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How Psychedelic Drugs Can Help Patients Face Death

By Phungushead, Apr 21, 2012 | | |
  1. Phungushead
    Pam Sakuda was 55 when she found out she was dying. Shortly after having a tumor removed from her colon, she heard the doctor’s dreaded words: Stage 4; metastatic. Sakuda was given 6 to 14 months to live. Determined to slow her disease’s insidious course, she ran several miles every day, even during her grueling treatment regimens. By nature upbeat, articulate and dignified, Sakuda — who died in November 2006, outlasting everyone’s expectations by living for four years — was alarmed when anxiety and depression came to claim her after she passed the 14-month mark, her days darkening as she grew closer to her biological demise. Norbert Litzinger, Sakuda’s husband, explained it this way: “When you pass your own death sentence by, you start to wonder: When? When? It got to the point where we couldn’t make even the most mundane plans, because we didn’t know if Pam would still be alive at that time — a concert, dinner with friends; would she still be here for that?” When came to claim the couple’s life completely, their anxiety building as they waited for the final day.

    As her fears intensified, Sakuda learned of a study being conducted by Charles Grob, a psychiatrist and researcher at Harbor-U.C.L.A. Medical Center who was administering psilocybin — an active component of magic mushrooms — to end-stage cancer patients to see if it could reduce their fear of death. Twenty-two months before she died, Sakuda became one of Grob’s 12 subjects. When the research was completed in 2008 — (and published in the Archives of General Psychiatry last year) — the results showed that administering psilocybin to terminally ill subjects could be done safely while reducing the subjects’ anxiety and depression about their impending deaths.

    Grob’s interest in the power of psychedelics to mitigate mortality’s sting is not just the obsession of one lone researcher. Dr. John Halpern, head of the Laboratory for Integrative Psychiatry at McLean Hospital in Belmont Mass., a psychiatric training hospital for Harvard Medical School, used MDMA — also known as ecstasy — in an effort to ease end-of-life anxieties in two patients with Stage 4 cancer. And there are two ongoing studies using psilocybin with terminal patients, one at New York University’s medical school, led by Stephen Ross, and another at Johns Hopkins Bayview Medical Center, where Roland Griffiths has administered psilocybin to 22 cancer patients and is aiming for a sample size of 44. “This research is in its very early stages,” Grob told me earlier this month, “but we’re getting consistently good results.”

    Grob and his colleagues are part of a resurgence of scientific interest in the healing power of psychedelics. Michael Mithoefer, for instance, has shown that MDMA is an effective treatment for severe P.T.S.D. Halpern has examined case studies of people with cluster headaches who took LSD and reported their symptoms greatly diminished. And psychedelics have been recently examined as treatment for alcoholism and other addictions.

    Despite the promise of these investigations, Grob and other end-of-life researchers are careful about the image they cultivate, distancing themselves as much as possible from the 1960s, when psychedelics were embraced by many and used in a host of controversial studies, most famously the psilocybin project run by Timothy Leary. Grob described the rampant drug use that characterized the ’60s as “out of control” and said of his and others’ current research, “We are trying to stay under the radar. We want to be anti-Leary.” Halpern agreed. “We are serious sober scientists,” he told me.

    Sakuda’s terminal diagnosis, combined with her otherwise perfect health, made her an ideal subject for Grob’s study. Beginning in January 2005, Grob and his research team gave Sakuda various psychological tests, including the Beck Depression Inventory and the Stai-Y anxiety scale to establish baseline measures of Sakuda’s psychological state and to rule out any severe psychiatric illness. “We wanted psychologically healthy people,” Grob says, “people whose depressions and anxieties are not the result of mental illness” but rather, he explained, a response to a devastating disease.

    Sakuda would take part in two sessions, one with psilocybin, one with niacin, an active placebo that can cause some flushing in the face. The study was double blind, which meant that neither the researchers nor the subjects knew what was in the capsules being administered. On the day of her first session, Sakuda was led into a room that researchers had transformed with flowing fabrics and fresh flowers to help create a soothing environment in an otherwise cold hospital setting. Sakuda swallowed a capsule and lay back on the bed to wait. Grob had invited her — as researchers do with all their subjects — to bring objects from home that had special significance. “These objects often personalize the session room for the volunteer and often prompt the patient to think about loved ones or important life events,” Roland Griffiths, of Johns Hopkins, says.

