as psilocybin, definitely hold promise for patients suffering crippling depression and anxiety. They also hold great potential for abuse, and when discussing the clinical merits of psychedelics, researchers and psychiatrists need do so with extreme prudence and caution.