Aldous Huxley and his wife, Laura, who gave him LSD as he was dying. Photograph: AP Alcoholism quiz.
When Aldous Huxley was dying in 1963, he asked his wife to inject him with LSD, and he passed away, she wrote afterwards, without any of the pain and distress that cancer can cause in the final hours.
“All five people in the room said that this was the most serene, the most beautiful death,” Laura Huxley, a psychotherapist, wrote to other members of his family.
Huxley, who wrote his 1954 essay The Doors of Perception about his experience of taking the psychedelic drug mescaline, anticipated just such a death in his last novel, Island. At the time, many in the psychiatric field thought psychedelic drugs such as psilocybin, the active ingredient of magic mushrooms, and LSD held huge promise to alleviate all kinds of severe mental distress. There were experiments, funded by the United States government, into the use of LSD at the end of life.
But the doors clanged shut in 1970, when the US government classified the drugs in schedule 1, which meant they had no medical use.
Nearly half a century later, two trials in the US may have proven that wrong. One, conducted at Johns Hopkins University and the other, at New York University, gave a single high dose of psilocybin, along with psychotherapy, to 80 people with advanced cancer who were experiencing depression and anxiety.
The results published this week were remarkable, prompting 10 eminent figures in the psychiatric world in the US and Europe to contribute commentaries to the Journal of Psychopharmacology, where the trial outcomes were published, calling for more research. In 80% of cases, patients’ distress was lifted and remained so for six to eight months.
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In the same week, the Food and Drug Administration in the US gave the green light to a phase 3 trial of MDMA, or ecstasy, for post-traumatic stress disorder (PTSD). This will be a large-scale trial, following several small and successful trials, capable of producing the evidence needed for the FDA to approve MDMA as a licensed medication.
It’s a watershed. Years of hard work by those convinced that mind-altering drugs have a place in medicine have led up to it, overcoming legal and financial obstacles to trials as well as social and political hostility. The multidisciplinary association for psychedelic studies (Maps), which has fought for this and other trials since 1986, believes ecstasy will be a licensed medicine within four years.
“We’re not counter-cultural in any sense,” says Brad Burge of California-based Maps, which will raise $20m to fund the final trials. “We are trying to develop a legitimate treatment option for people with PTSD and other illnesses.”
What has shifted over the decades is gradual recognition of the vast amount of untreated need. “There is a great deal more awareness than there used to be of PTSD as an epidemic worldwide,” says Burge.
The conventional treatments for PTSD such as anti-depressants and anti-anxiety pills do not work for most people, any more than they do for the sort of distress around life-threatening cancer that makes some sufferers have suicidal thoughts. Psychotherapy can help, but the psychiatric community is astounded by the lasting effect of a dose of MDMA on a war veteran who cannot leave his home for fear of reliving the horrors he has seen.
Prof David Nutt from Imperial College in London, editor of the journal that ran the psilocybin trials this week and involved in a smaller study that reported in May on the use of psilocybin in other sorts of depression, says MDMA works in a very different way from magic mushrooms.
“MDMA in PTSD is not a psychedelic,” he says. “I’m not sure psychedelics would work in PTSD. They might make it worse.
“What MDMA does is dampen down the brain circuit which is overactive in PTSD and that allows people to engage in the psychotherapy in a more efficient way. I’ve treated patients with PTSD and as soon as you say, look I want you to start thinking about the trauma, they faint. You can’t engage with them. The traumatic memories are so overwhelming.”
Psilocybin is different. Like LSD, it can produce a mystical experience. Scientists do not yet know if that is why it has a profound effect on depression. “That’s one of the key research questions,” says Nutt. “Do you need a mystical experience? Do you need to meet some greater being?”
Back before the US blanket ban in 1970, scientists trialled LSD as a treatment for alcoholism. The co-founder of Alcoholics Anonymous, Bill Wilson, credited mystical experiences on the drug for his own recovery. “His belief was that you had to find a higher power so that you could look down on this rather petty affection people have for alcohol,” said Nutt.
In his own depression study, he said, some people did have mystical experiences. Others had powerful emotional experiences. When it comes to using psychedelics at the end of life, which was very much of interest to scientists in the 1940s and 1950s, a mystical experience may be key.
“When you see that you are more than your current self and you have experiences as our patients do, feeling you are taken outside of your body and floating off into space and into other worlds, then you see the bigger picture. You realise you don’t ever die. No one ever dies. You stop breathing. You stop thinking. But the atoms are still there,” said Nutt.
“There used to be this wonderful little quiz question they set for scientists doing the Cambridge entrance exam. How many O2 molecules of Socrates’ last breath do you inhale every time you breathe? The answer is about 26 because those atoms, those molecules, are still around. We are just a rather complicated form of life but our matter doesn’t disappear – it’s just the way it’s organised that does.”
Whether such a mind-expanding experience can ever become part of mainstream psychotherapy is no longer just a rhetorical question.