THE MIND IS NOT A HAYLOFT

Erica Rex
Erica Rex
Sep 9, 2018 · 50 min read
Willow Creek, North Fork, California, May 2017

The day I arrived at Johns Hopkins Bayview Medical Center in May of 2012, Baltimore harbour was not visible from the Bayview campus. A winding road surrounds the grounds and its acres of parking lot. The front lawn slopes southward, towards the Patapsco River and Baltimore Harbor, the single green remains of the farms which once flourished here. To the west, I could discern only the sooty skyline of downtown. I was told that only on the most clarion of cloudless days, mostly in the dead of winter, you might actually catch a glimpse of a moored rig or two. All the same, I wasn’t here for the view. I’d come to Baltimore to take part in medical research as a study subject at the Johns Hopkins University School of Medicine’s Behavioral Pharmacology Research Unit. In the next few days, I would be taking a dose of psilocybin– the psychoactive ingredient in “magic mushrooms.” There would days-long physical and psychological screenings. The session itself wherein I would receive the psilocybin dose would last an entire day. The process would repeat a month later, in June, when I’d return.

In several experiments held at Bayview as well as other major research universities throughout the US, cancer patients like myself were being given psilocybin to test the hypothesis that psychoactive drugs provided significant relief to those who suffered from cancer-related depression. Over the course of a few months, with the aid of two guided medication sessions, patients had shown great improvement, and had consistently regained a sense of existential meaning in the face of deadly disease.

In the years between my departure from New York, in 2009 and the day I arrived at Bayview in 2012, I’d become someone I did not know. My life had receded from me like a tide vacating a storm-wrecked beach. I could not imagine life more than ten minutes into the future. Perspectives right and left narrowed into their vanishing points. I’d experienced this phenomenon before. During my teenage years, when life at my parents’ house descended into real hell, my world became limned within the outline of a keyhole. I had no peripheral vision. I knew something was truly wrong then. What I was doing tomorrow, next month, next year had become abstractions. Plan? What was a plan?

Before cancer, I had been career obsessed. My own career had become derailed in the late 1990s because of a previous major illness. I was married then, living in the Sierra Nevada Foothills in California in a small logging town. Endometriosis was debilitating in ways cancer was not. The magnitude of physical suffering it wrought — excruciating abdominal pain, nights spent racing down the mountain to the nearest emergency room sixty miles away, internal bleeding, shock, multiple hospitalisations, a dozen surgeries, a bowel resection, ensuing complications, and then, finally, a total hysterectomy — all that was a world apart. Gone were any illusions I’d had about becoming a mother.

During the time I was ill, my husband John had unbeknownst to me, recommenced his cocaine habit. His habit had been a problem in our relationship from the beginning. When I’d found out about it a few months after we’d started seeing each other, I’d told him to leave. After a while, he convinced me he’d stopped using and was in counseling. I started seeing him again on the condition he was not using. I naïvely believed he’d quit entirely before we married. It emerged, though, ten years later, he’d resumed. He blamed my illness and the endless hospitalisations. Each time I’d end up in the emergency room, he said, he thought I’d die. Cocaine was his drug of choice to combat anxiety and his own formidable depression, which at times was so severe he refused to engage in any real conversation for days.

After several years of go-rounds wherein I’d leave for a few months to give him a chance to stop, then return, knowing he used a lot more when I wasn’t there, he declared the discussion of drugs off the table in any reconciliation negotiations. Even though my endometriosis was more or less cured, overnight menopause had dragged along with it countless life-shellacking hormonal issues. Any faith I’d harboured about the emotional resiliency of my husband’s and my dozen-year union evaporated.

I had to leave. Like really leave. And I was terrified of starting over alone.

Endometriosis did give me one gift, however: that of an unqualified point of comparison disease to disease. Physically speaking, endometriosis made breast cancer seem like a walk in the park. Breast cancer was virtually painless.

John and I divorced in 2005, and I moved from my home in central California to New York in an attempt to find purchase on the narrow ledge of my journalism career where I’d left off some years before. I lived from hand to mouth in some of the sketchier sublet and apartment sharing situations New York is renowned for. There was the reefer-stoked aging hippie divorcée in Tribeca who turned off my electricity when I would not join her in a project to defraud the city for 9/11 relief funds; and the dog-faced sixty-something retired school teacher who invited friends in for sadomasochistic three-ways during the weekends in the apartment.

I took every editing test in the city — most publishers default point of entrée, regardless of résumé, qualifications or experience. I was in my late forties by then. The journalism and publishing world was in an insane state of implosion. No one would hire me.

I struggled from freelance assignment to freelance assignment, from fact checker, to book researcher, to travel guide writer, to short-term engagements at major magazines and news organizations, to the occasional article. I walked dogs. I worked in a bookstore.

I had health insurance coverage thanks to the California-mandated three years through my ex husband’s COBRA[1] plan. My benefits would expire in 2008, leaving me, unless I could find a job with a health plan, out of luck.

A former friend in California who worked at the local telephone company in North Fork, the mountain town where I’d lived during my marriage got a certain amount of derisory mileage out of contrasting what my life had become to that of the motivational speaker Elizabeth Murray, whose life story was depicted in the 2003 TV film: “From Homeless to Harvard.”

“She was ‘homeless to Harvard,’” quipped Cheryl. “You’re ‘from Harvard to homeless.’”

In 2008, barely scraping by, I realized a journalism degree might help. A return to graduate school might provide me a leg up, and a few new skills. At least it would give me a peer group, a frame of reference, and some contacts if I was lucky. I applied to Columbia Journalism School, where, once ensconced in a post-graduate science journalism fellowship, I could, for the first time in a long time start making future plans. It was transformational. The world opened.

Then came the lump. On April Fool’s Day of 2009, I was diagnosed with breast cancer.

I had gotten to know an Englishman online slightly in late 2008. Despite his exaggerated enthusiasm for the relationship which existed by dint of Skype and email, my own feelings were wildly ambivalent. All I’d had in mind was something light. No commitments. My career came first. The words ‘pen-pal’ or ‘occasional’ or ‘transitional’ came to mind.

My Columbia University student health insurance expired at the end of August, 2009. From the time I separated from John, I’d believed, given the right circumstances, I’d soon be back on the career train with a job, reliable income — and of course, health insurance. And yet here I was, a middle-aged breast cancer patient without job or family, or government-mandated healthcare clinging to the wreckage of the US economy trying not to drown in the undertow. Watching the Obama administration shovel bailouts at Wall Street was awe inspiring in the way observation of life itself can be awe inspiring if you’re so engaged while sipping a vodka martini from your rooftop garden, listening to the Doppler hiss of a world-ending meteor on its final approach. Obama’s plan to provide people like me with medical insurance was years away. And even then, I seriously doubted it had any chance of lasting a change of administration.

By the time cancer came calling in early 2009, it was clear the employment world as I’d known it no longer existed. Senior people at major news organizations were invited to retire early, or to take career-scuppering buyouts. I could no longer expect the offer of a job. Even with the aid of a Columbia degree, more publications in prestigious newspapers, now, looking forward to surgery, radiation therapy and possible chemotherapy, there was no way anyone would hire me. I could make it through surgery and radiation on my Columbia insurance. Copays were going to be another matter.

A bankruptcy lawyer provided me a free initial consultation. It took him ten minutes to tell me I had to be sleeping on friend’s sofa with less than $1,500 in the bank in order to qualify for Medicaid. After that, I was out of luck.

