How to Change Your Mind

by Michael Pollan

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  IN DECEMBER 2016, a front-page story in the New York Times reported on the dramatic results of the Johns Hopkins and NYU psilocybin cancer studies, which were published together in a special issue of the Journal of Psychopharmacology, along with nearly a dozen commentaries from prominent voices in the mental health establishment—including two past presidents of the American Psychiatric Association—hailing the findings.

  In both the NYU and the Hopkins trials, some 80 percent of cancer patients showed clinically significant reductions in standard measures of anxiety and depression, an effect that endured for at least six months after their psilocybin session. In both trials, the intensity of the mystical experience volunteers reported closely correlated with the degree to which their symptoms subsided. Few if any psychiatric interventions of any kind have demonstrated such dramatic and sustained results.*

  The trials were small—eighty subjects in all—and will have to be repeated on a larger scale before the government will consider rescheduling psilocybin and approving the treatment.* But the results were encouraging enough to win the attention and cautious support of the mental health community, which has called for more research. Dozens of medical schools have asked to participate in future trials, and funders have stepped forward to underwrite those trials. After decades in the shadows, psychedelic therapy is suddenly respectable again, or nearly so. New York University, which proudly promoted the results of a trial it had once only tolerated somewhat grudgingly, invited Stephen Ross to move his treatment room from the dental college into the main hospital. Even the NYU cancer center, which had initially been reluctant to refer patients to the psilocybin trial, asked Ross to set up a treatment room on its premises for an upcoming trial.

  The papers offered little in the way of a theory to explain the effects of psilocybin, except to point out that the patients with the best outcomes were the ones who had the most complete mystical experience. But exactly why should that experience translate into relief from anxiety and depression? Is it the intimation of some kind of immortality that accounts for the effect? This seems too simple and fails to account for the variety of experiences people had, many of which did not dwell on an afterlife. And some of the ones that did conceived of what happens after death in naturalistic terms, as when the anonymous volunteer imagined herself as “part of the earth,” molecules of matter being taken up by the roots of trees. This really happens.

  Of course the mystical experience consists of several components, most of which don’t require a supernatural explanation. The dissolution of the sense of self, for example, can be understood in either psychological or neurobiological terms (as possibly the disintegration of the default mode network) and may explain many of the benefits people experienced during their journeys without resort to any spiritual conception of “oneness.” Likewise, the sense of “sacredness” that classically accompanies the mystical experience can be understood in more secular terms as simply a heightened sense of meaning or purpose. It’s still early days in our understanding of consciousness, and no single one of our vocabularies for approaching the subject—the biological, the psychological, the philosophical, or the spiritual—has yet earned the right to claim it has the final word. It may be that by layering these different perspectives one upon the other, we can gain the richest picture of what might be going on.

  In a follow-up study to the NYU trial, “Patient Experiences of Psilocybin-Assisted Psychotherapy,” published in the Journal of Humanistic Psychology in 2017, Alexander Belser, a member of the NYU team, interviewed volunteers to better understand the psychological mechanisms underlying the transformations they experienced. I read the study as a subtle attempt to move beyond the mystical experience paradigm to a more humanistic one and at the same time to underscore the importance of the psychotherapist in the psychedelic experience. (Note the use of the term “psilocybin-assisted psychotherapy” in the title; neither of the papers in Psychopharmacology mentioned psychotherapy in its title, only the drug.)

  A few key themes emerged. All of the patients interviewed described powerful feelings of connection to loved ones (“relational embeddedness” is the term the authors used) and, more generally, a shift “from feelings of separateness to interconnectedness.” In most cases, this shift was accompanied by a repertoire of powerful emotions, including “exalted feelings of joy, bliss, and love.” Difficult passages during the journey were typically followed by positive feelings of surrender and acceptance (even of their cancers) as people’s fears fell away.

  Jeffrey Guss, a coauthor on the paper and a psychiatrist, interprets what happens during the session in terms of the psilocybin’s “egolytic” effects—the drug’s ability to either silence or at least muffle the voice of the ego. In his view, which is informed by his psychoanalytic training, the ego is a mental construct that performs certain functions on behalf of the self. Chief among these are maintaining the boundary between the conscious and the unconscious realms of the mind and the boundary between self and other, or subject and object. It is only when these boundaries fade or disappear, as they seem to do under the influence of psychedelics, that we can “let go of rigid patterns of thought, allowing us to perceive new meanings with less fear.”

  The whole question of meaning is central to the approach of the NYU therapists,* and is perhaps especially helpful in understanding the experience of the cancer patients on psilocybin. For many of these patients, a diagnosis of terminal cancer constitutes, among other things, a crisis of meaning. Why me? Why have I been singled out for this fate? Is there any sense to life and the universe? Under the weight of this existential crisis, one’s horizon shrinks, one’s emotional repertoire contracts, and one’s focus narrows as the mind turns in on itself, shutting out the world. Loops of rumination and worry come to occupy more of one’s mental time and space, reinforcing habits of thought it becomes ever more difficult to escape.

