faces of twenty-one participants, onWebcam, appeared along the top ofmy screen, some small and framed

the rooms around them, others socl e that I co d see their pores. Wesmi d and aved at one another;we al Tooke to be in our twentiesor thir 'es. O r supervisor, who waswearing pi k plush hat, introduceherself an n a crackling voice, 1 tus know th t we were welcome towear pajam~ next time. Like thesessions tha~ f lowed in the om-ing weeks, tlhis o was nine min-utes long b~}t felt ore like thirty.The trainingcombine two easureslargely lacking in adu lif,~: struc-tured increm ntal learnin d make-believe. Ina instant-m age box,we practiced replying to v io imag-inary texts. '~'he recom ende for-mula for repl~es is tenta er +fee 'nadjective + ource of feeling (`sounds like ou're fee ing ashamebecause your friend di n't invite yoto her party")' We also racticed parphrased refl ctions "You must ereally upset ith yo r friend"). elearned to as open- nded questio sand to acti ely id ntify a texte 'sstrengths: p intin out his brave yin reaching ut, co plimenting isself-awarene s. Th n we were pairup in order t prac ice these skill na role-play, o e o us pretendi ~tobe an upset t en- er and the of eracting as a C T.L volunteer Aft~r-ward, we an ota ed the t anscr ptwith "pluses" nd ̀wishes 'the or a-nization's pref ed angu e for "go d"and "bad." In rm tten y, the sup r-visor's cursor pp ar in the do u-ment to offer adv c .The thing fo nd most diffic It

was employi g risis Text Lin 'steachings whi sill coming acr sslike myself. T m im "Don't sou dlike a robot" s o ten repeated, a deventually i wa possible to achie ethis effect y imagining my wor sbeing rea by a teen-ager. Using smany co tractions as possible cato see surprisingly important, because ormality gets in the way oaf~ir ation. It was hard to fend offvague and echoey therapist-speak,and I wasted a lot of time trying torephrase the question "And how doesthat make you feel?"before realizing

that I didn't have to. There is some-thing humbling about Crisis TextLine, and, indeed, about help lines ingeneral: a person in pain will say whatshe wants to say, and it probablydoesn't matter much who does the

~ The weekly practices ssions aret e core of the traini g. olunteersso participate in bservationhifts (each three ou s long), inhich they have t e op ortunity toee actual conver atio s occur be-tween texters an a co nsellor. Cr'sis Text Line go s to gr at lengt toinsure that tex rs' ide tity re ainssecret, and tra'nees si n a ingentagreement to rotect on entiality.(I agreed not to divul e ersonal de-tails.) Duri g my fi t shift, I wit-nessed a hal ing co e sation betweena counsell r an a y ung girl withbody dys orp ia. T e conversationlasted fo a our a d a half. Theounsell~ rovided li ks to resources

peop~ struggling ith eating dis-or s, ~nd the girl e entually agreedto d' act herself wi h a bath and amo i Simultaneous y, that counsel-/1 wa exting with a irl who wanteo cud h self and w s having suicidal t~iough ,and wi h a third text r '~whose grade were ummetin~ b -caus~of depre ion. his last tex erwas uch less en ag din the pro essthan the others we .This isn't ak-ing~me feel much b tter," he or shewr te. Soon after, t commu ica-tio fizzled out entir ly.

week later, I sh ow d an therco nsellor. Her first c nvers io waswi h a girl who was fi hting ' h herco sin and struggling ainst t urgeto hurt herself. The n xt was i ac liege-aged young an wh w sc nfused about the ro antic f elingh harbored for his -boy riend,ho had sexually assau ted hi .The

c unsellor's last conver atio of thefight was with the daugh er o an abu-ive father. She wrote tha s avoidedim by spending lots of time locked

in her bedroom. The counsellor reas-sured her and asked about her plansfor the rest of the evening. She saidthat she was going shopping with herfamily, and that afterward she'd bealone. She typed, "Thats the part imscared for."

PROMOTION

".

NEWYORKER.COM{LI ES MORE THAN FIFTEENORI INAL STORIES A DAY

C011'Dh~ tVAS'C

THE NEW YORKER, FE6RUARY 9, 2015 35

ANNALS OF MEDICINE

THE TRIP TREATMENTResearch into psychedelics, shut down for decades, is now yielding exciting results.