The Englishman proposed an out. By then we’d met a few times, even spent Christmas together. He suggested we get engaged, and I could apply to move to the UK via the consular process, which could begin immediately. Under his nominal care, I could move and become a permanent resident, eventually a citizen if I chose. That way, the process would take around three years rather than five, which would be the elapsed time if I were, say, an asylum seeker. In so doing, I would receive ongoing medical treatment through the NHS.

At the time, my feelings veered between numbness, fear, and hysteria. Despite all of my attempts to do what Americans love to tell each other to do every time they encounter adversity: “pull yourself up by the bootstraps,” I’d run out of ideas. My boots were worn down to their insoles. The straps were broken. I’d lost my boot pulls. I’d always paid my bills. I’d always paid my taxes. I voted in every election. I was a good friend to my friends. I had no criminal record. I didn’t abuse drugs. I exercised, I ate healthily. And I believed everything that happened was my fault. My corrosive family-of-origin had conditioned me to a set of beliefs I had not yet shaken. It went like this: “If your life goes tits up we will not help you. No one will help you. You are on your own.” Both my socialization at the hands of my parents, and the twisted values of the post-industrial US power hierarchy reinforced those feelings. The rich would be fine. How ordinary mortals were supposed to be resourceful in this surreal rendering of 21st century America I had no idea. Norman Rockwell had disappeared into the realm of make-believe. The United States of America had arrived at full on Hieronymus Bosch.

It took another few years for real rage at the nation that had allowed me to arrive at this place to season. As a Dutch therapist at a breast cancer support organization in London whom I saw twice a few years later said the first time I met her — without missing a beat: “The American state takes the role of the abusive parent.”

Desperation is never the right frame of mind when making important decisions, but it was either take what was available, even if it wasn’t exactly my first choice, or throw myself on the mercy of public assistance in the city of New York.

I accepted the Englishman’s offer. During that sweltering summer of radiation therapy in Washington Heights, when I could barely stagger home from the radiation suite at Presbyterian Hospital to my studio apartment on Haven Avenue, I managed to sell most of my belongings, pack up what I could not leave behind and organized transporting my dog, Amalie, into the one country in the world that maintains it has eliminated rabies. I do not believe this, but I wasn’t arguing. I arranged for Amalie to have the rabies antibody titre test. Blood samples are sent away to the single vet lab in the US that performs it — Kansas State University, in Manhattan Kansas. Since almost no one ever needs it, the lab waits until they have enough samples to justify the cost of the test. The lead time can be months. I organized all of her papers for UK customs and the Department for Environment, Food and Rural Affairs. On September 1, 2009, I got on the plane to Heathrow.

I knew the moment I arrived at the Englishman’s house in the Midlands near Stoke-on-Trent that I had made a dreadful mistake. But by then, I had no choice but to stay the course.

It took three years of Border Agency interviews, sheaves of receipts and bills proving continuous residence, travel to Agency offices in cities like Sheffield, foreign travel restrictions, background checks, the requisite “Life in the UK Test” administered in the attic of the public library in Wolverhampton, US passport pages added and removed, and exorbitant fees for each and every immigration hurdle the Home Office devised. The £8,000 I paid the UK Border Agency over the course of those years was financed with the help of my former husband and my English partner’s boss, who felt, I can only surmise, he was performing a humanitarian act.

The good news was my cancer had not returned. That was supposed to be where the story ended. It certainly appeared to be the end of the story for the medical establishment. Their story was the cancer. Their story had nothing to do with me.

As far as my doctors were concerned, everything was going just fine. Three years after I’d left the US to obtain ongoing medical care in the UK, the broad perception that my treatment had been a success remained exempt from perforation. I, however, the embodied soul who was not synonymous with “the cancer” could not figure out why I thought survival had been a good idea in the first place.

Both in the UK and in the US where I had my surgery and radiation therapy, medicine excels at finding cures for disease and saving lives. All that excellence has created a kind of void, wherein treatment of the disease has outflanked the emotional and existential needs of patients. My demoralization is common among cancer patients. We obsess about survival and what the future holds for us.

I told no one about my feelings. To make matters worse, the English have a habit of telling one how one should feel about one’s life, given one’s circumstances. The word “grateful” kept popping up.

“You should be grateful that you were able to come here, and get free care on the NHS,” the lady friend of my partner’s boss’s told me one day. That must have been early 2010. I don’t believe he’d told her about his £3,000 donation towards my Border Agency experience.

“It was hardly free,” I said. “I paid the Border Agency over £8,000.”

“Well, still,” she said. “It’s not like it your care cost you anything.” She added: “That’s why the NHS is in such a terrible state. There are too many foreigners coming here for free care.”

“I underwent surgery and radiotherapy in the US. I chose not to have chemo even though the NHS oncologist pushed for it. I didn’t feel the cost was warranted. The only treatment I get here is Arimidex[2]. ”

She did not reply.

The Englishman, who also felt I should be fine, took to flouncing out of the house shouting about my having brought “negativity” into his life, where he just wanted to go for walks and he’d bought two folding bicycles for us — and I didn’t even give a damn! He left, sometimes for weeks. He emptied the joint checking account. Because I was a recent migrant to British shores still undergoing the settlement process with its conjoined wobbly legal status, I was not entitled to have my own checking account. I would not be able to have my own account until I’d achieved the redoubtable status of “indefinite leave to remain.” By then, I would have been in country two full years and each step in the settlement the process would have had to go seamlessly. It is not difficult to run afoul of the Border Agency at any time, for almost any reason, I learned, including not having sorted copies of telephone bills in correct chronological order when being called to the interview. I watched a despondent Indian couple being sent away with their sheaf of papers because of an evidence gap of a single month. One single receipt. They’d have to go through that particular stage again, including paying the requisite fee of £1200 a second time.

I had no idea what the Englishman was doing with the £400 per month I paid him in rent. For a while a bailiff — the UK equivalent of a sheriff’s marshal — sat in a car on the road outside the house, waiting for him to return. The Englishman hadn’t paid his council taxes for a year. He owed money to everyone, banks, the local council, his coworkers. He borrowed money on an almost daily basis from his colleagues at work. He consistently ran out of petrol en route. He did not answer his mobile phone.

I began an online search for effective ways to commit suicide. I had saved a small a stash of pain medication from my cancer treatment. A 37.5 centiliter bottle of vodka could also be useful, as was ammonia, and denatured alcohol.

On a Saturday morning in 2010, I thought I might be ready. I sat at my desk. Then felt someone staring. I turned, and saw Amalie, sitting behind me, regarding me fixedly.

What would happen to her if I died?

I’d seen a public service poster for an organisation called The Samaritans at Stafford Station one day while waiting for a train. They advertised help for the hopeless. A trained counselor willing to talk any time, day or night.

I found their number on the Internet. I rang. My expectations were not high. I’d never done anything like this before; and furthermore I was burdened with the prejudice that in order to call a despair phone line, a person should at the least be a heroin addict, and have an arrest record. I wasn’t sure my personal agonies would qualify me to take their time.

Somebody named Jo picked up. We spoke for almost two hours. It soon emerged that she herself was a breast cancer survivor.

That and subsequent return calls to me by Samaritan staff allowed me at least to start talking. I was able to see that my feelings about who I was and what I’d become weren’t being reflected back at me. I wasn’t someone who had created my absurd train wreck of a life out of something like whim, or poor life management skills. I wasn’t, in other words, to be denounced for having had a life-threatening disease, or for having dealt with the consequences by figuring out a way to access medical care, which my own country would not provide. Having been desperate, in Jo’s eyes, had not made me a bad person. She saw me as inventive and capable.

