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The Psychedelic Mystical Experience
in the Human Encounter With Death
Walter N. Pahnke
©Psychedelic Review, Number 11, 1971
Introduction
THIS Spring I received a long distance telephone call from
Dean Samuel Miller, who invited me to give this year's Ingersoll
Lecture on human immortality. Three days later, Dean Miller was
dead. When I heard the sad news, I, as many of you no doubt,
began to think about the way he had influenced me, especially
during my theological training here at Harvard Divinity School.
One of my most vivid memories was a point which he emphasized in
his class on Religion and Literature. Sam Miller felt strongly
that in our modern 20th century two of the most profound and
important experiences of human life are becoming more and more
insulated from everyday existence. These two experiences, birth
and death, have the potential for affecting the character and
quality of the rest of life. But in each instance, they are
falling victim to modern technological efficiency and adding to
the process of dehumanization rather than counteracting it.
How many mothers these days are awake and actively
participating when giving birth to their babies? And much more
rare, how many fathers even are given the opportunity to be
present with their wives at the moment of birth? Certainly there
are times when medical emergencies make the presence of the
father an encumbrance and anesthesia to the point of
unconsciousness a necessity for the mother. But from my own
experience delivering babies as a general practitioner in a
wilderness community in Alaska, most of the time an alert,
participating mother and father make human birth much more than
just another medical procedure to be mechanically processed. I
have also been in the role of the father at the birth of my own
three children. Although I am a physician, it was nevertheless
difficult to find a hospital which would allow me to be present
in the delivery room. But I am tremendously glad that I was.
Delivering someone else's baby cannot compare to witnessing the
birth of your own. This event made a profound impact on me in
regard to reverence for life.
If we turn now to the other end of human life, my experience
has taught me that a creative emotional impact is possible in the
events surrounding death in spite of the tragedy and sadness.
Unfortunately, we have become so "civilized" that
death, too, can be robbed of its function in revitalizing and
energizing the rest of life for those still alive.
What usually happens in our culture when someone is
terminally ill? First of all, the fact of death, although
uppermost in everyone's mind, is usually avoided. Talk in general
is diversionary, for example, about getting well or about
superficial news in an attempt to prevent any serious discussion
of more profound issues. As the dying patient's condition
worsens, he may be subjected to a barrage of heroic treatment
measures which many times can prolong physical life, but also
make meaningful interpersonal contact difficult or impossible.
The patient is rarely given a chance to express his feelings
about how or where he would like to die, e.g., at home or in the
hospital. How could he, when the whole issue of death is somehow
avoided? Then, as the moment of death approaches and the patient
is put on the danger list, family members can stay with him
outside of usual visiting hours, but many times this is subtly
discouraged because it can interfere with hospital routine.
Sometimes frantic last minute efforts to "revive" the
patient are carried out behind drawn white curtains with the
family excluded. When death finally and inevitably comes, whether
at home or in the hospital, the body is quickly removed by the
undertaker, who then proceeds to make the corpse look "as
lifelike" as possible. Our costly and elaborate funeral
procedures seem intent on disguising the fact of death and
somehow insulating the survivors from its impact.
In contrast, consider what happened in other days before our
society became so removed from these primary experiences of birth
and death. Most babies were born and most people died in their
own homes. In the case of death, this meant the preparation of
the body for burial—the tasks of bathing, dressing, and
grooming—was done by members of the family. This
psychological experience was inescapable and profound. Although I
believe that a return to more participation in the process of
birth is important and can be done in the desirable safety of a
hospital setting, I am not suggesting that the elimination of
morticians is either desirable or necessary. But perhaps more
attention to the events preceding and surrounding the moment of
death would add dignity and meaning to this potentially powerful
experience.
The Situation of the Terminal Cancer Patient
I do not know how many of you here today have had a primary
exposure to someone whom you knew well and intimately who was
dying of cancer, but at best this is a grim situation. What do we
usually find happening? In my work with such patients I have
become keenly aware of the fear, depression, anxiety, loneliness,
and suffering which are usually present.