  Existential distress at the end of life bears many of the hallmarks of a hyperactive default network, including obsessive self-reflection and an inability to jump the deepening grooves of negative thinking. The ego, faced with the prospect of its own extinction, turns inward and becomes hypervigilant, withdrawing its investment in the world and other people. The cancer patients I interviewed spoke of feeling closed off from loved ones, from the world, and from the full range of emotions; they felt, as one put it, “existentially alone.”

  By temporarily disabling the ego, psilocybin seems to open a new field of psychological possibility, symbolized by the death and rebirth reported by many of the patients I interviewed. At first, the falling away of the self feels threatening, but if one can let go and surrender, powerful and usually positive emotions flow in—along with formerly inaccessible memories and sense impressions and meanings. No longer defended by the ego, the gate between self and other—Huxley’s reducing valve—is thrown wide open. And what comes through that opening for many people, in a great flood, is love. Love for specific individuals, yes, but also, as Patrick Mettes came to feel (to know!), love for everyone and everything—love as the meaning and purpose of life, the key to the universe, and the ultimate truth.

  So it may be that the loss of self leads to a gain in meaning. Can this be explained biologically? Probably not yet, but recent neuroscience offers a few intriguing clues. Recall that the Imperial College team found that when the default mode network disintegrates (taking with it the sense of self), the brain’s overall connectivity increases, allowing brain regions that don’t ordinarily communicate to form new lines of connection. Is it possible that some of these new connections in the brain manifest in the mind as new meanings or perspectives? The connecting of formerly far-flung dots?

  It may also be that psychedelics can directly imbue otherwise irrelevant sensory information with meaning. A recent paper in Current Biology* described an experiment in which pieces of music that held no personal relevance for voluntee
rs were played for them while on LSD. Under the influence of the psychedelic, however, volunteers attributed marked and lasting personal meaning to the same songs.These medicines may help us construct meaning, if not discover it.

  No doubt the suggestibility of the mind on psychedelics and the guiding presence of psychotherapists also play a role in attributing meaning to the experience. In preparing volunteers for their journeys, Jeffrey Guss speaks explicitly about the acquisition of meaning, telling his patients “that the medicine will show you hidden or unknown shadow parts of yourself; that you will gain insight into yourself, and come to learn about the meaning of life and existence.” (He also tells them they may have a mystical or transcendent experience but carefully refrains from defining it.) “As a result of this molecule being in your body, you’ll understand more about yourself and life and the universe.” And more often than not this happens. Replace the science-y word “molecule” with “sacred mushroom” or “plant teacher,” and you have the incantations of a shaman at the start of a ceremonial healing.

  But however it works, and whatever vocabulary we use to explain it, this seems to me the great gift of the psychedelic journey, especially to the dying: its power to imbue everything in our field of experience with a heightened sense of purpose and consequence. Depending on one’s orientation, this can be understood either in humanistic or in spiritual terms—for what is the Sacred but a capitalized version of significance? Even for atheists like Dinah Bazer—like me!—psychedelics can charge a world from which the gods long ago departed with the pulse of meaning, the immanence with which they once infused it. The sense of a cold and arbitrary universe governed purely by chance is banished. Especially in the absence of faith, these medicines, in the right hands, may offer powerful antidotes for the existential terrors that afflict not only the dying.

  To believe that life has any meaning at all is of course a large presumption, requiring in some a leap of faith, but surely it is a helpful one, and never more so than at the approach of death. To situate the self in a larger context of meaning, whatever it is—a sense of oneness with nature or universal love—can make extinction of the self somewhat easier to contemplate. Religion has always understood this wager, but why should religion enjoy a monopoly? Bertrand Russell wrote that the best way to overcome one’s fear of death “is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life.” He goes on:

  An individual human existence should be like a river: small at first, narrowly contained within its banks, and rushing passionately past rocks and over waterfalls. Gradually, the river grows wider, the banks recede, the waters flow more quietly, and in the end, without any visible break, they become merged in the sea, and painlessly lose their individual being.

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  PATRICK METTES lived seventeen months after his psilocybin session, and according to Lisa those months were filled with a great many unexpected satisfactions, alongside Patrick’s dawning acceptance that he was going to die.

  Lisa had initially been wary of the NYU trial, interpreting Patrick’s desire to participate as a sign he’d given up the fight. In the event, he came away convinced he still had much to do in this life—much love to give and receive—and wasn’t yet ready to leave it and, especially, his wife. Patrick’s psychedelic journey had shifted his perspective, from a narrow lens trained on the prospect of dying to a renewed focus on how best to live the time left to him. “He had a new resolve. That there was a point to his life, that he got it, and was moving with it.

  “We still had our arguments,” Lisa recalled, “and we had a very trying summer” as they endured a calamitous apartment renovation in Brooklyn. “That was hell on earth,” Lisa recalled, but Patrick “had changed. He had a sense of patience he had never had before, and with me he had real joy about things. It was as if he had been relieved of the duty of caring about the details of life, and he could let all that go. Now it was about being with people, enjoying his sandwich and the walk on the promenade. It was as if we lived a lifetime in a year.”