4Y MICHAEL POLLAN

On an April Monday in 2010, Pat-rick Mettes, afifty-four-year-old

television news director being treated fora cancer of the bile ducts, read an articleon the front page of the Times that wouldchange his death. His diagnosis had comethree years earlier, shortly after his wife,Lisa, noticed that the whites of his eyeshad turned yellow By 2010, the cancerhad spread to Patrick's lungs and he wasbuckling under the weight of a debilitat-ingchemotherapy regimen and the grow-ing fear that he might not survive. Thearticle, headlined "HALLUC~IVOGENsHAVE DOCTORS TUNING IN AGAIN,"

mentioned clinical trials at several uni-versities,including N.Y.U., in which psi-locybin—the active ingredient in so-calledmagic mushrooms—was being adminis-tered to cancer patients in an effort torelieve their arixiety and "existential dis-tress."One ofthe researchers was quotedas saying that, under the influence of thehallucinogen,"individuals transcend theirprimary identification with their bodiesand e~:perience ego-free states ...and re-turnwith anew perspective and profoundacceptance." Patrick had never taken apsychedelic drug, but he immediatelywanted to volunteer. Lisa was against theidea. "I didn't want there to be an easyway out," she recently told me. "I wantedhim to fight."

Patrick made the call anyway and, afterfilling out some forms and answering along list of questions, was accepted intothe trial. Since hallucinogens can some-times bring to the surface latent psycho-logical problems, researchers try to weedout volunteers at high risk by aslting ques-tions about drug use and whether thereis a family history of schizophrenia or bi-polardisorder. After the screening, Metteswas assigned to a therapist named An-thony Bossis, abearded, bearish psychol-ogist in his mid-fifties, with a specialtyin palliative care. Bossis is a co-principalinvesrigator for the N.Y.U. trial.

After four meetings with Bossis,

Mettes was scheduled for two dosings—one of them an "active" placebo (in thiscase, a high dose of niacin, which canproduce a tingling sensation), and theother a pill containing the psilocybin.Both sessions, Mettes was told, wouldtake place in a room decorated to lookmore like a living room than like a med-icaloffice,with acomfortable couch, land-scape paintings on the wall, and, on theshelves, books of art and mythology, alongwith various aboriginal and spiritualtchotchkes, including a Buddha and aglazed ceramic mushroom. During eachsession, which would last the better partof a day, Mettes would lie on the couchwearing an eye mask and listening throughheadphones to a carefully curated play-list—Brian Eno, Philip Glass, PatMetheny, Ravi Shankar. Bossis and a sec-ond therapist would be there through-out, saying little but being available tohelp should he run into any trouble.

I met Bossis last year in the N.Y.U.treatment room, along with his colleagueStephen Ross, an associate professor ofpsychiatry at N.Y.U.'s medical school,who directs the ongoing psilocybin tri-als.Ross, who is in his forties, was dressedin a suit and could pass for a banker. Heis also the director of the substance-abusedivision at Bellevue, and he told me thathe had known little about psychedelics—drugs that produce radical changes inconsciousness, including hallucinations—until acolleague happened to mentionthat, in the nineteen-sixties, LSD hadbeen used successfully to treat alcohol-ics. Ross did some research and was as-tounded at what he found.

"I felt a little like an archeologist un-earthing acompletely buried body ofknowledge," he said. Beginning in thenineteen-fifties, psychedelics had beenused to treat a wide variety of conditions,including alcoholism and end-of-life arix-iety.The American Psychiatric Associa-tion held meetings centered on LSD."Some of the best minds in psychiatry

had seriously studied these compoundsin therapeutic models, with governmentfunding," Ross said.

Between 1953 and 1973, the federalgovernment spent four million dollars tofund a hundred and sixteen studies ofLSD, involving more than seventeen hun-dred subjects. (These figures don't in-clude classified research.) Through themid-nineteen-sixties, psilocybin and LSDwere legal and remarkably easy to obtain.Sandoz, the Swiss chemical companywhere, in 1938, Albert Hofmann firstsynthesized LSD, gave away large quan-tities of Delysid—LSD—to any re-searcher who requested it, in the hopethat someone would discover a market-able application. Psychedelics were testedon alcoholics, people struggling withobsessive-compulsive disorder, depres-sives, autistic children, schizophrenics,terminal cancer patients, and convicts, aswell as on perfectly healthy artists andscientists (to study creativity) and divin-ity students (to study spirituality). Theresults reported were frequently positive.But many of the studies were, by mod-ern standards, poorly designed and sel-domwell controlled, if at all. When therewere controls, it was difficult to blind theresearchers—that is, hide from themwhich volunteers had taken the actualdrug. (This remains a problem.)By the mid-nineteen-sixties, LSD

