K Carrigan: The Land of Eternal Waiting

Kali Garrigan: Psychedelics for existential distress at the end of life

Since the 1960’s, when the first clinical trial investigating the therapeutic use of LSD in patients with terminal cancer was undertaken by Eric Kast, several studies have been carried out on the potential of classical psychedelics such as LSD and psilocybin for the treatment of existential distress. After a hiatus of about twenty-five years, in which regulatory restrictions on the use of these substances made their use in clinical trials increasingly difficult, since 2006 there has been a “renaissance” in the scientific interest in serotonergic compounds for the treatment of a variety of pathologies including treatment-resistant depression (Carhart-Harris 2016), PTSD (Bouso et al. 2008), and addiction (Bogenschutz et al. 2015) amongst others.

This growing interest has also brought a renewed enthusiasm for the potential of psychoactive compounds for the treatment of sustained existential distress, depression, and anxiety in patients with a terminal illness diagnosis. The necessity for new solutions to the various psychosocial problems of dying has been spurred by a growing consensus in palliative care that existential distress –manifested as feelings of hopelessness, a loss of meaning, and a loss of will to live— is a core determinant of suffering in patients diagnosed with a life-threatening illness (cf. Reiche et al. 2018), and has been consistently associated with a low quality of life (Breitbart et al. 2005), poor treatment adherence (Arrieta et al. 2013), and higher mortality rates (Brown et al. 2013). However, to date, very few psychotherapeutic interventions are available for the treatment of existential distress, and no pharmacological treatments at all have so far been developed.

The growing interest in psychedelics as a potentially powerful therapy for the treatment of existential anxiety thus offers new and exciting possibilities for researchers. Recent double-blind studies, such as those led by Charles Grob, who administered psilocybin to patients with advanced stage cancer, have found remarkable reductions in terminal-illness related anxiety three months post-session, and a reduction of depressive symptoms by nearly 30% one month after the treatment session. Peter Gasser, who carried out a study of the effect of LSD-assisted psychotherapy in patients with a life- threatening disease, also observed typically long-lasting reductions in general anxiety, as well as fear of death post-treatment, whilst the majority of patients reported qualitative improvements in mood, physical wellbeing, facilitated access to emotions, and enhanced introspective abilities (Gasser et al. 2014). In this informal presentation, a general overview of the history, therapeutic potential, and current state of psychedelic-assisted psychotherapy for the treatment of existential distress at the end-of-life is proposed.

As a relatively new and niche field within the academic study of death and dying, this talk will invite the listener to take an active role in the discussion of the potential of psychedelic therapy in their own end-of-life care practice, as well as its potential risks, whilst their role as a “consciousness expanding” alternative to the “consciousness restricting” use of narcotics in pain-management at the end of life will also be discussed.