  After the psilocybin session, Lisa somehow convinced herself that Patrick was not going to die after all. He continued with his chemo and his spirits improved, but she now thinks all this time “he knew very well he wasn’t going to make it.” Lisa continued to work, and Patrick spent his good days walking the city. “He would walk everywhere, try every restaurant for lunch, and tell me about all the great places he discovered. But his good days got fewer and fewer.” Then, in March 2012, he told her he wanted to stop chemo.

  “He didn’t want to die,” Lisa says, “but I think he just decided that this is not how he wanted to live.”

  That fall his lungs began to fail, and Patrick wound up in the hospital. “He gathered everyone together and said good-bye and explained that this is how he wanted to die. He had a very conscious death.” Patrick’s seeming equanimity in the face of death exerted a powerful influence on everyone around him, Lisa said, and his room in the palliative care unit at Mount Sinai became a center of gravity in the hospital. “Everyone, the nurses and the doctors, wanted to hang out in our room; they just didn’t want to leave. Patrick would talk and talk. It was like he was a yogi. He put out so much love.” When Tony Bossis visited Patrick a week before he died, he was struck by the mood in the room and by Patrick’s serenity.

  “He was consoling me. He said his biggest sadness was leaving his wife. But he was not afraid.”

  Lisa e-mailed me a photograph of Patrick she had taken a few days before he died, and when the image popped open on my screen, it momentarily took my breath away. Here was an emaciated man in a hospital gown, an oxygen clip in his nose, but with bright, shining blue eyes and a broad smile. On the eve of death, the man was beaming.

  Lisa stayed with Patrick in his hospital room night after night, the two of them often talking into the wee hours. “I feel like I have one foot in this world and one in the next,” he told her at one point. “One of the last nights we were together, he said, ‘Honey, don’t push me. I’m finding my way.’” At the same time, he sought to comfort her. “This is simply the wheel of life,” she recalls him saying. “‘You feel like you’re being ground down by it now, but the wheel is going to turn and you’ll be on top again.’”

  Lisa hadn’t had a shower in days, and her brother finally persuaded her to go home for a few hours. Minutes before she returned to his bedside, Patrick slipped away. “I went home to shower and he died.” We were speaking on the phone, and I could hear her crying softly. “He wasn’t going to die as long as I was there. My brother had told me, ‘You need to let him go.’”

  Patrick was gone by the time she got back to the hospital. “He had died seconds before. It was like something had evaporated from him. I sat with him for three hours. It’s a long time before the soul is out of the room.”

  “It was a good death,” Lisa told me, a fact she credits to the people at NYU and to Patrick’s psilocybin journey. “I feel indebted to them for what they allowed him to experience—the deep resources they allowed him to tap into. These were his own deep resources. That, I think, is what these mind-altering drugs do.”

  “Patrick was far more spiritual than I was to begin with,” Lisa told me the last time we spoke. It was clear his journey had changed her too. “It was an affirmation of a world I knew nothing about. But there are more dimensions to this world than I ever knew existed.”

  Two: Addiction

  The dozen or so Apollo astronauts who have escaped Earth’s orbit and traveled to the moon had the privilege of seeing the planet from a perspective never before available to our species, and several of them reported that the experience changed them in profound and enduring ways. The sight of that “pale blue dot” hanging in the infinite black void of space erased the national borders on our maps and rendered Earth small, vulnerable, e
xceptional, and precious.

  Edgar Mitchell, returning from the moon on Apollo 14, had what he has described as a mystical experience, specifically a savikalpa samadhi, in which the ego vanishes when confronted with the immensity of the universe during the course of a meditation on an object—in this case, planet Earth.

  “The biggest joy was on the way home,” he recalled. “In my cockpit window, every two minutes: the earth, the moon, the sun, and the whole panorama of the heavens. That was a powerful, overwhelming experience.

  “And suddenly I realized that the molecules of my body, and the molecules of my spacecraft, the molecules in the body of my partners, were prototyped, manufactured in some ancient generation of stars. [I felt] an overwhelming sense of oneness, of connectedness . . . It wasn’t ‘Them and Us,’ it was ‘That’s me! That’s all of it, it’s one thing.’ And it was accompanied by an ecstasy, a sense of ‘Oh my God, wow, yes’—an insight, an epiphany.”*

  It was the power of this novel perspective—the same perspective that Stewart Brand, after his 1966 LSD trip on a North Beach rooftop, worked so hard to disseminate to the culture—that helped to inspire the modern environmental movement as well as the Gaia hypothesis, the idea that Earth and its atmosphere together constitute a single living organism.

  I thought about this so-called overview effect during my conversations with volunteers in the psilocybin trials, and especially with those who had overcome their addictions after a psychedelic journey—to inner space, if you will. Several volunteers described achieving a new distance on their own lives, a vantage from which matters that had once seemed daunting now seemed smaller and more manageable, including their addictions. It sounded as though the psychedelic experience had given many of them an overview effect on the scenes of their own lives, making possible a shift in worldview and priorities that allowed them to let go of old habits, sometimes with remarkable ease. As one lifetime smoker put it to me in terms so simple I found it hard to believe, “Smoking became irrelevant, so I stopped.”