had escaped from the laboratory andswept through the counterculture. In1970, Richard Nixon signed the Con-trolled Substances Act and put mostpsychedelics on Schedule 1, prohibit-ing their use for any purpose. Researchsoon came to a halt, and what had beenlearned was all but erased from the fieldof psychiatry. "By the time I got to med-ical school, no one even talked aboutit," Ross said.

The clinical trials at N.Y.U.—a sec-ond one, using psilocybin to treat alco-hol addiction, is now getting under way—are part of a renaissance of psychedelic

~6 THE NEW YORKER, FE6RUARY 9, 2015

ILLUSTRATION BY STEPHEN DOYLE THE NEW YORKER, FE6RUARY 9, 2015 37

Psilocybin may be useful in treating anxiety, addiction, and depression, and in studying the neurobiology of mystical experience.

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research taking place at several univer-sities in the United States, includingJohns Hopkins, the Harbor-U.C.L.A.Medical Center, and the University ofNew Mexico, as well as at Imperial Col-lege, in London, and the University ofZurich. As the drug war subsides, sci-entists are eager to reconsider the ther-apeutic potential of these drugs, begin-ning with psilocybin. (Last month TheLancet, the United Kingdom's mostprominent medical journal, published aguest editorial in support of such re-search.)The effects of psilocybin resem-ble those of LSD, but, as one researcherexplained, "it carries none of the polit-ical and cultural baggage of those threeletters." LSD is also stronger and lon-ger-lasting in its effects, and is consid-ered more likely to produce adverse re-actions. Researchers are using or planningto use psilocybin not only to treat anx-iety, addiction (to smoking and alcohol),and depression but also to study the neu-robiology ofmystical experience, whichthe drug, at high doses, can reliably oc-casion. Forty years after the Nixon Ad-ministration effectively shut down mostpsychedelic research, the government isgingerly allowing a small number of sci-entists to resume working with thesepowerful and still somewhat mysteriousmolecules.As I chatted with Tony Bossis and

Stephen Ross in the treatment room atN.Y.U., their excitement about the re-

suits was evident. According to Ross,cancer patients receiving just a singledose of psilocybin experienced imme-diate and dramatic reductions in anxi-ety and depression, improvements thatwere sustained for at least six months.The data are still being analyzed andhave not yet been submitted to a jour-nal for peer review, but the researchersexpect to publish later this year.

"I thought the first ten or twentypeople were plants—that they must befaking it," Ross told me. "They weresaying things like ̀ I understand love isthe most powerful force on the planet,'or ̀I had an encounter with my cancer,this black cloud of smoke.' People whohad been palpably scared of death—theylost their fear. The fact that a druggiven once can have such an effect forso long is an unprecedented finding.We have never had anything like it inthe psychiatric field."

I was surprised to hear such unguardedenthusiasm from a scientist, and a sub-stance-abuse specialist, about a street drugthat, since 1970, has been classified bythe government as having no acceptedmedical use and a high potential for abuse.But the support for renewed research onpsychedelics is widespread among med-ical experts. "I'm personally biased in favorof these type of studies," Thomas R.Insel,the director of the National Institute ofMental Health (N.I.M.H.) and a neu-roscientist, told me. "If it proves useful

to people who are really suffering, weshould look at it. Just because it is a psy-chedelic doesn't disqualify it in our eyes."Nora Volkow, the director of the Na-tional Institute on Drug Abuse (1vIDA),emphasized that "it is important to re-mind people that experimenting withdrugs of abuse outside a research settingcan produce serious harms."Many researchers I spoke with de-

scribed their findings with excitement,some using words like "mind-blowing."Bossis said, "People don't realize how fewtools we have in psychiatry to address ex-istential distress. Xanax isdt the answer.So how can we not explore this, if it canrecalibrate how we die?"