    “I think it’s kind of goofy,” Halpern says, “but the thinking is that with the aid of the psychedelic, you may come to see the object in a different light. It may help bring back memories; it promotes introspection, it can be a touchstone, it can be grounding.”

    Sakuda brought a few pictures of loved ones, which, Grob recalled, she clutched in her hands as she lay back on the bed. By her side were Grob and one of his research assistants, both of whom stayed with the subjects for the six-to-seven-hour treatment session. Sakuda knew that there would be time set aside in the days and weeks following when she would meet with Grob and his team to process what would happen in that room. Black eyeshades were draped over Sakuda’s face, encouraging her to look inward. She was given headphones. Music was piped in: the sounds of rivers rushing, sweet staccatos, deep drumming. Each hour, Grob and his staff checked in with Sakuda, as they did with every subject, asking if all was O.K. and taking her blood pressure. At one point, Grob observed that Sakuda, with the eyeshades draped over her face, began to cry. Later on, Sakuda would reveal to Grob that the source of her tears was a keen empathetic understanding of what her spouse Norbert would feel when she died.

    Grob’s setup — the eyeshades, the objects, the mystical music, the floral aromas and flowing fabrics — was drawn from the work of Stanislav Grof, a psychiatrist born in Prague and a father of the study of psychedelic medicine for the dying. In the mid-’60s — before words like “acid” and “bong” and “Deadhead” transformed the American landscape, at a time when psychedelics were not illegal because most people didn’t know what they were and thus had no urge to ingest them — Grof began giving the drug to cancer patients at the Spring Grove State Hospital near Baltimore and documenting their effects.

    Grof kept careful notes of his many psychedelic sessions, and in his various papers and books derived from those sessions, he described cancer patients clenched with fear who, under the influence of LSD or DPT, experienced relief from the terror of dying — and not just during their psychedelic sessions but for weeks and months afterward. Grof continued his investigations into psychedelics for the dying until the culture caught up with him — the recreational use of drugs and the reaction against them leading to harsh antidrug laws. (Richard Nixon famously called Timothy Leary “the most dangerous man in America.”) Financing for psychedelic studies dried up, and Grof turned his attention to developing alternative methods of accessing higher states of consciousness. It is only now, decades later, that Grob and a handful of his fellow scientists feel they can re-examine Grof’s methods and outcomes without risking their reputations.

    Norbert Litzinger remembers picking up his wife from the medical center after her first session and seeing that this deeply distressed woman was now “glowing from the inside out.” Before Pam Sakuda died, she described her psilocybin experience on video: “I felt this lump of emotions welling up . . . almost like an entity,” Sakuda said, as she spoke straight into the camera. “I started to cry. . . . Everything was concentrated and came welling up and then . . . it started to dissipate, and I started to look at it differently. . . . I began to realize that all of this negative fear and guilt was such a hindrance . . . to making the most of and enjoying the healthy time that I’m having.” Sakuda went on to explain that, under the influence of the psilocybin, she came to a very visceral understanding that there was a present, a now, and that it was hers to have.

    Two weeks after Sakuda’s psilocybin session, Grob readministered the depression and anxiety assessments. Over all among his subjects, he found that their scores on the anxiety scale at one and three months after treatment “demonstrated a sustained reduction in anxiety,” the researchers wrote in The Archives of General Psychiatry. They also found that their subjects’ scores on the Beck Depression Inventory dropped significantly at the six-month follow-up. “The dose of psilocybin that we gave our subjects was relatively low in comparison to the doses in Stanislav Grof’s studies,” Grob told me. “Nevertheless, and even with this modest dose, it appears the drug can relieve the angst and fear of the dying.”

    Lauri Reamer is a 48-year-old survivor of adult-onset leukemia. Before the leukemia, she was an anesthesiologist and a committed agnostic who believed in “validity” and “reliability,” the scientific method her route to truth. Reamer recalls the morning when all that changed, when, utterly depleted, she bumped her leg on a railing and saw a bruise rush up, livid on her pale flesh; it was then she knew something was terribly wrong. After that came the diagnosis, the bone-marrow biopsies, the terrible trek toward a recovery that was tentative at best. “I believed I was going to die,” Reamer told me.