My present life situation provoked a relentless anxiety, despite the fact my physical health was much improved. Objective reality about healthcare and social welfare in the UK failed to dislodge my emotional state. Rational thought rarely does. Despite its faults, Britain has a social safety net, to which I was entitled. Europeans, including the British, could not, would not, and will not understand how I felt. The resolute fact of social structures to aid people when they need it form the weft of individual belief about survival and human bonds. They are woven into the fabric of society. Europeans understand people develop life-threatening illnesses. They are part of life. The idea neither family nor society will not look after one of its members — this does presuppose membership — in her hour of need is so preposterous to Europeans that they simply cannot get their minds around it. Private enterprise is proscribed from profiting by denying care to those who are suffering.

A young man from the Samaritans who rang me back that afternoon suggested I make a list. “It seems silly, it seems trivial. But it’s one way to start tackling things that right now might seem out of control. I even do it myself,” he added.

I made several lists that day and subsequent days. The first item: find a place to live in London. The second: get my life back.

I moved at the end of 2010 after returning from a reporting trip to California, first to the apartment of a fellow Columbia alumna, then to a share in east London, in Tower Hamlets.

Then my three year mammogram rolled around. Even though I was functioning by all objective criteria, and I was working a lot more, which helped, as far as my outlook on life was concerned, little had changed.

I arrived at Barts and the London Hospital breast centre in central London for my appointment. I registered and sat down to wait. The ceiling must have been four metres high, and covered in tin. A television yapped in the corner, its shrieking repartee banged off the walls and ceiling unmodulated. The ancient linoleum floor was pocked and streaked. Soot coated the floor next to the baseboards. Pink bunting festooned the walls. There were pink ribbon pins on offer at the desk. It was horrible. I tried to find a corner to sit in away from the blare of the ‘telly.’ There wasn’t one. A staff member encouraged me to sit down and relax. I said I’d relax if they switched off the telly. Not possible, she said. “The other patients like it.”

“Ask them if they really mind,” I replied. “Then you can turn it off.”

She turned on her heel and went back to her perch at the reception desk.

I managed to get through the physical exam, and then was sent back to wait in the waiting room for my scan. The television’s squawk was so oppressive I felt as though there was a pink hippopotamus seated squarely on my chest. I couldn’t tolerate it. I got up, collected my coat, and headed for the exit.

“Where are you going?” said the receptionist. “Your scan?”

“I’ll reschedule,” I said over my shoulder. “I’ll ring and reschedule.” I headed for the stairs.

“Wait, wait a minute,” she said, standing also, and coming around the other side of the desk.

I hurried down the staircase. A staff member followed me. I pushed opened the exterior door of the building, and headed to the Tube. Later that day, the receptionist rang. The Breast Centre’s pursuit continued that day and the next. With each imprecation to reschedule, I declined more earnestly. “You can have my breast,” I thought to myself. “I’ll leave it off for you in a bag.”

Around that time, I’d begun work on an article about some new research coming out of Imperial College, London, one of the pre-eminent scientific and medical research institutions in the UK. Dr Robin Carhart-Harris, now Head of Psychedelic Research, Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College used functional magnetic imaging (fMRI) to study how psilocybin worked in the brain. Healthy volunteers were given an injection of psilocybin. Then they underwent an MRI brain scan.

Dr Carhart-Harris focused on two key structural hubs, the posterior cingulate cortex (PCC), a brain region associated with consciousness, and and the medial prefrontal cortex (mPFC) a region associated with executive functioning, which includes mental processes such as making plans, decision making, and moderating social behavior. The mPFC, located in the front part of the brain, and the PCC, tucked in the middle, participate in the brain’s default-mode network, a set of regions whose activity has been closely linked to our sense of self. Past research has shown that constrained, ruminative thinking, which is one symptom of depression — it was for me — is associated with hyperactivity and connectivity in the default-mode network.

The PCC and the mPFC tend to activate in concert, like the first violin and the oboe playing in a symphony orchestra. When a research subject was given psilocybin, these functions in the brain became far less synchronized. Although the PCC and mPFC still play together on psilocybin, it is as though the conductor has left the room. The music changes character. If the brain in its normal state is Beethoven’s Violin Concerto, on psilocybin it becomes improvisational jazz. The mind no longer dwells on questions limned by the ego such as “How will I survive if I’m laid off?” or “I wonder if my husband is having an affair with another woman?”

Although psilocybin was used as a therapeutic aid in the 1960s, the neurobiological rationale for its use was never scientifically investigated until Dr Carhart-Harris began his research.

Among many unexpected findings, Dr Carhart-Harris found blood flow to the PCC decreased by 20 percent when psilocybin was present, contradicting a long-standing assumption that psilocybin works by stimulating these areas of the brain. The PCC, and other regions in the default-mode network with which it is associated, are critical connector hubs for information transfer and organization. Putting a damper on the default-mode network is like sending the early 20th century telephone switchboard operator working the rural party-line out to lunch. The guardian at the cognitive gate stops minding the store for a while. All working phone circuits become available, and everybody can listen to everybody else’s gossip. In terms of the brain, this translates into a less inhibited flow of information between regions. Reduced control on the part of the default-mode network disrupts some of the symptoms experienced by people suffering from depression, among them the narrowing of thought processes and the tendency to fixate on a particular problem. For cancer patients like me, the inability to remove my focus from my anxiety about my cancer and what would happen in my future was paralyzing.

Human and animal studies showed the 5-HT2A receptor to be the key mediator in the neurological effects of hallucinogens. Psilocybin molecules bind to 5-HT2A cell receptors in much the same way as serotonin and antidepressants do, preventing the serotonin molecule from attaching itself to the cell surface. But structurally, the psilocybin molecule has some key differences. It comprises two molecular groups that the serotonin molecule does not: a phosphoryl group plus two methyl groups. These molecular alterations add up to biochemical change downstream, once the psilocybin molecule binds to the 5-HT2A receptor, creating an entirely different neurophysiological outcome: the psychedelic trip.

Once psilocybin is ingested, the phosphoryl group is removed through an enzymatic process and metabolised into the active psychedelic compound, psilocin.

Psilocybin as well as other psychoactive drugs cause the talon grip of ego to loosen, and with that, the consciousness of a wider perspective emerges. With ego dissolution comes the freedom to experience the internal world without constraint.

Dr Carhart-Harris viewed this experience as inestimable for people who are terminally ill.

“We’re all gripped by our self importance and our perceived place in the world, our ego. Terminal illness diminishes the sense of self and of agency,” said Dr Carhart-Harris. The existential insights subjects undergo when under the influence of psychoactive drugs and their enduring positive effects make an undeniable case for their use in psychotherapy.

As we concluded the conversation, Dr Carhart-Harris asked me with whom else I was speaking. Had I spoken to Dr Charles Grob, professor of psychiatry and biobehavioral sciences and Director of Division of Child and Adolescent Psychiatry at the University of California Los Angeles? Dr Grob and his colleagues carried out the first contemporary clinical study using psilocybin to treat depression in end-stage cancer patients at Harbor-UCLA Medical Center between 2004 and 2008.

I hadn’t realized until that moment that psychoactive drugs had actually begun a quiet return to the treatment room.

Dr Grob assessed 12 patients with advanced-stage cancer using standardized psychological measurements of depression and mood, as well as screening for other psychiatric symptoms, such as paranoia and grandiosity. They were given two doses of psilocybin in a hospital setting a month apart. The sessions were guided, with trained psychotherapists present at all times during the sessions.

All the patients who took part in the study reported sustained mood improvement and anxiety reduction after the sessions. The effects lasted for at least six months.