Herbert D. Kleber, a psychiatrist andthe director of the substance-abuse di-vision at the Columbia University—N.Y.State Psychiatric Institute, who is oneof the nations leading experts on drugabuse, struck a cautionary note. "Thewhole area of research is fascinating,"he said. "But it's important to remem-ber that the sample sizes are small." Healso stressed the risk of adverse effectsand the importance of "having guidesin the room, since you can have a goodexperience or a frightful one." But headded, referring to the N.Y.U. and JohnsHopkins research, "These studies arebeing carried out by very well trainedand dedicated therapists who know whatthey're doing.The question is, is it readyfor prime time?"

The idea of giving a psychedelic drugto the dying was conceived by a nov-

elist: Aldous Huxley. In 1953, HumphryOsmond, an English psychiatrist, intro-duced Huxley to mescaline, an experi-ence he chronicled in "The Doors of Per-ception," in 1954. (Osmond coined theword "psychedelic,"which means "mind-manifesting," in a 19571etter to Huxley.)Hwcley proposed a research project in-volving the "administration of LSD toterminal cancer cases, in the hope that itwould make dying a more spiritual, lessstrictly physiological process."Huxley hadhis wife inject him with the drug on hisdeathbed; he died at sixty-nine, of laryn-geal cancer, on November 22,1963.

Psilocybin mushrooms first came tothe attention of Western medicine (andpopular culture) in a fifteen-page 1957Life article by an amateur mycologist—and avice-president of J. P. Morgan in

38 THE NEW YORKER, FEDRUARY 9, 2015

New York—named R. Gordon Wasson.

In 1955, after years spent chasing down

reports of the clandestine use of magic

mushrooms among indigenous Mexi-

cans, Wasson was introduced to them

by Maria Sabina, a curandera—a healer,

or shaman—in southern Mexico. Was-

son's awed first-person account of his

psychedelic journey during a nocturnal

mushroom ceremony inspired several

scientists, including Timothy Leary, a

well-regarded psychologist doing per-

sonalityresearch at Harvard, to take up

the study of psilocybin. After trying

magic mushrooms in Cuernavaca, in

1960, Leary conceived the Harvard Psi-

locybin Project, to study the therapeu-

tic potential of hallucinogens. His in-

volvement with LSD came a few years

later.In the wake of Wassods research, Al-

bert Hofmann e~:perimented with magic

mushrooms in 1957. "Thirty minutes

after my taking the mushrooms, the ex-

terior world began to undergo a strange

transformation," he wrote. "Everything

assumed a Mexican character."Hofmann

proceeded to identify, isolate, and then

synthesize the active ingredient, psilocy-

bin, the compound being used in the cur-

rent research.Perhaps the most influential and rig-

orous of these early studies was the Good

Friday experiment, conducted in 1962

by Walter Pahnke, a psychiatrist and

minister working on a Ph.D. disserta-

tion under Leary at Harvard. In a dou-

ble-blind experiment, twenty divinity

students received a capsule ofwhite pow-

der right before a Good Friday service

at Marsh Chapel, on the Boston Uni-

versity campus; ten contained psilocy-

bin,ten anactive placebo (nicotinic acid).

Eight of the ten students receiving psi-

locybin reported a mystical experience,

while only one in the control group ex-

perienced afeeling of "sacredness" and

a "sense of peace." (Telling the subjects

apart was not difficult, rendering the

double-blind a somewhat .hollow con-

ceit: those on the placebo sat sedately

in their pews while the others lay down

or wandered around the chapel, mutter-

ing things like "God is everywhere" and

"Oh, the glory!") Pahnke concluded that

the experiences of eight who received

the psilocybin were "indistinguishable

from, if not identical with," the classic

mystical experiences reported in the lit-

erature by William James, Walter Stace,

and others.In 1991, Rick Doblin, the director of

the Multidisciplinary Association for

Psychedelic Studies (MAPS), published

a follow-up study, in which he tracked

down all but one of the divinity students

who received psilocybin at Marsh Chapel

and interviewed seven of them. They all

reported that the experience had shaped

their lives and work in profound and

enduring ways. But Doblin found flaws

in Pahnke's published account: he had

failed to mention that several subjects

struggled with acute arixiety during their

experience. One had to be restrained

and given Thorazine, a powerful anti-

psychotic, after he ran from the chapel

and headed down Commonwealth Av-

enue, convinced that he had been cho-

sen to announce that the Messiah had

arrived.The first wave of research into psy-

chedelics was doomed by an excessive

exuberance about their potenrial. For peo-

ple working with these remarkable mol-

ecules, it was difficult not to conclude

that they were suddenly in possession of

news with the power to change the

world—a psychedelic gospel.They found

it hard to justify confining these drugs

to the laboratory or using them only for

the benefit of the sick It didn't take long

for once respectable scientists such as

Leary to grow impatient with the rig-

marole of objective science. He came to

see science as just another societal "game,"