There is a certain degree of underlying fear on the part of
everyone involved—not only the patient himself, but also his
family and friends, the nurses, and even the doctors. This fear
manifests itself in many ways, both consciously and
unconsciously, and is basically a fear of the unknown. No matter
how much we have been told about death, its implications for
life, or what might follow afterwards, down deep we all know that
some day each one of us must face this experience as an
individual at the end of his own life. This is a very personal
thing, and one that can stir deep emotions in any person who is
involved even as an observer. Thus, it is not surprising that
frequently in this situation the fear is expressed by an
avoidance of the issue in many ways, some subtle and some not so
subtle. There is hesitation to tell the dying person the gravity
of the condition, especially if his diagnosis is cancer. Doctors
many times advise the distraught family not to tell. The
implication is that the patient psychologically could not take
such ominous news and would disintegrate under the stress. A
common rationalization is that hope would be taken away and the
patient plunged into a deep depression. The assumption is made
for the patient that if he knew the truth, a bad situation would
automatically be made worse. By this line of reasoning, any show
of powerful emotions, even though genuine, is to be avoided at
all costs because the patient cannot take it. But what the family
really means is that they themselves are afraid to face the fact
of death. Undoubtedly, such a course of action, though admittedly
dishonest, seems justified by the situation "for the
patient's own good" and is many times the easiest thing to
do at first. The patient's direct questions, if any, are parried
with cheerful reassurance or adroitly avoided by changing the
subject or avowing ignorance. Nurses can do the same or, if
cornered, can refer the patient to his doctor, who can fill the
time spent with the patient during medical rounds with questions
about details of bowel function, appetite, and pain control.
But what does the patient think and feel about these
happenings? At first he may believe everything he is told,
especially because it is what he would like to think, but as his
condition worsens into a progressively downhill course, he may
realize more and more that something more serious is occurring.
In spite of the natural defense of denial, which can sustain some
patients for a while, he will begin to wonder if he is being told
the truth. If the pretense is continued, and sometimes at this
point it is even intensified, the patient will be getting a
powerful nonverbal message to avoid the issue. The fears of the
family will also be communicated and will reinforce the patient's
own private anxiety. Picking up the emotional turmoil of the
family in spite of attempts to hide it, the patient wonders what
they really know, but out of concern for them chooses not to
bring up issues which they are obviously avoiding. Each side then
attempts the heroic posture of protecting the other from what is
imagined to be too difficult to bear.
The more this dishonesty is perpetuated, the more difficult
it is to face the issues, and the more desperate the situation
becomes. Family members wonder what the patient will think of
them if he finally finds out that such vital information has been
withheld. It is almost as if the participants really believed
that not talking about something unpleasant would make it
magically disappear.
Perhaps the most devastating effect of such deception, even
when done with the honest intention of trying to make the
patient's burden lighter, is to increase the patient's
psychological isolation. At the very time when the welfare and
support of those closest to him could help him the most he feels
cut off at a basic level because his trust is undermined. He
cannot even talk about the things which concern him deeply. In
actuality the emotional pressure is increased for both patient
and family at this deadly game of pretense is played out.
It is no wonder that under such circumstances most patients
become depressed. With cancer patients the usual downhill course
also involves an increase in pain and suffering. When this is
treated with increasing doses of narcotic pain-killing drugs,
there is increased clouding of consciousness. Aldous Huxley in
his last novel, Island, describes the all too common
situation for the dying cancer patient as increasing pain,
increasing anxiety, increasing morphine, increasing addiction,
increasing demandingness, with the ultimate disintegration of
personality and loss of the opportunity to die with dignity. (1) To this list I
would add psychological isolation, withdrawal, and depression.
The LSD research in which I have engaged for the last few
years has been an attempt to alter this dehumanization in the
course of events prior to death. How, you may ask, can the use of
LSD, a powerful and sometimes dangerous psychoactive drug, be of
any value to a person who may soon be dead? Don't these poor
patients have enough drugs already—anti-cancer medicines,
pain-killing narcotics, tranquilizers, and anti-depressants, to
mention only a few?
Review of Some Basic Facts About
LSD and Psychedelic Experiences
In order to discuss these questions in perspective, the
psychological phenomena which can occur when LSD is administered
to human beings needs to be kept in mind. Five kinds of potential
psychedelic experiences have been described in detail with
examples elsewhere. (2,3)
Let me briefly review these.
First is the psychotic psychedelic experience
characterized by the intense negative experience of fear to the
point of panic, paranoid delusions of suspicion or grandeur,
total confusion, impairment of abstract reasoning, remorse,
depression, isolation, and/or somatic discomfort; all of these
can be of very powerful magnitude.
Second is the pschodynamic psychedelic experience
characterized by a dramatic emergence into consciousness of
material that has previously been unconscious or preconscious.
Abreaction and catharsis are elements of what subjectively is
experienced as an actual reliving of incidents from the past or a
symbolic portrayal of important conflicts.
Third is the cognitive psychedelic experience,
characterized by astonishing lucid thought. Problems can be seen
from a novel perspective, and the inner relationships of many
levels or dimensions can be seen all at once. The creative
experience may have something in common with this kind of
psychedelic experience, but such a possibility must await the
results of future investigation.
Fourth is the aesthetic psychedelic experience,
characterized by a change and intensification of all sensory
modalities. Fascinating changes in sensations and perception can
occur: synesthesia in which sounds can be "seen,"
objects such as flowers or stones that appear to pulsate and
become "alive," ordinary things that seem imbued with
great beauty, music that takes on an incredible emotional power,
and visions of beautiful colors, intricate geometric patterns,
architectural forms, landscapes, and almost anything imaginable.