The important thing, said Dr Grob when I spoke with him, is that forty years ago, clinicians working with psilocybin and lysergic acid (LSD) found in alcohol abuse treatment, as well as cancer anxiety, a single treatment session with psilocybin could create a “psychospiritual epiphany” allowing subjects to become less fearful, more spiritually aware, more engaged with their loved ones and able to see their lives as having meaning beyond what they were experiencing in their physical bodies. Not only did the drug diminish patients’ symptoms immediately, it improved therapeutic outcomes for months, even years afterwards.

Prior to their banishment in the 1970s, hallucinogens were prescribed to approximately 40,000 research subjects who suffered from a variety of emotional disorders, from severe depression, to end-of-life anxiety to alcholism. The results showed remarkable promise in helping the majority of them, particularly the terminally ill, in overcoming pain, fear, psychological isolation and depression.

The therapeutic benefit of psilocybin lies in its capacity to provide a neurochemical bridge between spiritual guidance and talk therapy. The drug’s value depends entirely on the patient’s feelings and perceptions during the session and the way he or she processes the memories afterward. Patients who undergo a transcendent peak while taking psilocybin describe it as among the most meaningful events in their lives.

“The drug is a skeleton key which unlocks an interior door to places we don’t generally have access to,” said psychologist William A. Richards of BPRU, one of the researchers who successfully treated terminally ill patients with hallucinogens from the early 1960s until 1977, when the work was shut down. “It’s a therapeutic accelerant.”

Unlike psychoactive drugs, anxiolytic medications such as Xanax help patients only while they are taking them. The effect wears off when the body clears the drug from the system. Patients must repeat the regimen, often increasing the dosage to obtain the same effect. In contrast, the healing constituent of psilocybin lies within the intrapsychic world the drug evokes during a session. Psilocybin is an ‘entactogen’: it touches a person within. Rather than merely dulling emotions as anxiolytics do, psychoactive drugs enable subjects to follow distinctive emotional trajectories, creating space for insights whose touch endures long after the drug effect has dissipated.

“The profession itself forgot about the promise of the early findings,” said Dr Grob “Forty years later here we are.”

His words were amplified by Stephen Ross, MD, Principal Investigator of the New York University Psilocybin Cancer Anxiety Study, who carried out a clinical trial on terminally ill cancer patients at NYU much like the that of Dr Grob, at UCLA.

“The issues around alcohol addiction and terminal illness are the same thing,” Dr Ross told me. “These are people in an acute spiritual deficit state.”

A spiritual deficit state destroys patients’ ability to manage their affairs, or to connect in any meaningful way with loved ones. Defined as “severe distress and emotional suffering associated with events that threaten the intactness of the person,” many feel that life is now worthless.

Modern medical care isn’t designed to manage end-of-life or even life-threatening illness issues, from pain relief, to family worries, to existential anxiety. Even in Britain, where the hospice movement originated more than fifty years ago, the emphasis is placed primarily on family support, pain relief, and physical and occupational therapy. Psychospiritual issues are swept under the carpet. The abundance of “feel better” messages like the pink ribbons and pink bunting festooning the breast cancer clinic do little more than sabotage patients true feelings and dash any hope they might have that real emotions — like fear and anguish — are permissible. And if, God forbid, one tries to express such feelings in the presence of a doctor or a nurse, they’re more likely than not to be squashed, with encouraging words like “come now, stiff upper lip” in favour, I imagine, of not upsetting the staff.

“Existential terror in the dying is the most taboo conversation in medicine,” said Anthony Bossis, PhD, Clinical Assistant Professor of Psychiatry at NYU, and that study’s Co-Principal Investigator. “You can count on clearing the room of internists the moment you mention death.”

Care givers and doctors fall back on what they’re good at doing: biological medicine and technological interventions. Forget the human being, she’s way too complicated.

I asked Dr Grob if he had any surviving subjects who would be willing to speak with me. He didn’t but he suggested I speak with Roland Griffiths, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine who had been conducting studies with psilocybin for several years. Dr Griffiths had an ongoing Phase II (safety and efficacy) clinical trial with cancer patients who were not necessarily terminally ill but were suffering from anxiety and depression related to their illness.

I called Dr Griffiths. About ten minutes into the interview I said: “Dr Griffiths, if it’s all right with you, I’d like to reframe our discussion. I’d like to take part in the clinical trial.”

“Well,” he said, “we can see if you qualify.”

***

By the time I went to Baltimore in May of 2012, I’d only just moved to my own place. I’d found a tiny terraced house with a garden in Uxbridge, at the end of the Metropolitan line in northwest London. I’d endured the UK immigration machine and had become a legal UK resident. All that was left was a citizenship ceremony, and a passport. I’d extracted myself from the survival-threatening machinations of the Englishman, a man in the end who made a point of getting even.

The Bayview campus comprises an institutional jumble of mid-rise edifices whose design, construction, and demolition have been ongoing for about 150 years. The Behavioral Psychology Research Unit (BPRU), the building where I was going to be spending the better part of the next several days was located in a newer part of campus, a building separate from the hospital. The research taking place at BPRU was in keeping with the institution’s tradition of breaking new ground in medicine and public health.

The messy tear-down of one old building known as B Building, an enormous gray Art Deco structure, dominated the landscape while I was there. The half-demolished brick shell, once part of the original Bayview Asylum, stood amidst heaps of rubble. Most recently, B Building had housed patients diagnosed with psychiatric disorders who self-medicated with street drugs or alcohol.

Bayview is part of the massive Johns Hopkins University and Johns Hopkins Hospital and Health System. The facility is at once teaching hospital, world-renowned research center, and clinical medical centre. The redoubtable institution as it exists now retains only a faint echo of its humble beginnings.

The hospital started life in Baltimore proper as the city’s almshouse. Almshouses were a common feature of rapidly urbanizing metropolises of both Britain and the US during the 18th and 19th centuries. They were the first social service institutions to offer respite and shelter to society’s outcasts. They oversaw a range of services for a diverse group of the disenfranchised, including criminals, the elderly, orphans, alcoholics and the mentally ill. Yet the Baltimore Almshouse offered something most others of its era did not: it retained a staff of trained doctors, pioneering public healthcare in an era when it was almost unheard of. Its medical heritage lent what is now a hospital among hospitals institutional legitimacy back in a world where Almshouses were primarily known as dumping grounds for undesirables.

The Baltimore Almshouse spearheaded a public health vanguard by administering the first smallpox vaccination in the state of Maryland in 1801 — forty-five years before Ignaz Semmelweis’s childbed fever revelation — that doctors themselves were spreading the disease from woman to woman by failing to wash their hands after examining infected patients — and fifty-three years before John Snow identified water from an east London pump as culprit in that city’s 1854 cholera outbreak.

By the mid 1860s, the original Almshouse was both outmoded and overcrowded. The city purchased farmland on Baltimore’s eastern outskirts to allow for the construction of a larger facility offering improved services, which became known as The Baltimore Bayview Asylum. The Asylum admitted its first patients in 1866. In its airy, uncluttered new quarters, the rural Asylum overlooking the port provided its residents respite from the crush of the city, and a convenient out-of-the-way location to warehouse those whose families or communities had deemed them unfit for society. The Asylum was among the first in the country to accept African-American patients. There was a working farm on the grounds which provided the 19th century version of occupational therapy and needed cash. A preponderance of patients at Baltimore Bayview Asylum suffered from mental illness which conferred upon the institution a long-standing reputation as insane asylum.