a conventional box it was time

to blow up—along with all

the others.Was the suppression of

psychedelic research inevita-

ble? Stanislav Grof, a Czech-

born psychiatrist who used

LSD extensively in his prac-

tice in the nineteen-sixties,

believes that psychedelics

"loosed the Dionysian ele-ment" on America, posing a

threat to the country's Puritan values that

was bound to be repulsed. (He thinks the

same thing could happen again.) Roland

Griffiths, a psychophannacologist at Johns

Hopkins University School of Medicine,

points out that ours is not the first cul-

ture to feel threatened by psychedelics:

the reason Gordon Wasson had to redis-

cover magic mushrooms in Mexico was

that the Spanish had suppressed them

so thoroughly, deeming them dangerous

instruments of paganism.

"There is such a sense of authority

that comes out of the primary mystical

experience that it can be threatening to

existing hierarchical structures,"Griffiths

told me when we met in his office last

spring. "We ended up demonizing these

compounds. Can you think of another

area of science regarded as so dangerous

and taboo that all research gets shut down

for decades? It's unprecedented in mod-

ern science."

Early in 2006, Tony Bossis, Stephen

Ross, and Jeffrey Guss, a psychia-

trist and N.Y.U. colleague, began meet-

ing after work on Friday afternoons to

read up on and discuss the scientific lit-

erature on psychedelics.They called them-

selves the P.R.G., or Psychedelic Read-

ing Group, but within a few months the

"R" in P. R. G. had come to stand for "Re-

search."They had decided to try to start

an experimental trial at N.Y.U., using

psilocybin alongside therapy to treat anx-

iety in cancer patients. The obstacles to

such a trial were formidable: Would the

F.D.A. and the D.E.A. grant permission

to use the drug? Would N.Y.U.'s Insti-

tutional Review Board, charged with

protecting experimental subjects, allow

them to administer a psychedelic to can-

cer patients? Then, in July of 2006, the

journal Psychopharmacology published a

landmark article by Roland Griffiths, et

al., titled "Psilocybin Can Occasion Mys-tical Type Experiences Hav-

ing Substanrial and Sustained

Personal Meaning and Spir-itual Significance.""We all rushed in with Ro-

~ land's arricle," Bossis recalls.

"It solidified our confidence

that we could do this work.

Johns Hopkins had shown it

could be done safely."The ar-

~. ticle also gave Ross the am-

munition he needed to per-

suade askeptical I.R.B. "The fact that

psychedelic research was being done at

Hopkins—considered the premier med-

ical center in the country—made it eas-

ier toget it approved here. It was an amaz-

ing study, with such an elegant design.

And it opened up the field." (Even so,

psychedelic research remains tightly reg-

ulatedand closely scrutinized.The N.Y.U.

trial could not begin until Ross obtained

THE NEW YORKER, FE6RUARY 9, 2015 39

~'

approvals first from the F.D.A., then fromN.Y.U.'s Oncology Review Board, andthen from the I.R.B., the Bellevue Re-search Review Committee, the BluestoneCenter for Clinical Research, the Clini-cal and Translational Science Institute,and, finally, the Drug Enforcement Ad-ministration, which must grant the li-cense to use a Schedule 1 substance.)

Griffiths's double-blind study reprisedthe work done by Pahnke in the nine-teen-sixties, but with considerably morescientific rigor. Thirty-six volunteers, noneof whom had ever taken a hallucinogen,received a pill containing either psilocy-bin or an active placebo (methylpheni-date, or Ritalin); in a subsequent sessionthe pills were reversed. "When adminis-tered under supportive conditions," thepaper concluded, "psilocybin occasionedexperiences similar to spontaneously oc-curring mystical experiences." Partici-pants ranked these experiences as amongthe most meaningful in their lives, com-parable to the birth of a child or the deathof a parent. Two-thirds of the partici-pants rated the psilocybin session amongthe top five most spiritually significantexperiences of their lives; a third rankedit at the top. Fourteen months later, theseratings had slipped only slightly.