The fifth and last type of psychedelic experience may
ultimately prove to be the most valuable and is the focus in
regard to treatment of the dying patient. This experience has
been called by various names: psychedelic-peak; cosmic,
transcendental, or mystical. Nine universal
psychological characteristics were derived from a study of the
literature of spontaneous mystical experience reported throughout
world history from almost all cultures and religions. When
subjected to a scientific experiment, these characteristics
proved to be identical for spontaneous and psychedelic mystical
experiences. (4,5)
1. Unity is a sense of cosmic oneness achieved through
positive ego transcendence. Although the usual sense of identity,
or ego, fades away, consciousness and memory are not lost;
instead, the person becomes very much aware of being part of a
dimension much vaster and greater than himself. In addition to
the route of the "inner world" where external sense
impressions are left behind, unity can also be experienced
through the external world, so that a person reports that he
feels a part of everything that is (for example, objects, other
people, or the universe), or more simply, that "all is
One."
2. Transcendence of Time and Space means that the
subject feels beyond past, present, and future, and beyond
ordinary three-dimension space in a realm of eternity or
infinity.
3. Deeply Felt Positive Mood contains the elements of
joy, blessedness, peace and love to an overwhelming degree of
intensity, often accompanied by tears.
4. Sense of Sacredness is a nonrational, intuitive,
hushed, palpitant response of awe and wonder in the presence of
inspiring Reality. The main elements are awe, humility, and
reverence, but the terms of traditional theology or religion need
not necessarily be used in the description.
5. The Noetic Quality, as named by William James, (6) is a feeling of
insight or illumination that, on an intuitive, nonrational level
and with a tremendous force of certainty, subjectively has the
status of Ultimate Reality. This knowledge is not an increase of
facts but is a gain in psychological, philosophical, or
theological insight.
6. Paradoxicality refers to the logical contradictions
that become apparent if descriptions are strictly analyzed. A
person may realize that he is experiencing, for example, an
"identity of opposites," yet it seems to make sense at
the time, and also afterwards.
7. Alleged ineffability means that the experience is
felt to be beyond words, non-verbal, and impossible to describe;
yet most persons who insist on the ineffability do in fact make
elaborate attempts to communicate the experience.
8. Transiency means that the psychedelic peak does not
last in its full intensity, but instead passes into an afterglow
and remains only as a memory.
9. Persisting Positive Changes in Attitudes and Behavior
are toward self, others, life, and the experience itself.
All the research I have done with psychedelic drugs for the
past six years supports the hypothesis that the kind of
experience is strongly dependent upon the necessary drug dosage,
but only as a trigger or facilitating agent, and upon the crucial
extra-drug variables of set and setting. Psychological set refers
to factors within the subject, such as personality, life history,
expectation, preparation, mood prior to the session, and, perhaps
most important of all the ability to trust, to let go, and to be
open to whatever comes. The setting refers to factors outside the
individual, such as the physical environment in which the drug is
taken, the psychological and emotional atmosphere to which the
subject is exposed, how he is treated by those around him, and
what the experimenter expects the drug reaction will be.
Elements of all these kinds of psychedelic experiences may
appear in any one psychedelic session, but the psychedelic
mystical experience is the most rare, being achieved by only 25
to 50 per cent of subjects, even under the most optimal
conditions of set and setting. The more control that is gained
over these variables, the more predictable is the chance of
obtaining the psychedelic mystical experience, but it is by no
means automatic. Yet when such an event is experienced and then
adequately integrated, it can provide the fulcrum for
transformations of attitude and behavior.
The Procedure of Psychedelic Psychotherapy
in our Current Research with the Dying Patient
At the Sinai Hospital in Baltimore, Maryland. we have been
assessing the impact of psychedelic psychotherapy utilizing LSD,
in the management of terminal cancer patients. (7) An LSD session is imbedded within the
matrix of brief intensive psychotherapy. Every effort is made to
maximize the possibility for the psychedelic mystical experience
to occur.
After a patient is referred for the special treatment, he is
screened both by psychiatric interviews and by psychological
tests. Then an informed consent is obtained in writing from both
the patient and his closest relative. By informed consent, I mean
that the nature and aim of the research are explained, including
the possible risks and benefits. Because of the sensationalism in
the mass media about the dangers of LSD, most patients do not
suffer from lack of information about risks. In fact, their
exaggerated ideas make a positive preparation more difficult, and
some patients who might benefit greatly refuse to participate in
the research because of fear. Most patients are surprised to
learn that the safety record of LSD when given by trained
personnel under medically controlled conditions is comparable to
that of other commonly used psychiatric procedures. (8)
Patients are told that LSD will not cure their physical
illness, hut may give them more emotional strength to cope with
what lies ahead. Usually control of pain is one of the presenting
problems. Although most of our patients have some degree of
physical pain, we try to emphasize that the analgesic effect of
LSD cannot he guaranteed and is not the main reason for the
treatment.