    Reamer made it through the leukemia — or, rather, she went into remission — but the illness and the brutal bone-marrow treatments she underwent left a deep mental scar, a profound fear that the cancer would return made it difficult to experience any joy in life. Her illness was lurking around every corner, waiting to haul her away. “When I was near death, I wasn’t so afraid of it,” Reamer said, “but once I went into remission, well, I had an intense fear and anxiety around relapse and death.”

    It was in the midst of this fear that, one day in May 2010, Reamer learned about Griffiths’s study at Johns Hopkins. For years, Griffiths had been studying the effects of psilocybin on healthy volunteers. He wanted to see if particular doses of the drug could induce mystical states similar to naturally occurring ones: think Joan of Arc or Paul on the road to Damascus. Griffiths says that he and his research team found an ideal range of dosage levels — 20 to 30 milligrams of psilocybin — that not only reliably stimulated “mystical insights” but also elicited “sustained positive changes in attitude, mood and behavior” in the study volunteers. Specifically, when Griffiths administered a psychological test called the Death Transcendance Scale at the 1- and 14-month follow-up, he saw subjects’ ratings rise on statements like “Death is never just an ending but part of a process” and “My death does not end my personal existence.”

    “After transcendent experiences, people often have much less fear of death,” Griffiths says. Fourteen months after participating in a psilocybin study that was published in The Journal of Psychopharmacology last year, 94 percent of subjects said that it was one of the five most meaningful experiences of their lives; 39 percent said that it was the most meaningful experience.

    Wondering whether he could see the same shifts in attitude in terminally ill patients, he designed a study that gave subjects a high dose of psilocybin (higher than Grob had given) in one session and a dose that varied from subject to subject in a second session. Because the study is continuing, Griffiths did not want to discuss the precise amounts of the drug given, but said that “dose selection in the cancer study is informed by what we have learned in the prior studies.”

    At the end of September 2010, Lauri Reamer took her first dose of psilocybin. “I mostly just cried through that session,” she says. Three weeks later, she went back to Johns Hopkins for her second dose. She remembers a lovely room with a large plush couch. Griffiths entered and wished her well. Reamer had pictures of her children and items that reminded her of her recently deceased father, and after swallowing the psilocybin capsule, Reamer sat with two study coordinators and looked at the memorabilia. She talked about what each item meant to her, waiting for the drug to take effect, assessing her own internal state. “And then it happened,” she told me. “I was at first sitting up on the couch and talking about my daughter’s baby blanket, which I’d brought with me, and then I went supine. They dimmed the lights. I got dark eyeshades. They put headphones on me, and music started pouring into my ears. Some dark opera. Some choral music. Some mystical music. There was a bowl of grapes; they were big juicy grapes,” Reamer says, and she remembers the sweetness, the freshness, the tiny seeds embedded in the gel.

    Once the drug took effect, Reamer lay there and rode the music’s dips and peaks. Reamer said that her mind became like a series of rooms, and she could go in and out of these rooms with remarkable ease. In one room there was the grief her father experienced when Reamer got leukemia. In another, her mother’s grief, and in another, her children’s. In yet another room was her father’s perspective on raising her. “I was able to see things through his eyes and through my mother’s eyes and through my children’s eyes; I was able to see what it had been like for them when I was so sick.”

    Reamer took the psilocybin at about 9 a.m., and its effects lasted until about 4 p.m. That night at home, she slept better than she had in a long time. The darkness finally stopped scaring her, and she was willing to go under, not because she knew she would come back up but because “under” was not as frightening. Why she was less afraid to die is hard for her to explain. “I now have the distinct sense that there’s so much more,” she says, “so many different states of being. I have the sense that death is not the end but just part of a process, a way of moving into a different sphere, a different way of being.”

    Despite their differing stances, MAPS and researchers meet at many points. Doblin, for instance, has F.D.A. approval to do a study on the psychological effects of MDMA when taken by healthy volunteers. His subjects will be therapists who are taking part in a MAPS program that teaches them how to guide their clients through psychedelic journeys. Doblin also worked closely with the Swiss researcher Dr. Peter Gasser in investigating the safety and efficacy of LSD-assisted psychotherapy for subjects with anxiety stemming from life-threatening illnesses.