Furthermore, the "completeness" ofthe mystical experience closely trackedthe improvements reported in personalwell-being, life satisfaction, and "positivebehavior change" measured two monthsand then fourteen months after the ses-sion. (The researchers relied on bothself-assessments and the assessments ofco-workers, friends, and family.) The au-thors determined the completeness of amystical experience using two question-naires, including the Pahnke-RichardsMystical Experience Questionnaire,which is based in part on William James'swriting in "The Varieties of ReligiousExperience."T'he questionnaire measuresfeelings of unity, sacredness, ineffability,peace and joy, as weld as the impressionof having transcended space and timeand the "poetic sense" that the experi-ence has disclosed some objective truthabout reality. A "complete" mystical ex-perience is one that exhibits all six char-acteristics.Griffiths believes that the long-term effectiveness of the drug is due toits ability to occasion such a transforma-tive experience, but not by changing thebrain's long-term chemistry, as a conven-

tional psychiatric drug like Prozac does.A follow-up study by Katherine Mac-

Lean, apsychologist in Griffiths's lab,found that the psilocybin experience alsohad a positive and lasting effect on thepersonality of most participants. This isa striking result, since the conventionalwisdom in psychology holds that per-sonality is usually fixed by age thirty andthereafter is unlikely to substantiallychange. But more than a year after theirpsilocybin sessions volunteers who hadhad the most complete mystical e~:peri-ences showed significant increases in their"openness," one of the five domains thatpsychologists look at in assessing person-alitytraits. (The others are conscientious-ness, extroversion, agreeableness, and neu-roticism.) Openness,which encompassesaesthetic appreciation, imagination, andtolerance of others'viewpoints, is a goodpredictor of creativity.

"I don't want to use the word ̀mind-blowing,"' Griffiths told me, "but, as ascientific phenomenon, if you can createconditions in which seventy per centof people will say they have had oneof the five most meaningful experiencesof their lives? To a scientist, that's justincredible."

he revival of psychedelic researchtoday owes much to the respectabil-

ity of its new advocates. At sixty-eight,Roland Griffiths, who was trained as abehaviorist and holds senior appoint-ments in psychiatry and neuroscience atHopkins, is one of the nation's leadingdrug-addiction researchers. More thansix feet tall, he is rail-thin and stands boltupright; the only undisciplined thingabout him is a thatch of white hair sodense that it appears to have held hiscomb to a draw His long, productive re-larionship with NIDA has resulted in somethree hundred and fifty papers, with ti-tles such as "Reduction of HeroinSelf-Administration in Baboons byMa-nipulation of Behavioral and Pharmaco-logical Conditions." Tom Insel, the di-rector ofthe N.I.M.H.,described Griffithsas "a very careful, thoughtful scientist"with "a reputation for meticulous dataanalysis. So it's fascinating that he's nowinvolved in an area that other peoplemight view as pushing the edge."

Griffiths's career took an unexpectedturn in the nineteen-nineties after twoserendipitous introductions. The first

came when a friend introduced him toSiddha Yoga, in 1994. He told me thatmeditation acquainted him with "some-thing way, way beyond a material worldview that I can't really talk to my col-leagues about, because it involves meta-phors or assumptions that I'm really un-comfortable with as a scientist."He beganentertaining "fanciful thoughts" of quit-ting science and going to India.

In 1996, an old friend and colleaguenamed Charles R. (Bob) Schuster, re-cently retired as the head of N~DA, sug-gested that Griffiths tallc to Robert Jesse,a young man he'd recently met at Esalen,the retreat center in Big Sur, California.Jesse was neither a medical professionalnor a scientist; he was a computer guy, avice-president at Oracle, who had madeit his mission to revive the science of psy-chedelics, as a tool not so much of med-icine as of spirituality. He had organizeda gathering of researchers and religiousfigures to discuss the spiritual and ther-apeutic potential of psychedelic drugsand how they might be rehabilitated.When the history of second-wave

psychedelic research is written, Bob Jessewill be remembered as one of two sci-entific outsiders who worked for years,mostly behind the scenes, to get it offthe ground. (The other is Rick Doblin,the founder of MAPS.) While on leavefrom Oracle, Jesse established a non-profit called the Council on SpiritualPractices, with the aim of "making di-rect experience of the sacred more avail-able to more people." (He prefers theterm "entheogen,"or "God-facilitating,"to "psychedelic.") In 1996, the C.S.P.organized the historic gathering at Es-alen.Many ofthe fifteen in attendancewere "psychedelic elders," researcherssuch as James Fadiman and Willis Har-man,both ofwhom had done early psy-chedelicresearch while at Stanford, andreligious figures like Huston Smith, thescholar of comparative religion. But Jessewisely decided to invite an outsider aswell: Bob Schuster, adrug-abuse expertwho had served in two Republican Ad-ministrations. By the end of the meet-ing, the Esalen group had decided ona plan: "to get aboveboard, unassail-able research done, at an institutionwith investigators beyond reproach,"and, ideally, "do this without any prom-ise of clinical treatment."Jesse was ulti-mately less interested in people's mental