After consent is obtained, preparation for the LSD session
begins in the form of intensive individual psychotherapy for 8 to
10 hours. The aim is to get to know the person in as much depth
as possible by reviewing his life story and his important past
and current interpersonal relationships. Into this discussion
inevitably come his philosophy of life, religious experiences,
and hopes for the future. No attempt is made to force a
discussion of diagnosis or prognosis: but any indication of a
desire to explore these areas is sensitively dealt with in a way
appropriate to each individual. Above all the development of deep
rapport and trust is essential before LSD can he safely given.
Family members, too, are drawn into the therapy both
individually and in groups, with and without the patient. Some of
the issues discussed are positive and negative feelings, the
quality of interpersonal relationships, communication with the
patient, fear of death, and concern about the future. Their
questions and fears about LSD also must be aired.
Finally, after days of preparations when the patient is
deemed ready, LSD is administered in a private hospital room,
decorated with flowers and objects which have meaning for the
patient. The therapist who has worked with the patient and a
trained psychiatric nurse are in constant attendance throughout
the 10-to 12-hour session. For most of the day, the patient
listens to classical music through stereophonic high fidelity
earphones. The purpose of the music is to help him let go of his
usual ego controls and experience the unusual emotional awareness
which is possible under these conditions of altered brain
physiology.
In the evening, when the LSD effects have waned, the closest
family members visit the patient. These times can be an
opportunity for a gratifying emotional interchange. In the days
after the session, the patient is helped to integrate new
experiences, feelings, and insights.
Results of our Research
With this procedure thus far, we have treated only 17
patients in a pilot study with no control group. (9) While not much weight can be given to
our tentative findings in any scientific sense some results can
be mentioned to stimulate our thinking in regard to our subject
here today—man's approach to death and what may lie beyond.
Bearing in mind the inconclusiveness of our impressions, what
have we seen following the combined procedure of LSD plus
associated psychotherapy when measured against the situation
encountered at the beginning of treatment? First, no patients
seemed to have been harmed, even those who were physically quite
ill. In general, about one-third of the patients were not
particularly helped, one-third w ere helped somewhat, and
one-third were helped dramatically.
Let us look at the direction of the change, especially in
those patients who were helped the most. The LSD session seemed
to provide the focus around which a new situation could evolve in
the milieu provided by the psychotherapy. The most dramatic
effects came in the wake of psychedelic mystical experience.
There was a decrease in fear, anxiety, worry, and depression.
Sometimes the need for pain medications was lessened, but mainly
because the patient was able to tolerate what pain he had more
easily. There was an increase in serenity, peace, and calmness.
Most striking was a decrease in the fear of death. It seem as if
the mystical experience, by opening the patient to usually
untapped ranges of human consciousness, can provide a sense of
security that transcends even death. Once the patient is able to
release all the psychic energy which he has tied to the fear of
death and worry about the future, he seems able to live more
meaningfully in the present. He can turn his attention to the
things which have the most significance in the here and now. This
change of attitude has an effect on all the people around him.
The depth and intensity of interpersonal closeness can be
increased so that honesty and courage emerge in a joint
confrontation and acceptance of the total situation.
Let me illustrate some of the things I have seen by
describing an actual case. A 49-year-old woman with inoperable
cancer of the pancreas was brought to the hospital by her husband
and daughter when they could no longer tolerate her increasing
agony because of the intractable pain that was not satisfactorily
controlled by narcotic drugs. At this point, she was more like a
whimpering animal than a human being. In my work with the family
it soon became apparent that they were not only at the end of
their rope in regard to physical management of the patient but
were becoming increasingly concerned lest the patient discover
the true nature of her "tumor" and become even more
depressed than she already was. After I had gained his
confidence, the husband one day asked me directly if I did not
think that "mercy killing" was the most humane solution
in such cases.
After the usual period of screening and preparation, the
patient was given an LSD session that was filled with religious
symbolism and during which the patient reviewed many events of
her life. During part of the day the patient strongly felt the
presence of God and, through this experience, a sense of release
from guilt feelings about certain of her past actions. Although
the patient did not have a complete psychedelic mystical
experience, she carried a definite degree of psychedelic
afterglow into the evening fleeting with her family. Her mood was
brighter, and they noticed increased relaxation and peace of
mind. Her pain although still present, was controlled with
narcotic drugs and did not have the same disabling quality as
before admission to the hospital.