    Rick Doblin has done a lot for the field, but he is more of a populist,” Grob says. “We need careful and controlled scientific studies showing the efficacy of these drugs so funding can continue.” Broader awareness of these sorts of end-of-life psychedelic studies could be good for everyone, the researchers say. “If insurance companies knew about our outcomes, they might get a lot more interested in what we’re doing here.” Griffiths continued: “When you make people less afraid to die, then they’re less likely to cling to life at a huge cost to society. After having such a transcendent experience, individuals with terminal illness often show a markedly reduced fear of dying and no longer feel the need to aggressively pursue every last medical intervention available. Instead they become more interested in the quality of their remaining life as well as the quality of their death.”

    In a future still far off, Grob imagines retreat centers where the dying could have psilocybin administered to them by a staff trained for the task. Doblin asks: “Why confine this to just the dying? This powerful intervention could be used with young adults who could then reap the benefits of it much earlier.” The subjects who have undergone psilocybin treatment report an increased appreciation for the time they have left, a deeper awareness of their roles in the cycle of life and an increased motivation to invest their days with meaning. “Imagine allowing young adults, who have their whole lives in front of them, access to this kind of therapy,” Doblin says. “Imagine the kind of lives they could then create.”

    If David Nutt, in Britain, is able to prove the efficacy of psilocybin for treatment-resistant depression, would the F.D.A. ever consider approving it for that use? And if that ever were to happen, what sort of slippery slope would we find ourselves on? 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?

    Halpern is not particularly worried about this theoretical future, in large part because he doesn’t see much hope for psilocybin as a medicine. “There’s no money in it,” he says. “What drug company is going to invest millions in a substance widely available in our flora and fauna?” Grob has a more practical response, suggesting that, in our theoretical future, drugs like psilocybin should be reserved for only those who have no other alternatives. “There’s a lot of good treatment for depression,” he says. “And anxiety too. A drug like psilocybin, or maybe psilocybin itself, should be reserved for those who have no other treatment options.”

    Besides, Grob told me, scientists are still at the very early stages of this research. “Twelve people,” he says of the size of his study. “One study with 12 people is not very definitive.” And yet, talking to him, you can hear a hint of excitement, something rising. “We saw remarkable and sustained changes in cancer patients’ spiritual dispositions. People’s entire sense of who they are has been altered in a positive manner.” He is looking forward to the day, he told me, when Griffiths and Ross “crunch their numbers” from their current studies. Grob says, “From what they say they’re seeing, it all sounds very positive.” Perhaps, then, we need not understand precisely how and why psilocybin works, accepting, as Halpern puts it, that “when you combine the chemical, the corporeal and the spiritual, you get a spark. You get magic.”

    April 20, 2012



  1. Phungushead
    Psychedelic drug given to Stage 4 cancer patients in FDA-approved study

    [IMGR="white"]http://www.drugs-forum.com/forum/attachment.php?attachmentid=26045&d=1336270963[/IMGR]NEW YORK - Imagine getting the news you're going to die of an incurable disease.

    Devastating, right?

    Some doctors are thinking outside of the box when it comes to helping patients cope with such news.

    With incurable stage-four cancer spreading through her body, artist Norma Lauring decided she had little to lose.

    Early one morning, in a Manhattan doctor's office she put on headphones, lay down, and swallowed a powerful psychedelic drug with the same chemical properties as those magic mushrooms that came to define the Woodstock generation of the 60's.

    “It was kind of wonderful visual world of colors and figures and motion,” Lauring said. “More profound for me was a feeling of being connected, through time to other artists - to a creative force - and a feeling of peace.”

    In combination with therapy, that feeling lasted nearly five months. Though for some people taking part in this FDA approved New York University study, the feeling has lasted even longer.

    Because it's in the same legal category as cocaine, heroin and crystal meth, the drug is kept under lock and key.

    Dr. Stephen Ross, an addiction specialist at NYU, has been given a license by drug agents to test whether the drug can help end-stage cancer patients like Norma.

    “I've been very surprised in terms of patients having reduction or resolution of death anxiety, decreased depression, more connecting to family, shifting from a fearful-state-towards- death to a much more meaningful life,” Dr. Ross said.

    Dr. Jeffrey Guss is one of the main investigators.

    “Sometimes people with cancer begin to die earlier than their body actually dies” Dr. Guss said. “They begin to withdraw, feel like life has no purpose, life has no meaning.”

    The trial is only in its second phase, but Guss says findings show a single dose helps people with terminal cancer let go of lifelong behaviors and habits.