When I arrived at Bayview, I was not quite insane, but I was not quite sane either. When I pushed open the heavy exterior door of BPRU that Wednesday morning, I was exhausted. I had not slept in days because of my recent move. I had not slept on the plane. The vestibule I entered was more of a guard’s station than a waiting area, complete with what appeared to be a building security control panel on the wall beside the reception desk and walkie-talkie on the counter. I gave my name to the guard who asked me to sign in. Then she phoned upstairs. Through the square reinforced window on the door opposite I could see a stairwell leading up the second floor. The guard asked me to wait and gestured to a plastic chair in the corridor. The facility is heavily secured and comings and goings are strictly monitored, both, I learned, because of the necessity of keeping study subjects anonymous — we’re not supposed to meet, much less get to know each other — and because Bayview houses an inpatient rehab center for those undergoing drug and alcohol treatment. Sometimes, as happened one day during my visit, patients choose to leave suddenly, and make their way into other buildings.

A young woman with straight blonde hair came down the stairs. She introduced herself as Samantha. She was the research program assistant who would be supervising my visit. I followed her to the second floor.

Samantha showed me to an alcove sofa, offered me some tea, and gave me a sheaf of questionnaires to fill out. She took my blood pressure, a procedure which was to become a ritual for the next few days. My blood pressure was monitored every fifteen minutes for two hours.

All study subjects are screened for mental, emotional, and physical problems before we’re officially admitted into the study. Before I’d left London I had filled out several questionaires designed to winnow out those who might have disorders they didn’t know about. There were questions like: “Do you ever think there are people or other beings who are transmitting secret coded messages to you alone?”

No, that hadn’t happened to me. That question and many like it were repeated several times in different ways over the course of the workup. I learned later why: for people who have underlying psychotic disorders or schizophrenia, hallucinogens like psilocybin can be catastrophic.

Patients in the study visit the Baltimore clinic twice, receiving a low dose of psilocybin on one visit and a moderately high dose on the next. The doses are given blind — in other words, neither the subject nor the guides know which dose is given during which session.

Later, Mary Cosimano, the study coordinator I had spoken to several times over the phone invited me into her office, where I filled out even more questionaires including assessments of optimism and pessimism, pain scales, depression scales, queries about my life style, and my habits, as well as one called Assessment of Spirituality and Religious Sentiments. Mary asked questions about my marriage, family of origin, my life in England, my education, my work. She asked me about my illness, my diagnosis, and my feelings about my prognosis. I told her about running out of the breast centre. After an hour, I was crying. She, like everybody I spoke with during my time at Hopkins had a box of Kleenex tissues on her desk. She asked me if I meditated — I had done some mindfulness meditation — so she suggested we meditate together for a few minutes. Mary turned out to be a master of three-minute meditation breaks. I took several over the next few days.

Following the interview with Mary, a full-tilt psychotherapeutic dissection ensued. All my feelings and experiences — from childhood trauma to attitude to internal conflicts — were subjected to scrutiny. The guides attendant at the psilocybin sessions themselves have to know the lay of the psychic land so they can be supportive if complex or painful feelings arise during the session. They often do.

The medical workup was equally thorough, and included every possible blood test including liver function, white blood cell count, and inflammation factors. The physical exams often uncover maladies subjects themselves aren’t aware of. Borderline diabetes, heart arrhythmia or slightly off-par liver function will get you excluded, as well as traces of alcohol or drugs. There was an echocardiogram and a neurological workup. I was told later on there have been people who have arrived entirely ignorant they had Hepatitis C, or a heart murmur. They had to be sent home.

There were also those who remembered in the middle of an interview — even two days after their arrival — that a grandmother had been hospitalised for something later determined to be bipolar disorder. Even those with second- or third degree relatives with schizoaffective disorders were considered too risky. I have an asymptomatic clotting disorder, which is treated with low-dose aspirin. The internist who examined me wanted a second opinion. She wanted to be sure that psilocybin which sometimes causes an increase in blood pressure was not going to be risky for me.

At the end of the day, I had my first meeting with Roland Griffiths.

There’s a bit of Ichabod Crane about Roland, who is tall and thin and has head of pure white hair. He wears enormous glasses. His gaze pierces. His demeanor together with the hair, and his temperate methodical way of moving made me think of a snowy owl. Thematically his office decor consisted entirely of caffeine in various manifestations. There’s a picture of hands holding coffee cups, and some old Coca Cola posters. Roland spent years studying the long-term effects of caffeine on the brain.

I’d spoken with Roland at length on the phone. He’d emphasised before we’d even agreed I’d come to Baltimore that I could not take part in the psilocybin study if it were going to be just a journalistic exercise. For the purposes of the study, which was both expensive and complex to conduct — the foundation underwriting the research had paid my airfare, and was paying the lion’s share of the hotel — my participation would become invalid if I were merely observing. Furthermore, if I maintained a deliberate emotional distance my likelihood of having a bad trip would increase.

I reiterated that I had not come as a journalist. I’d parked journalism at Heathrow Airport. I’d handed in the scientific article before I left London. It dealt solely with neuroscience discoveries Dr Carhart-Harris had made during the course of his psilocybin research using magnetic resonance imaging. Though his work and his scientific discoveries were fascinating and far reaching in their implications, as journalism per se, I myself could hardly call it a riveting tale. I was there as myself, as someone who was upset and anxious and depressed because of everything that had happened since my cancer diagnosis.

Roland’s concerns were not just verbal choreography around how a game of table tennis ought to be played in the interest of creating an optimally sporting experience. They had to do with the essentials of “set and setting,” key factors in the hallucinogen-assisted therapy equation. “Set” refers to “mind set” — the subject’s mental and emotional attitude toward the hallucinogenic experience. “Setting” is the physical and social environment — the room or space itself, and the people who are present with the subject during the experience.

Part of the “set and setting” reckoning includes the ability to have complete trust in the guides, trained psychotherapists who remain with the subject throughout the entire session. The images and feelings a person experiences can be beautiful and transcendent, or terrifying and disgusting — or all of these over the course the day.

“Radical curiosity,” said Roland. “That’s how you have to approach this.”

His message was clear: if the current of the experience carries you downriver, metaphorically speaking, do not resist, just go with it. Engage with the trip and why you’re going. Struggling toward shore will get you nowhere. The subject’s “set” had to include a willingness to move toward repellent or frightening thoughts and images, rather than trying to avoid or fight them. When you arrive at a precipice, you have to allow yourself to plummet over. Or submit to capture by the fugitive slave catcher. Or get eaten by a bear.

Roland talked a lot about “Ego.” Part of our conscious mind comprises an ego, the sense of “I” as separate and distinct from other people or beings or objects in the external world. Ego is the mistress of our individuality. Normally, ego is the element of mind that keeps a person from jumping off the real-world cliff just because it might be an interesting experiment in weightlessness. Ego forms the basis of our instinct for self-preservation.

In the psychedelic therapy setting, if ego tries to to keep the experience at bay, its interference would run athwart the entire process. Where ego can’t or won’t get out of the way because of a lack of trust and transparency, bad trips often result.

Those who carried out therapy with psychoactive drugs during the 1960s and ’70s and who are engaged in these projects today have a mantra they repeat: “trust, let go, be open.” Some study subjects have a very hard time doing this. Face it, most of us who were raised in the United States over the last two generations are control freaks. On one occasion at BPRU, a study subject resisted the experience to such a degree, he fled the session room and had to be coaxed back. In another case, the patient became so terrified and so resistant during the induction phase (the period of time when the drug starts to have an effect) that he panicked. The guides had to restrain him physically and reassure him until he could once again trust, let go and be open.