A few days after her LSD session, as I was sitting by her
bedside, the patient asked me directly, "Doctor, I have been
wondering what really is the matter with me. Do I have
cancer?" In this particular case the patient's personal
physician had advised me that neither he nor the family had felt
it wise to discuss the diagnosis. I asked the patient if she had
discussed the matter with her doctor. "I have tried
to," she said, "but everyone avoids my questions. I
think I do have cancer, because if I didn't they would say so
directly." I then proceeded to explore with the patient the
meaning of such a diagnosis for her if it were, indeed true.
Discussing the question posed in this half-hypothetical manner,
the patient indicated that if she did have cancer, she would have
to learn to live with it and accept it as a fact of her life. At
that very moment we heard the voice of the patient's physician in
the hallway. The patient asked me to get him. After I had advised
him of the nature of the preceding discussion, we entered the
room together. Without too much hesitation, the patient posed for
him the same question she had asked me, "Is this tumor that
I have a cancer?" He answered, "Well, it's
cancerous." "But is it a cancer?" she insistently
asked. When he indicated that it was, she gave a sigh and said:
"Well, it's a relief to know what I really have, even though
it isn't good news." Then she asked with some concern:
"Do my family know and have they known all along?" He
nodded, and she sank back on the bed half in amusement and half
in disgust, saying, "And they wouldn't even tell me."
In talking with the husband and daughter that afternoon, I
informed them what had happened. The news upset them even when
they learned that the patient had taken it calmly. They felt
unmasked and wondered how they could face the patient. They could
not quite believe that she could have accepted it so well and
felt that there would be an emotional "scene." After
discussing their feeling about the issue, I suggested that we go
and see the patient together. As we neared the room, the daughter
became visibly upset and at the doorway refused to go in. After
more discussion she reluctantly agreed, and we entered the room
together.
As soon as the patient saw her husband, she smiled and said:
"Well, I guess you know now that I'm going to die."
With this the husband broke down and began to sob uncontrollably.
The patient stretched out her arms inviting him to come to her
bedside. She took him in her arms and consoled him,
explaining that we all have to die sometime, that she was
grateful for what life had given her, and that she was sure they
would all get through this together. A sense of relief and
intense interpersonal closeness pervaded the room.
Before the patient left the hospital she had a second LSD
session. This time one of the major concerns that she explored
was the way she would explain to her young grandchildren what was
happening to her and what the ultimate outcome would be. This was
an issue which the daughter had also discussed with me. She
wondered whether she should even let the children see their
grandmother, who was becoming progressively emaciated. During the
LSD session the patient had a vision of all her grandchildren
standing by her beside. She had a very intense experience of
positive emotional feelings of love which she had for these
children and yet was able to come to a resolution of what she
could share with them in the days ahead.
After discharge from the hospital, the patient's husband and
daughter were able to care for her satisfactorily at home during
the month before she died. Her pain was now adequately controlled
with the aid of narcotics, but the daughter remarked on how much
better her mother seemed to be able to bear the pain than
previously. The patient was able to see her grandchildren for
some time each day, and they understood what was happening as she
got progressively weaker. They took this opportunity to discuss
with her some of their own questions about death, and
particularly her own death.
Discussion
At this point let us turn our attention to the question of
why the psychedelic mystical experience seems to help these
patients. I suggest that this experience has the potential for
opening up the channels of positive feeling which may have been
previously closed or clogged. Our experiments have indicated that
deep within every human being there are vast usually untapped
resources of love, joy, and peace. One aspect of the psychedelic
mystical experience is a release of these positive feelings with
subsequent decrease in negative feelings of depression, despair,
and anxiety. But this shift in mood is not enough to account for
our most dramatic finding—loss of the fear of death. In
fact, the experience of deeply felt positive mood may be more the
result than the cause of this change in attitude toward death.
Our data show that these feelings are released most fully when
there is complete surrender to the ego-loss experience of
positive ego transcendence, which is often experienced as a
moment of death and rebirth. At this point, unless the patient
previously had experienced mystical consciousness spontaneously,
he becomes intensely aware of completely new dimensions of
experience which he might never before have imagined possible.
From his own personal experience, he now knows that there is more
to the potential range of human consciousness than we ordinarily
realize. This profound and awe-inspiring insight sometimes is
experienced as if a veil had been lifted and can transform
attitude and behavior. Once a person has had this vision, life
and death can be looked at from a new perspective. Patients seem
able to meet the unknown with a new sense of self-confidence and
security. Logical arguments that human experience must be limited
to the narrow range of ordinary human consciousness never can
have the same force again. One patient, after his LSD experience,
wondered how he could have been so worried about death, which now
seemed to be just another step in the life process. Others
frankly and calmly stated that they would be "ready to
go" when the time to die came. This degree of acceptance and
willingness to face the unknown ahead was in strong contrast to
the atmosphere of fear among the family and patient before
psychedelic psychotherapy was started.