    “It's our hope that helping them have a spiritual or mystical experience will awaken and relatively quickly awaken a new way of understanding themselves,” Guss said.

    Norma Lauring, a naturally positive person, says she's now more at peace.

    “A feeling of being connected to people, the universe, the past, the present - that I'm just sort of passing through here,” she said.


    CNN News
  2. Phungushead
    Psychiatric Power and Taboo in Modern Psychedelia

    [IMGL="white"]http://www.drugs-forum.com/forum/attachment.php?attachmentid=27691&stc=1&d=1345302144[/IMGL] In the April 20 edition of the New York Times Magazine, a front-page article appeared outlining the current state of scientific research in the field of psychedelic medicine. The article -- entitled "How Psychedelic Drugs Can Help Patients Face Death" -- described clinical trials in which substances such as psilocybin, LSD, and MDMA have been administered to adult volunteers suffering from a variety of medical conditions, ranging from cluster headaches to life-threatening forms of cancer. Such research has become increasingly common during the last two decades, with numerous studies gaining F.D.A. approval and receiving the support of prominent institutions such as Harvard and Johns Hopkins. The result of this trend has been the formation of a new paradigm of psychedelic practice -- one defined by a thoroughgoing medicalization of psychedelic discourse; a scientific professionalization of access to, and control over, psychedelic experiences; and an incorporation of psychedelic chemicals into the pharmacopeia of modern industrial medicine.

    For the most part, the novelty of this paradigm lies not in the discovery of new information about the healing powers of psychedelic substances, but in the emergence of a new political and scientific apparatus within which a range of legitimate psychedelic investigations can be carried out. Essential to the functioning of this apparatus is the cultivation of a reformed public image, based on the appearance of a rupture with the "dangerous" psychedelic experiments of the American counterculture of the past fifty years. Accordingly, as with much recent commentary on the subject, one finds that the New York Times Magazine article is written in a kind of doxastic code. "Anti-Leary" is the term used by Dr. Charles Grob -- one of the psychiatrists interviewed in the article -- to describe the outlook he shares with other members of the new professional class of psychedelic researchers. This attitude is echoed elsewhere by some of the earliest and most influential proponents of legitimized psychedelic research, who invoke the dangers of "unsupervised" and "uncontrolled" use of psychedelics, and lament the "misuse and improper use" that, in their judgment, characterized the "drug culture" of the 1960s and 70s.

    This attempt to identify "improper" experimentation with the figure of Timothy Leary also situates the new wave of psychedelic research in relation to an older sectarian debate over the appropriate use of psychedelics in modern society. As the psychedelic experience suddenly emerged as an object of critical reflection for Anglophone intellectuals in the 1950s and 60s, Leary came to represent the "populist" side of this debate, in contrast to figures such as Aldous Huxley, who believed psychedelics should be reserved for an elite class of visionaries and cultural pioneers. However, there was another dimension to Leary's role in this controversy -- his refusal to confine his psychedelic experiments within the boundaries of established scientific protocol -- and it is this aspect of Leary's legacy that his present-day opponents find most disturbing.

    The coded discourse of the New York Times Magazine article reveals the extent to which the public debate on psychedelics has shifted, in recent years, in favor of this "Anti-Leary" prejudice. Whereas in the 1960s, the central rift was between advocates of institutional research, on the one hand, and proponents of free, "unsupervised" experimentation on the other, now the problem of psychedelics is addressed almost exclusively within the framework of scientific oversight and control. Both sides of the intellectual polarity set up in the New York Times Magazine article, for example, fall squarely within the "Anti-Leary" end of the spectrum.

    Rick Doblin, whom the article casts as its token representative of psychedelic "populism," is the founding director of the Multidisciplinary Association of Psychedelic Studies (MAPS), an organization whose primary mission is to finance and publicize clinical research carried out by scientific institutions in collaboration with government regulatory agencies. Doblin's supposed "populism" consists in his willingness to extend the scientific legitimation of psychedelic research beyond the treatment of terminally and severely ill patients to include the general promotion of psychological health and self-realization among members of the undiagnosed population. While this approach holds the promise of facilitating access to psychedelic drugs for law-abiding individuals unburdened by serious medical conditions, it leaves the more difficult question of the appropriateness of scientific, psychotherapeutic, and state-regulatory models for the administration of psychedelic experiences largely unexamined.