Toward the end of our meeting, Roland told me he knew Deborah. Over the decades, I’d periodically googled my siblings. I knew Deborah was a neurologist, and had worked for at least two federal agencies, the National Institute on Drug Abuse and the Center for Drug Evaluation and Research. I knew before I came it was very likely she and Roland had crossed paths professionally. I was not surprised, I told him, I knew it was a risk. He quickly dismissed any notion their acquaintance was a risk. He told me they’d served on a few boards together. They were not friends, he assured me, and they did not see each other socially.

He repeated: “It’s not a risk.”

I am not sure he understood my response. Perhaps he was concerned I doubted his professional integrity.

Far from it.

I knew Roland himself would never betray confidence, or breach privacy. Such an act would be conduct unbecoming his profession, and unbecoming the conduct of anyone in the medical or psychotherapeutic community. What he did not yet know was that I had to take his integrity as an article of faith. I had to believe his character did not bear any resemblance to that of my parents, their peers, and members of the medical and psychotherapeutic fields with whom I’d been acquainted over the years.

More than once, I’d heard my parents talk openly about matters told to them in private, by their friends, by their own children, as well as their patients. They discussed what others would consider confidences freely, mentioning subjects by name. My father bragged openly about having seen the poet Anne Sexton in therapy in Boston for a short while when her regular psychiatrist was away. He spoke of her in terms at once misogynistic and licentious, taking credit for a book she was working on while under his care. He bragged about giving tapes he made of their sessions to an English professor at Stanford, who later wrote a book[3].

It was like listening to someone revel in a tale of intimate grand larceny, or rape.

In the 1980s, I cut all ties with my family of origin. My decision did not sit well with my parents. They persevered in tracking me down despite my moving repeatedly and changing phone numbers. Eventually, thinking I was not making my point clearly enough, I penned a letter letting them know the relationship was well and truly over. I had already begun therapy with Chet Villalba by then, a San Francisco clinical social worker. He and I had a good rapport. Not perfect, but therapeutic.

Rather than giving rise to mature self-assessment or introspection one might at least hope to see from trained psychiatrists, the letter just incited them further. They contacted my friends, former employers and doctors. They even managed to locate me by way of my automobile registration after I’d moved to the mountains.

My parents expected everyone they knew — and even those they didn’t — to connive with them. In describing me, I later learned, they laid out a narrative of unalloyed psychosis. Deborah herself contacted the attorney I’d retained to write cease and desist letters and tried to coerce him to work with “the family” as a go-between. That Deborah could be oblivious to the law and the corresponding code of ethics which she so blithely breached could seem farfetched to those not familiar with my parents’ approach to interpersonal maneuvering. In the context of “the family,” it made a bit more sense: both she an my brother glided like sleepwalkers through my parents’ burnished confabulations. My brother showed up at my house one day unannounced, I guess to haul me in. I didn’t open the door.

A very old friend from childhood told me she’d encountered Deborah at a high school reunion. Tearfully, Deborah maintained she did not understand why I was doing what I was doing. She’d read a personal essay I’d written published on the Internet. She wanted to know why I was writing such terrible horrible lies about “the family.” To this day, I don’t know who “the family” was other than a my parents’ private Third Reich.

Trusting Roland and the process was a decision I’d made before I even got on the plane. It was going to be one of the “set and setting” tasks for me. Trust, let go, be open. I knew from what I’d read and from speaking with him, Roland was not interested in creating power relationships. He was not a man of the 20th century’s misogynistic psychoanalytic school. Roland was interested in humanity and spirituality. Roland wanted to talk about about ego, of course, but he mostly wanted to talk about God.

“What do you think about God?” he asked me that first day. “Where do we go when we die?” I had no idea how he expected me to answer.

Roland himself is a serious meditator. He’d taken part in several silent meditation retreats, ten or more days each time, in meditation for ten hours each day.

Over the course of the workup which lasted two days — a tryout to see if I would actually be accepted into the study — I spoke with four different psychologists and researchers. Mary herself interviewed me for hours. One researcher, Dr Matthew Johnson who was studying smoking cessation using guided psilocybin sessions asked me during our interview: “If you had to spend the day being nauseated, could you tolerate it?”

I suspected nausea was going to be the least of my problems.

I had true emotional rapport with Chet, yet my feelings towards most people in the field were — and are — largely negative. My sensibilities did not spring fully formed out of nowhere. In my experience, there are too many people whose wholesome nature I’d call into question who have entered the professions grouped broadly under the umbrella of “psychology.” I’m in no position to speculate about how or why people choose any given profession. But I am, whether I like it or not, cursed with an innate ability to see errant therapists for what and who they are the moment I meet them. They appear before me like dystopic Commedia dell’arte harlequinos. They may as well wear motleys, carry wands and sport hook-toed slippers decked with bells. They are counter empathic. They caricature empathy.

Thursday morning, one of these lurched into the picture.

I arrived for my scheduled appointment at ten. Mary accompanied me because the social worker I’d be meeting was not a senior Hopkins researcher but rather a trainee doing his internship, which meant he could not meet with subjects or patients unsupervised.

We waited expectantly in an office. The trainee, introduced as Dan, finally arrived late, flustered, perspiring, in a flurry of motion. He sat down and without hesitating, or making eye contact, started pulling papers out of his folder and flapping them onto the table in front of him.

He leaned back in his chair and crossed his legs.

“Tell me about yourself, Erica. What brings you to Baltimore? What brings you to Hopkins?”

I looked at Mary, who explained Dan had been briefed about my background, but wanted to find out a bit more about me in my own words.

I recounted, as I had done now several times over the past twenty-four hours, what had happened since I was diagnosed with breast cancer and left New York. He interrupted me mid-sentence.

“On one of your questionnaires says something about horses. Do you still ride?”

“No, I don’t.” I replied. “I can’t afford to. I haven’t since I left California. I sold my horse in 2004.”

“Why?” he said.

“Well, I don’t exactly have that life anymore, my life has changed a lot and–”

“But why not, if you enjoyed it?” he interrupted.

I looked at him.

“Because I’m broke, and my life changed. I changed countries. I lived in New York, then I left New York and now I live in London.”

“Yes but you could have ridden in New York, right?”

I glanced at Mary, who had pasted a look of benign disinterest across her face.

“I just told you I was broke. That also meant in New York. I moved to England for medical care because I was broke and could not get care any longer in the United States. I am a breast cancer patient. That runs my life now. Why would I be in Baltimore in the first place if I weren’t a cancer patient who wanted to be in the Hopkins study?”

“Right,” he said, as if it was the first time he’d heard of it.

I looked down at my hands.

“I don’t know how they choose guides, but I hope you’re not going to be my guide,” I said, “because it won’t go well.”

Dan’s face turned crimson.

“I am trying to find out why you would stop doing something you liked doing, that’s all,” he said, implying, I can only surmise, I could take more responsibility for improving my own life.

“I don’t know what to say,” I said after a few moments. “I’ve said repeatedly I couldn’t afford to ride or keep a horse anymore, not in New York, not in England, not anywhere. I’ve tried to answer your questions and yet you interrupt me and keep repeating the same question over and over. I have no other answers.” I paused. “And I really couldn’t see going into a situation with someone like you where I’d have to be self-revealing.”

“I think Dan is trying to get a sense of how your life was before you had cancer,” said Mary.

“I have nothing else to say,” I said.

The meeting ended quickly thereafter.