Before discussing the relevance of the psychedelic mystical
experience to immortality it would be well to review what William
James said in his Ingersoll Lecture 70 years ago. (10) In his view the
brain is a filter of consciousness which transmits part of the
Vaster Consciousness of Reality, like a partially opaque glass
allowing through a few rays of a super solar blaze. The
"degree of opacity" or threshold of brain activity can
vary so that under certain conditions "more light" or
an awareness of a wider and more intense range of consciousness
is possible. According to this hypothesis, the physical brain is
necessary only as a means to transmit a part of this Larger
Consciousness into the dimension of ordinary reality perceived by
individual normal waking consciousness. If an individual brain is
damaged, disintegrates, or dies, this Larger Consciousness does
not cease.
The interesting thing is that our LSD patients who have had
the psychedelic mystical experience and who previously knew
nothing of this transmission theory are supplying data which
precisely fit this hypothesis. Their threshold seems to be
lowered so that they directly experience this Vaster
Consciousness in an Eternal Now, beyond time and space. Again and
again we are told that this experience subjectively occurs
"out of the body."
But what is the relationship of individual self-consciousness
of the abiding presence of this Vaster Consciousness? William
James did not settle this question nor can I, but again the
psychedelic mystical experience may provide some clues. During
the mystical experience when the experiencer has lost
individuality and become a part of a Reality Greater-than-self,
paradoxically, something of the self remains to record the
experience in memory. One of the greatest fears about human death
is that personal individual existence and memory will be gone
forever. Yet having passed through psychological ego death in the
mystical experience, a person still preserves enough
self-consciousness so that at least part of individual memory is
not lost. In comparison, the loss of other attributes of
individuality such as bodily sensations and personal ego
accomplishments do not appear too important. It is at least
suggestive that persons experiencing mystical consciousness do
not feel that they have "lost" anything crucial—in
fact, a common report is that they have "come home" and
regained proper perspective.
By now I hope it is clear that LSD used in conjunction with
psychedelic psychotherapy is not another chemo-therapeutic method
to achieve a euphoric death, such as increasing doses of
painkillers which have a dulling effect on consciousness. With
such narcotics an escape is provided from harsh and painful
reality, but such cherished human experiences as love and
interpersonal closeness are not particularly enhanced. If the
fear surrounding death is dealt with at all, it is by sedating
the patient so much that he may be unaware of what is really
happening.
In contrast, when LSD is judiciously used, the mind becomes
more active and alert. Problems concerning death can be dealt
with rather than escaped from. Positive emotions can be released
in the service of deepened interpersonal relationships. An
important distinction is that LSD is not used on a continuing
basis. The purpose is not to keep the patient continuously under
the effect of LSD. One treatment is sometimes enough to make a
lasting difference. Even repeated treatments are spaced to allow
time for meaningful integration of the experience. Our data thus
far have indicated that the earlier LSD is given in the course of
the disease, the better chance there is for the patient to
utilize any insights gained. Although the treatment may prepare a
patient for death, the quality of living in the days before death
can be also affected.
Let me illustrate: one of our patients with metastatic breast
cancer had a son in his early twenties. His first bitter reaction
when the possibility of LSD treatment was mentioned was,
"What do you want to do, make my mother die with a smile on
her face?" Much to his surprise, the most important effect
of the treatment was to establish their somewhat ruptured
relationship on a new creative level. Now, five months after her
only treatment, this patient is still working on the implications
of this positive change in her family situation.
Does this treatment threaten to manipulate the human mind in
an unethical and dehumanizing manner? If by manipulation we mean
that human begins are used for purposes to which they neither
consent nor understand, the answer is no. Just the opposite is
true. The goal is to help the patient become more fully human and
able to use the last days of his life in a meaningful way—in
fact, a way which highlights the very things most basic and
important: human love, sharing, closeness, and thoughtful
reflection about the meaning and events of human life. As one of
our patients put it: "You get a clear picture of what is
important and what isn't. All the rushing around and the worry
about keeping my house neat was so unimportant compared to the
expression of feelings toward my family. I now fully realize that
the core of life is love."
