When 33-year-old Mara Howell was dying of cancer, the pain she experienced was so severe that even the highest doses of opioids, methadone, IV ethanol and even an intrathecal pump weren’t working. She was bedridden, and depression and anxiety crashed down on top of the pain.
As Mara’s mother Marilyn Howell recalls in her memoir Honor Thy Daughter, published by the nonprofit Multidisciplinary Association for Psychedelic Studies (MAPS):
“However much courage Mara had, the waves of illness that washed over her were unrelenting. Diligent exercise didn’t make her stronger, an antidepressant didn’t make her happier.”
The only thing that helped at all was marijuana, but the help was subtle and less than ideal.
Marilyn, a mind-body educator who developed the first psychophysical curriculum in public education, describes in her book how Mara’s pain didn’t seem to be stemming solely from physical problems. After exhausting every legal option imaginable, Marilyn –– along with Mara’s hospice care worker, Joyce Vassallo –– began to consider alternatives. Eventually they landed on something unusual to help ease Mara’s suffering: psychedelics.
Marilyn was already aware of the potential for psychedelics to help ease psychological traumas. Years before her daughter fell ill, she read Aldous Huxley’s 1954 book The Doors of Perception, which details his experiences with mescaline, and learned about Huxley’s use of LSD to ease his own death from terminal cancer. Huxley’s wife, Laura, injected him with LSD at the time of his death, and recorded the experience in a chapter of her book This Timeless Moment. (Marilyn ultimately read the chapter to Mara as she passed away.) Marilyn had participated in an LSD-assisted therapy session when she was younger, and knew that before it was criminalized, hundreds of papers had catalogued LSD’s ability to reduce severe anxiety, depression and addiction. She also learned that psychotherapists used MDMA (aka ecstasy) to treat psychological traumas before it was made illegal in the ’80s, and several FDA-approved studies have since confirmed the promising ability of MDMA to help mitigate anxiety, depression and PTSD symptoms.
Joyce Vassallo, the hospice care worker, looked up psychiatrists who had recently performed MDMA-assisted psychotherapy for a study at McLean Hospital and set up a time for a session with a therapist.
“He came and did a guided session with [Mara] with MDMA, and Marilyn did it with her,” Joyce said. “They reported that she was pain free during that time. I think [she] died pain free a few days after that.”
In her final days of life, Mara underwent carefully supervised psychotherapy sessions under the influence of MDMA, LSD and psilocybin “magic” mushrooms. The treatments eased her pain, and she was able to get out of bed to take walks in a nearby park. The medicines also helped Mara reach a deep sense of acceptance of her imminent death.
Vassallo, Mara’s hospice care provider, says this was the only time in decades of working in hospice that she’s witnessed psychedelic therapy playing a role, but that the results were astounding.
“[For Mara] it was just always about pain, pain, pain, pain, pain, pain, no matter what we did,” Vassallo said. “And we did a lot … to try to control her pain, and really nothing worked. My theory is that the pain –– I don’t think it was conscience, but it was on the subconscious level –– [Mara] needed to have the pain, because if everyone was focused on the pain, that kept everyone unfocused on the fact that this 32-year-old was dying.”
Vassallo said the psychedelic-assisted therapy seemed to open Mara up to the reality of the situation, and allow her a sense of peace in her final days.
Photo: Mara Howell
While the use of psychedelics in hospice care is very rare, a number of studies have pointed to their ability to ease anxiety and other psychological issues that often coincide with the end of life.
Last year a study concluded that LSD-assisted psychotherapy is effective in easing anxiety in dying patients. The double-blind, placebo-controlled study was sponsored by MAPS and conducted by Swiss psychiatrist Peter Gasser and his colleagues. They tracked 12 people who were in the process of dying, primarily due to terminal illness, as they attended LSD-assisted psychotherapy sessions. All but one of the participants had never taken LSD prior to participating in the study. An Austrian participant named Peter described the experience as follows:
“My LSD experience brought back some lost emotions and ability to trust, lots of psychological insights, and a timeless moment when the universe didn’t seem like a trap, but like a revelation of utter beauty.”
Charles Grob, a psychiatrist and researcher at Harbor-U.C.L.A. Medical Center, completed a study in 2008 that showed the ability of psilocybin (the active component in psychedelic mushrooms) to ease fear of death in 12 end-stage cancer patients. The study results, published in the Archives of General Psychiatry in 2011, concluded that the treatment could be done safely and successfully reduced all subjects’ anxiety and depression about impending death.
Research involving ayahuasca has also turned out encouraging data showing its ability to reduce psychological traumas and anxieties, and several studies involving MDMA-assisted psychotherapy have shown it to be statistically significant in reducing anxiety and PTSD symptoms in study participants. To date, clinical trials looking specifically at psychedelics for the end of life are limited, but determined researchers continue to delve into the potentials of various substances.
An upcoming clinical study of MDMA for easing anxiety in 18 patients with terminal illnesses is slated to take place in Marin, California. The study’s lead researcher is Phil Wolfson, a psychotherapist who lost his 16-year-old son to leukemia more than three decades ago. He wrote the book Noe: A Father-Son Song of Life, Love, Illness and Death about the experience. Wolfson was among a number of therapists who used MDMA in the ‘80s, before it was designated as illegal, to assist in therapy sessions. The results were overwhelmingly positive at the time, and many of the therapists who used MDMA back then have been fighting to re-legalize it for medical purposes ever since.
Psychedelics: The Hospice Care of the Future?
Joyce Vassallo said if psychedelic-assisted therapy were made legal, it would make sense in hospice care, on a case-by-case basis. She said while the current generation of dying people are not likely to be open to psychedelics, the Baby Boomer generation will likely embrace more alternative end-of-life experiences.
“Its time will come,” she said. “The few that are dying now are the last of the WWII Vets. They are stoic, they are the last of the holocaust survivors, they want to die on their own terms.”
Sixty-year-old Vassallo said like many in her generation, she experimented with psychedelics and other in the ’70s –– ”everything except heroin.”
“[Y]ou can work through some shit [on psychedelics],” she said, noting that there’s much better potential if you participate in a guided session with a therapist. “If I am experiencing something at the end of my life, I may say, ‘Yeah, I’ll try it. What the hell! What have I got to lose?’”
Vassallo said most people come to a natural acceptance of death when they near the end of life, but psychedelics might be helpful for those who are struggling to come to terms.
“If someone had much extra special angst about dying and just couldn’t wrap their head around it… I think for in those kinds of people, if they were open to the psychedelic, it could help.”
She said war veterans are one group that could benefit from end-of-life psychedelics.
“They are dying, pretty ugly deaths these days because they’ve got all kinds of psychological issues,” she said. “They’re angry and they killed kids and they can’t forgive themselves. They are really not laying down and going into that bright light easily. I think for people with those kinds of issues like that, where they just can’t make peace with themselves before they die [it could help].”
Vassallo said she often thinks about what it will be like when “the hippies start dying.” She said one of the reasons the Baby Boomer generation might be more open to alternative death experiences is that, in caring for their elderly parents, they’re sensitized to the “pitfalls of dying in our society.”
She notes that the Baby Boomer generation is already helping to force the discussion about assisted dying rights, and the significant costs of aging in America.
“We are dealing with adult children of dying people who are like, ‘Oh my god, when I get to this point, don’t do this shit to me,’” she said. “Again you’ve got to switch generations. You are not going to convince an 89-year-old of today to do it I don’t think… It is not a drug generation that’s dying right now. The next generation will be a drug generation dying.”