Back in Mary’s office, she wanted to talk about my reaction to Dan. The discussion devolved into a paradoxical and circular discussion about my honesty — which was evidently considered a good thing — while my reaction to his antagonistic ineptitude was certainly not.

Still jet lagged, and still having not slept since I arrived, I was so tired and burned out by then, I could not stop crying.

“If this is about pleasing someone who doesn’t know what he’s doing, then I’d should go back to London. That would be fine with me, really,” I said.

“No no,” said Mary, handing me Kleenex. She suggested we meditate for a few minutes.

Later that morning, after I’d returned from the clinical medical wing where I’d gone for more tests, I met with Roland again.

“I have to tell you, we were concerned about your reactivity to Dan. We’re worried about whether you’re a suitable subject for the study.”

“You want me to leave? Sure, no problem.”

“It’s not that,” said Roland. “It was your extreme reactivity in that situation.”

“Some guy who is supposed to be psychologist fires questions at me in an interview room and interrupts me when I try to reply. He asked me three times why I don’t ride anymore. He ignored my responses. I’m supposed to sit back and smile and take it? You’ve got me coming and going, Roland. I’m perfectly happy to leave right now if this is how it’s going to be. Really.”

“Ok, this is administrative, and technically not your concern, but I think I should tell you,” said Roland. “We confronted Dan about what happened this morning because he had some answering to do for how it went. He said he was flustered. There had been a traffic jam and he was stuck in traffic which is why he was late. He owns his behavior.”

“I see,” I said, “and as the somewhat compromised person who came all this way, I have the privilege of paying the price for his traffic jam and abominable clinical skills. That is rich. Makes me feel right at home.”

I could not control my tears. Roland handed me the Kleenex box.

“Here’s the thing. When you’re in the session, you can’t fight it. We say, trust, let go be open. Ego can’t get in the way.”

“If I’m being attacked by an Ego in the present tense, I defend myself,” I said. “If he or anyone like him is going to be the guide, I’m not the person for this job.”

“He isn’t a guide. He’s a trainee social worker,” said Roland. “I’m not talking about Dan. I’m talking about being able to trust the situation with your guide. You have to trust the person and the situation. Trust, let go, be open,” he said, repeating the mantra again. “We should talk after you spend time with Fred.”

“Who is Fred?”

“Your guide. Depending upon how it goes, we’ll make a decision. You’ll meet with him later this afternoon, and then all day tomorrow and Monday.”

“Okay,” I said. “But if I feel as badly tomorrow afternoon as I do now, I will leave. I can call the airline this afternoon. I don’t need this.” I stood to go.

“Let’s see how it goes,” said Roland. He stood also. Then he came over and gave me a hug.

Besides my questionable capacity to trust, let go and be open, there remained an unresolved concern about my clotting disorder. Roland had not heard back from the consultant haematologist.

I went to the alcove wait in for Samantha to take my blood pressure. I leafed through books about spirituality, and books of pictures. I stared at the beautiful renderings of psychedelic imagery and photographs of the natural world. I thought about times I felt okay in the universe.

That afternoon, Roland introduced me to Fred Reinholdt, who would be my guide. We headed into an empty office.

Fred was tall and loose-jointed. His presence, even the way he moved, was wakeful and open and perceptive. His face conveyed a kind of buoyancy, which I’d now characterize as mirthful. I had the sense of someone inhabiting the world as an integrated soul, fully incarnate, living in his skin without squirming. Fred was also a meditator. From what I learned about him over the next several days, he’d arrived at meditation after years of searching for a spiritual practice that worked for him. His spiritual journey really began, he said, “when I finally decided to take up the cushion.”

The spiritual journey theme recurred several times during those days. As the woman who became my support person and met me at Bayview after the session, Nancy-Bets Hay, herself a counselor at a cancer support organization in suburban Baltimore put it: “People don’t choose spiritual journeys. The journey chooses you. The journey carries you along and you can’t dictate how it moves forward.”

That afternoon, another emotional evisceration got underway. The singular difference was Fred himself. He already knew a bit about me from speaking with Roland and Mary and Matt. He told me if I wanted to ask questions about the process, or about him, or anything at any point, I was free to do so.

Later on we moved to the session room — a regular hospital room to be sure — but decorated with shelves of books, and sculptures and pictures of mushrooms. Lit with incandescent table lamps rather than the overhead fluorescent lights characteristic of most hospital rooms, the space resembled a lounge. There was sofa in lieu of a bed; and there were numerous books of photographs of the natural world. Mushroom imagery dominated the decorative scheme. A swish audio system was set up to play a carefully curated music track during the session, throughout which I would wear headphones and an eye mask. The eye mask is de rigeur in these sessions, as a way of helping the subject turn inward to the interior world. An automated blood pressure monitor would take my blood pressure several times an hour. Fred pointed to a small unobtrusive video camera concealed on a high shelf. The sessions were recorded for legal reasons.

We rehearsed what would happen on the day of the session. Fred started up the the music track. I lay down on the sofa with the eye mask and headphones on and closed my eyes, and meditated for a few minutes.

Friday we met in the session room again. This time Fred was joined by a woman named Porche, who would be my second guide. There are always two, a man and a woman. Again we went over aspects of my life, many of which I was visiting for a second and third time since my arrival.

At the end of the afternoon, Fred and I went to speak with Roland. As we waited in the hall outside of his door, I was overcome with apprehension. I was tempted to flee. Fred asked me how I was feeling. I confessed to extreme unease which had nothing to do with the prospect of taking a psychedelic drug, but rather because of what had transpired during the process of getting to this moment right now. I was intimidated by Roland, and freaked out by the very fact that I had been reduced to a state of vulnerability I had not experienced in years.

“How about this. How about handing over your anxiety to me for a little while. I’ll carry it into the meeting for you and then it will be off your hands. And it won’t make any difference at all to me. Anxiety doesn’t weigh anything.” I looked at him. The idea was ludicrous and inspired. He held out his hands.

“Okay,” I said. “Here you go.”

I handed it over. Fred took the anxiety in his hands. Then Roland opened the door. We entered and sat down.

Roland asked me how I was doing.

“I was apprehensive and nervous,” I said. “But then Fred said he’d carry my apprehension for a while. So I gave it to him. He’s carrying it now. I feel okay.”

“That’s great,” said Roland. Then he smiled for the first time since I’d met him.

We chatted a bit more, and then Roland asked me to wait in the alcove.

A bit later Fred emerged. “Think you’ll be ready by Monday afternoon?”

“So I’ve passed the test?”

“If you want to call it that, yes. How do you feel?” asked Fred.

“I’m fine,” I said. “I’m happy I won’t have to undergo another day of emotional flaying. I wouldn’t last.” I asked about the clotting disorder. A second haemotologist had been found and consulted. The path led forward now free of obstacles.

There was one thing, though, which stuck in my craw, the matter of the negative scrutiny over my defensive response to the trainee. Fred listened attentively.

I’d had way too much experience with shrinks — from my family of origin, to therapy, to the decades of not being believed by those to whom I told my story. Shrinks covered for each other, and in so doing they’d damaged my life and the lives of generations of women.

“Roland, you, and the Hopkin’s trainee do not know me better than I know myself,” I said. “I will not allow a shrink to abuse me narcissistically to protect himself from his own bullshit. Again. Ever.”

“If it’s okay with you, I’d like to mention this to Roland,” said Fred when I was done. “You feel you’re being dissed because of your life experiences, which are authentic. I think he should know that.”

“If you want to talk with him about it that’s fine,” I replied. “But if it’s going to get me evicted from the study perhaps you should tell him now, before the weekend, so I have time to change my ticket.”