In an ethical consideration of any new experimental
procedure, the proportionate degree of risk compared to the
potential benefit must be considered. From what we have seen in
our research so far, the benefits in human terms have been
impressive, the risks minimal. The danger of LSD depends on how
it is used. As Dr. Albert Kurland, who is responsible for all the
LSD projects at the Maryland Psychiatric Research Center, has
indicated, the role of LSD in therapy is like that of a scalpel
in surgical intervention: the scalpel is helpful, but without the
skilled surgeon it is merely a dangerous instrument. (11)
One consequence of the mystical experience is the inevitable
attempt to make intellectual sense of it. The primary
psychological experience must be interpreted. While some persons
use such symbols as a More, a Beyond, or the Ground of Being,
other speak of the presence of God as the most adequate
reflection of what was encountered. The fact that this experience
was triggered or facilitated with a drug may cause some to feel
uneasy. The troublesome implication seems to be that God can thus
be controlled, limited, or manipulated. Yet the psychedelic
mystical experience is by no means automatic, and there are many
unexplained factors. All chemical substances, including LSD, are
part of God's creation. Man, of course, has the freedom to misuse
or abuse them, but the use of LSD to give comfort to the dying
patient hardly seems an abuse. For man to decide that God cannot
work through any part of his creation would be to limit the
freedom and omnipotence of God. (12)
That such profound experiences are possible with the aid of a
drug may seem on first impression to be an easy and somewhat
sacrilegious means of "instant salvation." On the
contrary, much intensive preparation is needed for the
psychedelic mystical experience to occur at all. Then, perhaps
even more importantly, the work of follow-up integration is
necessary for the experience to be therapeutically useful rather
than only a pleasant memory. Yet, subjectively, there is also a
profound feeling of gratitude because such an experience seems
undeserved. The concept of gratuitous grace as another example of
God's freedom is appropriate here.
The mystical experience itself by emphasizing an immediate
perception of the Divine dimension has historically met
opposition from the church. Mysticism has also always been
accused of pantheism. Yet the indwelling of the Spirit is as
deeply rooted in Christian tradition as the absolute
transcendence of God.
Implications
What implications would there be if further research
substantiates the promise that psychedelic psychotherapy has
shown in the treatment of the dying patient? In my own work I
have welcomed the collaboration of religious professionals, part
of whose job is ministering to the dying. In our modern age this
task has become increasingly difficult because of the growing
dissatisfaction with traditional formulations and beliefs. The
psychedelic mystical experience has the potential for opening up
new ways of thinking and feeling. Patients are eager to discuss
the meaning of these new insights, many of which are imbedded in
religious symbolism. Ministers, priests, and rabbis, if they have
some understanding of the use of psychedelic drugs, can be of
tremendous help in integrating these experiences.
In the future it might be possible to establish centers where
dying patients could be sent to have a psychedelic experience in
the most optimal setting. The staff of such a place would include
psychiatrists, psychologists, and religious professionals. This
suggestion is not as utopian as it might sound. Dr. Cecily
Saunders in England has already pioneered a successful center
where medical treatment is given to keep dying patients as
comfortable as possible in their last days. (13) LSD has not been tried there, but
adequate doses of alcohol and heroin are used to combat
depression and pain. Our preliminary results suggest that
psychedelic drugs might accomplish much more. Certainly this
hypothesis can be tested experimentally.
If the use of psychedelic psychotherapy for the dying patient
ever should become widespread in our society, there would
probably be a change in our whole approach toward death. There
might be less fear and more acceptance of this part of the life
process. Certainly more honesty and less pretense would be a
healthy change for our culture.
Conclusion
Although the question of human immortality may always remain
a tantalizing enigma. the psychedelic mystical experience at
least teaches that there is more to the range of human
consciousness than we might ordinarily assume. Because the answer
cannot be definitely proved either way, there is certainly no
cause for pessimistic despair. Perhaps it is not so unfortunate
that each person must ultimately find out for himself. The
psychedelic mystical experience can prepare one to face that
moment with a sense of open adventure.
Footnotes
1 Aldous HUXLEY, Island (New
York: Harper & Row 1962). (back)
2 WALTER N. PAHNKE, and WILLIAM A.
RICHARDS Implications of LSD and Experimental Mysticism, Journal
of Religion and Health 5 (1966), 175-208. (back)
3 WALTER N. PAHNKE, LSD and Religious
Experience In LSD, Man and Society. Leaf and Debold (ed.)
(Middletown, Connecticut: Wesleyan University Press, 1967)
4 WALTER N. PAHNKE, Drugs and
Mysticism: An Analysis of the Relationship between Psychedelic
Drugs ant the Mystical Consciousness. Unpublished Ph.D. thesis
Cambridge, Massachusetts: Harvard University, 1963. (back)
5 For a summary of this experiment,
see WALTER N PAHNKE, The Contribution of the Psychology of
Religion to the Therapeutic Use of the Psychedelic Substances, in
The Use of LSD in Psychotherapy and Alcoholism, H. A
ABRAMSON (ed.) (Indianapolis: Bobbs-Merrill, 1967) 629-52.
6 WILLIAM JAMES, The Varieties of
Religious Experience (Modern Library Edition) (New York:
Random House, 1902), 371f. (back)
7 A. KURLAND, W. PAHNKE, S. UNGER,
and C. SAVAGE Psychedelic Therapy (Utilizing LSD) with Terminal
Cancer Patients, Journal of Psychopharmacology Vol. II (in
press, 1968). (back)
8 In the several large-scale research
projects which have been approved by the U.S. Government in the
last few years, permanent adverse effects have been quite rare.