    Even as the terms of the public discourse on psychedelics move further in this clinicalized, regulatory direction, cultures of independent psychedelic exploration continue to grow in both influence and complexity. Indeed, without trivializing the efforts of MAPS and other scientific researchers to actualize the healing powers of psychedelic medicine, it must be acknowledged that the vast majority of successful psychedelic experimentation throughout human history has been carried out independent of scientific, medical, and state oversight. The inability of the new legitimizing discourse to take this body of research into account is symptomatic of a deeply rooted taboo in modern civilization on the matter of psychedelic experience. This taboo is not reducible to the legal prohibition of psychedelic substances, as instituted by the Controlled Substances Act of 1970, though criminalization is one of its functions. Rather, it is a taboo that conceals, distorts, and excludes specific channels of information made available in the course of psychedelic experience -- information that implies a fundamental break with the metaphysical order upon which industrial mass society is based. By seeking to incorporate the powers of psychedelic experience into the institutional and philosophical matrix of modern science, the new paradigm of psychedelic research participates in the enforcement of this taboo, even as it tries to ameliorate some of its inhumane effects.

    The logic by which this taboo operates is illustrated in paradigmatic form by the discursive regime of the New York Times Magazine article, "How Psychedelic Drugs Can Help Patients Face Death." As indicated by the title, the key medical breakthrough attributed to psychedelics in the article is their ability to aid certain individuals in establishing a modified relationship to death. Elsewhere, a leading psychiatric researcher claims that psychedelic substances, taken under favorable conditions, have the power to "alleviate or even eliminate" fear of death, and "to positively transform the experience of dying," in those who receive them.

    Patients approaching the end-stages of a terminal illness have been the principal subjects of research in this area, and the New York Times Magazine article focuses almost exclusively on such cases, reporting their results as the latest achievements of cutting-edge medical science. However, far from being confined to any narrow clinical context, the relation to death is a problem that must be faced by all civilized human beings. Indeed, this problem, rooted in the modern-historical conception of death as the absolute negation of the existence of the separate self, is one of the fundamental sources of the suffering and alienation inherent in civilized life. It is not only the sudden awareness of mortality brought on by extreme illness, but the unbearable, irresolvable consciousness of death inscribed in all lapsarian worldviews, that calls for our attention. And yet the New York Times Magazine article excludes the possibility that psychedelics could be utilized by independent experimenters to break through the pain and fear encoded in the modern consciousness of death. On the contrary, the author assumes from the outset that such transformative effects of psychedelics do not actually manifest beyond the boundaries of institutional and clinical studies -- an assumption which many readers of this journal will recognize as patently false.

    This denial of common psychedelic experience, on the part of the "paper of record," is made possible by a background of manufactured consensus on the subject of psychedelics -- a background that is not fundamentally distinct from the generalized cultural consensus maintained by the New York Times and other agents of mass media. Within this controlled environment, the use of psychedelics is classified by default as a form of criminal activity, and independent psychedelic experimenters are relegated to the status of criminals, worthy of punishment. Far from qualifying as healing or spiritual behavior, the activity of seeking transformative experiences through the ingestion of LSD or psilocybin is defined as an immoral, pathological state -- a state of being "on drugs."

    Moreover, even when psychedelic experiences are recognized by the user as possessing extraordinary healing or revelatory value, this value is ultimately explained away as a by-product of hallucination, or as an anomalous episode of merely subjective enthusiasm. In this way, the civilizational taboo on psychedelic experience is enforced through an encoded logic of exclusion and pathologization, according to which the user of psychedelic substances is identified as a degenerate, criminal, and abnormal subject, capable only of errant or delusional perceptions, contributing nothing of enduring transformative benefit or truth-value to the wider community.

    With the institution of a new scientific and professional model for the use of psychedelics, a place is established in the dominant cultural order for psychedelic substances, along with a new set of mechanisms by which the taboo on psychedelic experience can be formalized, regulated, and systematically applied. Under this regime, not only psychedelic experiences, but the need for psychedelic experience, becomes defined according to technically precise categories of health and pathology. Access to psychedelic substances is restricted on the basis of these categories, with the new quasi-priestly class of psychedelic scientists serving as official gatekeepers and mediators of psychedelic knowledge. A new discourse is generated, in which the normative, clinical analysis of the mediating expert is prioritized over the "first-person" perspective of direct, unmediated experience.