“Roland has already left for the day. And it won’t. The decision has been made. I value your opinion. I can speak for him in saying he also values your opinion.”

Monday was much like Friday, spent in the session room with Fred and Porche, talking about my life and getting used to the mask, the music, the headphones, and the automatic blood pressure cuff huffing away to itself throughout the day. The six-hour music compilation progresses over the course of the session. No track is repeated. The opening tracks consist mostly of liturgical music, dissolving gradually into classical selections, then world and ethnic music. Then, at the end, Here Comes the Sun.

Late in the day, I met again with Roland who had yet more to say about ego, and letting go.

Ego, he said, wants to prevent us from having this experience. The last thing ego wants to do is dissolve. It will do its best to throw up all kinds of obstacles because in the material world, we need ego for our survival. So what was the best way to counteract ego when it gets in the way?

“Trust, let go, be open?” I said.

“I’ve suggested to subjects if you get to a scary place, something really terrifying, you ask whatever it is that’s scaring you: What do you want to teach me? You might even get an answer. And once you ask, you stop being scared. If you approach ego for what it is, the fearful image or experience moves away,” said Roland. “Does that make sense?”

In its own weird way, it did.

Then Session Day finally arrived. I was brought into the now-familiar room. There was a vase with a rose in it on the table.

Subjects are encouraged to bring photos and memorabilia to look at and talk about before the psilocybin takes effect. Some people had brought rugs, hangings, even sculptures, redecorating the entire room for the day. I’d brought a number of photos of my younger sister, who died of metastatic colon cancer in 2005, as well as pictures from my former life in the mountains of California, when I was married. I brought photos of my horse, my dogs, the landscape, wildlife, all things that meant a lot to me.

The actual administration of the psilocybin capsule was done
ritually — partly to make sure the study’s protocol was being followed, and as part of the set and setting equation. Roland came in to the session room to give me the capsule, and watched to make sure I drank the entire cup of water. Then he left.

I sat on the sofa, and shared some of my photos with Fred and Porche. Fred suggested I look at a few pictures in one of the books. Then my head began to feel heavy. I lay down under the sheet and put on headphones and the light-blocking eye shade.

I found myself at a bus stop, getting on a bus. A youngish woman standing near me realized she was on the wrong bus and was shocked and upset by it. She wanted to get off. I was taken aback by her intensity. I thought to myself: buses do go both ways.

Then John came into the picture, not as a distinct physical presence, but as emotional being. I had a sense of how distraught he’d been during my illness, and how I had been so absorbed with my own pain I had been unable to be compassionate towards him. I started to cry.

A friend who is something of a connoisseur of the psychedelic experience told me later this often happens to people during the induction phase. Feelings of profound sadness or profound fear arise when the ego starts to dissolve. As far as dissolution is concerned, Ego would prefer not to.

“Those tears are payment to the ferryman who takes you to the other side,” he told me. “He’ll ferry you across but he always exacts a price.”

A few moment later, I noticed a young boy with a slingshot standing a few yards in front of me. He steadied his arm against a tree trunk, his elbow resting on a branch. He aimed straight at my forehead, and pulled back the rubber band. I stared at him, unfazed. I thought gosh if this is supposed to scare me into not wanting to go ahead, the effort is rather pathetic.

Beside me there was an explosion. A blinding white light erupted geyserlike out of an aperture in the earth.

Then the notes of a violin solo lit three strands of deep red light, which trickled like water in my right visual field. Deeper tones poured from above in huge blue clouds in the middle distance. Another violin flourish turned the sky yellow and brought with it a comet’s tail of body parts flying from the upper left of my visual field to the lower right, disappearing behind me.

Some time later, I found myself inside a steel industrial space. I became aware of my animosity toward my two living siblings. A woman seated at the end of a long table, wearing a net cap, white clothes, and working busily, turned and handed me a Dixie cup.

“You can put that in here,” she said. So I did. The cup filled itself with my bilious, sibling-directed feelings. “We’ll put it over here,” she said, and placed it on a table at the back of the room. Then she went matter-of-factly back to work, along with now numerous busy women who occupied this space.

Up until then, I had not shared anything at all with my guides. I was completely absorbed by the experience. Some subjects interact with the guides more than others. Some want to share bit too much, which can detract from the internal journey, and is gently discouraged. For me, the process was so interior and so compelling I had not even thought of sitting up and talking about it.

Then Fred asked me if I’d like to share what was going on.

“What a lot of busy women,” I said, sitting up and removing the eye mask, as though the irony of their presence was obvious to everyone. As I recounted the scene, I began to laugh out loud, and then Fred began to laugh, and my own laughter appeared to me in a midnight blue, cloud-dark sky as an effusion of twinkling gemstones, glittering rhythmically with my peals of laughter.

Late that afternoon, I’d returned to what Roland termed “consensual reality” Mary, Roland, Fred, Matt, Porche, Samantha and Nancy-Bets gathered with me in the session room for a debriefing. When I told them about my own laughter at the busy women setting off a fountain of jewels issuing forth from the universe Fred said: “Let that be a lesson to you, young lady.”

During the session, the subject of cancer did not arise. Other parts of life appeared and revealed themselves in myriad ways: the present, the past, people known, people loved and people reviled. The session defies description in the logic of everyday language. It is impossible to force the literal world onto the experience, or even to try to characterize it in terms of a narrative progression, or distinct lessons learned. There was logic to my experience, to be sure, but it was internal and sui generis.

Unlike some other subjects, I did not have a peak or transcendent experience. I had hoped to see the face of God, and I did not.

Those who have undergone the psychedelic experience and attained what is commonly thought of as a transcendent peak, describe it in explicit terms: a sense of oneness with the universe, a complete sense of dissolution of self and being part of something magnificent yet ineffable. I did not have the distinct sensation of being part of all things and one with the universe, although I had hints of it — the blinding white geyser, the jewels welling out of the sky symphonically with my laughter. Where I would have expected each of these parts of the experience to effloresce infinitely until the universe revealed itself in its entirety, each image or scenario simply ended, or was elided by something else.

I told Fred and later Roland that I was disappointed.

Both pointed out it was an experience you can’t dictate and which cannot be controlled. That, so it seemed, was part of the lesson, and part of the journey.

A day later, while I waited at the airport for my flight back to London, I spoke on the phone at length with Dr Anthony Bossis, the NYU cancer study’s co-principal investigator. He’d offered to speak with me about the experience afterwards if I thought it would help me process it, and given me his mobile telephone number so I could call him afterward.

I told him about my disappointment at not seeing the face of God.

“This may not be satisfying, but truthfully, these experiences are like peeling an onion. You don’t get to there until you’re ready to. You’ll get there, through whatever the modality when it’s time.”

[1] The Consolidated Omnibus Budget Reconciliation Act which confers continuing group health insurance coverage to family members under certain circumstances, divorce being one of them.

[2] A drug in the class of aromatase inhibitors. Aromatase inhibitors arrest the cellular process by which estrogen is created in the body, and are thought to prevent estrogen-receptor positive cancer recurrence. Almost all human cells produce a tiny amount of estrogen. They are the post-surgery and post-chemo drugs for estrogen-receptor-positive breast cancers. They are administered in ongoing years-long treatment regimens.

[3] Middlebrook, Diane. Anne Sexton: A Biography (New York, Vintage, 1992).

Erica Rex

Written by

Erica Rex

Journalist, essayist New York Times, Scientific American, The Independent, Salon, The North American Review, winner Nat‘l Magazine Award & rescuer of baby birds

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