At the Spring Grove State Hospital, for example, over 300
patients have been treated with LSD without a single case of
long-term psychological or physical harm directly attributable to
the treatment, although there have been two transient post-LSD
disturbances which have subsequently responded well to
conventional treatment. (back)
9 The fact that there was no control
group against which to measure these results immediately raises
the possibility that our findings were due to powerful suggestion
implemented by the intensive psychotherapy rather than anything
to do with the administration of LSD. It might be argued that a
placebo control group would attain the same results, but other
experimental evidence concerning the occurrence of psychedelic
mystical experience tends to cast some doubt on this argument. In
two previous series of psychedelic drug experiments that I have
helped to plan and supervise, double blind control groups were
utilized. In each instance the psychedelic mystical experience
occurred to a statistically significant degree in those persons
who received a high dose of psilocybin when compared to control
groups which had exactly the same preparation, expectation, and
suggestion, but received only a placebo or control substance with
active physiological effects. (W. N. PAHNKE, thesis, op. cit.;
and W. N. PAHNKE, LSD and Religious Experience, op. cit.)
Consideration of the powerful placebo effect is certainly
important. Recent research has demonstrated that giving LSD
mainly as a chemotherapy without adequate preparation and
suggestion does not provide any advantage over psychotherapy
alone in the treatment of alcoholism. (A LUDWIG, J. LEVINE, and
L. STARK, A Clinical Evaluation of LSD Treatment in Alcoholism,
Paper presented to the American Psychiatric Association meeting
in Boston, Massachusetts, May 15, 1968.)
This finding underlines the importance of utilizing
suggestion to the maximum in combination with LSD as has been our
practice. For example, at the Spring Grove State Hospital in
Baltimore, the double blind control study of psychedelic peak
therapy utilizing LSD has demonstrated that one out of four
alcoholics who received 450 micrograms of LSD had a profound
mystical experience compared to one out of ten who received only
50 micrograms (total N = 122). Both groups received exactly the
same amount of pre-LSD psychotherapy and identical preparation
for the LSD session. In this particular study the results in
terms of clinical outcome are not yet completely evaluated, but
early trends in the data show that those patients who had a
profound psychedelic peak experience achieved greater clinical
improvement. (A. KURLAND, S. UNGER, C. SAVAGE, J. OLSSON, W.
PAHNKE, Psychedelic Therapy Utilizing LSD in the Treatment of the
Alcoholic Patient: A Progress Report paper presented to the
American Psychiatric Association meeting in Boston,
Massachusetts, May 15, 1968.)
Thus, in the research with cancer patients there is reason to
suppose that the beneficial results observed are not due to
either the psycho-pharmacological effects of LSD or the placebo
effect (suggestion and preparation) alone, but rather a
combination of set, setting, and drug. For the best results it
seems essential that the placebo effect be utilized to the utmost
in conjunction with the psychedelic drug which is then seen to be
a necessary, but not sufficient, condition. (back)
10 WILLIAM JAMES, Human Immortality:
Two Supposed Objections to the Doctrine, The Ingersoll Lecture on
Human Immortality, 1898, in William James on Psychical
Research, GARDNER MURPHY and ROBERT BALLOU (eds.) (New York:
The Viking Press, 1960), 279-308. (back)
11 ALBERT A. KURLAND, with CHARLES
SAVAGE, JOHN W. SHAFFER, and SANFORD UNGER, The Therapeutic
Potential of LSD in Medicine, in LSD, Man and Society,
LEAF and DEBOLD (ed.) (Middletown, Connecticut: Wesleyan
University Press, 1968), 34. (back)
12 Those who have lived fully and
deeply know that suffering can have a redemptive value in terms
of personal growth and understanding. Yet in my medical
experience the slow and tortuous devastation to the human spirit
caused by the usual course of terminal cancer is mostly on the
negative side. Reflecting my bias as a physician dedicated to the
alleviation of suffering, I do not feel that this kind of
emotional and physical torment serves much useful purpose. For
this reason, I feel that the addition of psychedelic drugs to the
medical armamentarium against human suffering cannot be objected
to on the grounds that man has no right to interfere with an
element of human life which may serve a useful purpose in God's
plan for man's development. Such an argument is too similar to
the theological objections raised against the introduction of
smallpox vaccination or the invention of rapid transportation. (back)
13 CECILY SAUNDERS, The Treatment of
Intractable Pain in Terminal Cancer, Proceedings of the Royal
Society of Medicine, Vol. 56, No. 3 (March, 1963), 191-97. (back)
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