    The result is a meta-psychedelic form of knowledge -- a predominantly "third-person" form of knowledge about the clinical effects of psychedelic substances -- which increasingly supersedes any immediate receptivity to the information contained and transmitted in the experiences themselves. Taking this logic one step further, the very nature and content of the subject's own experience comes to be governed by the norms of clinical psychiatry -- with its underlying values of instrumental reason and functional self-integration -- while the crucial particulars of set and setting are micromanaged by professionals to serve these normative ends. Most fundamentally, the metaphysical decision, built into this scientific apparatus, to psychologize the contents of psychedelic experience, thereby reducing novel discoveries to projections of a nonmaterial subjective consciousness, sets strict limits on what realms can be traversed in the course of psychedelic experimentation. The mere fact that we call our experiences "psychedelic" ("mind-manifesting") indicates the extent to which this reduction is built into our engagement with extra-worldly dimensions, such that, in the modern world, the psychedelic experience is defined primarily by a resistance to the revelations that can occur when the limits of normal waking consciousness are temporarily suspended.

    Coda: Reconjurations

    The attempt to control and re-engineer psychedelic experience according to the norms of scientific discipline perpetuates a longstanding defensive strategy against experiences that violate the metaphysical boundaries of the modern-historical worldview. Ultimately, this strategy requires not only a denial or absorption of the ecstatic experiences of independent modern investigators, but an active suppression of the vast psychedelic prehistory of the human species. In addition to promoting universal pathways of experience that would burst open the modern-historical conception of death, prehistoric and tribal cultures have long maintained free and open contact with interdimensional, extraterrestrial, and transrational zones of intelligibility through the use of psychedelic materials. Under the modern gaze of scientific mediation, the implications of these boundary-crossing experiences are subjected to a series of a priori restrictions and assimilations, until psychedelic phenomena are divested of their original cosmic force and absorbed into the order of scientific knowledge. (In a similar fashion, such phenomena may be viewed from the supposedly privileged standpoint of anthropological observation, thus withdrawing their content from epistemic consideration and reducing them to the status of cultural artifacts.)

    To some extent, this process is coextensive with the ongoing destruction of tribal lifeways, and the violent harvesting of aboriginal knowledge for the advancement of civilizational ends. However, as much of the information revealed by ancient psychedelic practices cannot be fully accommodated by the epistemology and metaphysics of modern science, the strategy of appropriation has often given way to one of exclusion, pathologization, and willful ignorance. In still other cases, more or less systematic efforts have been made to recover the memory of prehistoric psychedelic experience in the form of myths, esoteric religious images, and fantasy, but the information preserved in these media likewise becomes devalued and domesticated as it is separated from its origin in direct transconscious experience. Even the most sympathetic efforts to analyze psychedelic experiences in modern psychological or spiritual terms are implicitly designed to uproot their content from the domain of empirical reality, thereby neutralizing any threat to the modern image of humankind and its place in the universe. By operating within this restricted metaphysical framework, it becomes possible to harness the power of psychedelic experience, making it work on behalf of the rational self and its "healthy" integration into the order of civilized existence.

    Subordinated to the demands of rational representation, the common information disclosed in psychedelic experiences is buried beneath the edifice of specialized knowledge, obscuring the fact that, for many millennia, prehistoric humans enjoyed widespread, communally shared interaction with the extra-worldly dimensions opened up by psychedelics, and were able to accept these dimensions as part of the natural interplay of vast cosmic forces. Psychoactive plants, fungi, and other naturally-occurring psychedelic agents facilitated the transmission of vital information to the human species, and constant refinement of this network of inter-species relationships allowed the channels of psychedelic communication to remain open. That such experiences still occur, despite all the efforts to convert psychedelics into standardized industrial medicine, suggests the presence of an endogenous factor in these experiences, an innate ecological spark or nexus that connects human beings to psychedelic dimensions as part of our inalienable nature. What these experiences also imply, if we receive their lessons somewhat optimistically, is that the modern-historical worldview, which so far has been only a brief aberration in the evolution of our species, lacks the power to separate us completely from our thousand-centuried prehistoric heritage, and that by reawakening the flows of our immanent ecology, which wire us naturally into psychedelic infinity, we affirm the possibility of breaking out of our strange, silent dormancy, and of listening again to the multitude of voices that remind us of what we are and have always been.

    August 16, 2012

    Patrick Roseman Dunn
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