40 THE NEW YORKER, FEDRUARY 9, 2015

disorders than in their spiritual well-

being—in using entheogens for what

he calls "the betterment of well people."

Shortly after the Esalen meeting, Bob

Schuster (who died in 2011) phoned Jesse

to tell him about his old friend Roland

Griffiths, whom he described as "the in-

vestigator beyond reproach" Jesse was

looking for. Jesse flew to Baltimore to

meet Griffiths, inaugurating a series of

conversations and meetings about med-

itation and spirituality that eventually

drew Griffiths into psychedelic research

and would culminate, a few years later,

in the 2006 paper in Psychopharmacology.

The significance of the 2006 paper

went far beyond its findings. The jour-

nal invited several prominent drug re-

searchers and neuroscientists to comment

on the study, and all of them treated it

as a convincing case for further research.

Herbert Kleber, of Columbia, applauded

the paper and acknowledged that "major

therapeutic possibiliries"could result from

further psychedelic research studies, some

of which "merit N.I.H. support." Solo-

mon Snyder, the Hopkins neuroscientist

who, in the nineteen-seventies, discov-

eredthe brain's opioid receptors, summa-

rizedwhat Griffiths had achieved for the

field: "The ability of these researchers to

conduct adouble-blind, well-controlled

study tells us that clinical research with

psychedelic drugs need not be so risky as

to be off-limits to most investigators."

Roland Griffiths and Bob Jesse had

opened a door that had been tightly shut

for more than three decades. Charles

Grob, at U.C.L.A., was the first to step

through it, winning F.D.A. approval for

a Phase I pilot study to assess the safety,

dosing, and efficacy of psilocybin in the

treatment of arixiety in cancer patients.

Next came the Phase II trials, just con-

cluded at both Hopkins and N.Y.U., in-

volving higher doses and larger groups

(twenty-nine at N.Y.U.; fifty-six at Hop-

kins)—including Patrick Mettes and

about a dozen other cancer patients in

New York and Baltimore whom I re-

cently interviewed.Since 2006, Griffiths's lab has con-

ducted apilot study on the potential of

psilocybin to treat smoking addiction,

the results of which were published last

November in the Journal of Psycho~har-

macology. The sample is tiny—fifteen

smokers—but the success rate is strik-

ing. Twelve subjects, all of whom had

4

C

"We re upgrading our business to something worse. "

tried to quit multiple times, using vari-

ous methods, were verified as abstinent

six months after treatment, a success rate

of eighty per cent. (Currently, the lead-

ing cessation treatment is nicotine-

replacement therapy; a recent review ar-

ticle in the BMJ—formerly the British

MedicalJournal—reported that the treat-

ment helped smokers remain abstinent

for six months in less than seven per cent

of cases.) In the Hopkins study, subjects

underwent two or three psilocybin ses-

sions and a course of cognitive-behav-

ioral therapy to help them deal with crav-

ings.The psychedelic experience seems

to allow many subjects to reframe, and

then break, a lifelong habit. "Smoking

seemed irrelevant, so I stopped,"one sub-

jecttold me.The volunteers who reported

amore complete mystical experience had

greater success in breaking the habit. A

larger, Phase II trial comparing psilocy-

bin to nicotine replacement (both in con-

junctionwith cognitive behavioral ther-

apy) is getting under way at Hopkins.

"We desperately need a new treat-

ment approach for addiction," Herbert

Kleber told me. "Done in the right

hands—and I stress that, because the

whole psychedelic area attracts people

who often think that they know the truth

before doing the science—this could be

a very useful one."

Thus far, criticism of psychedelic re-

search has been limited. Last summer,

Florian Holsboer, the director of the Marc

Planck Institute of Psychiatry, in Mu-

nich,told Science, "You can't give patients

some substance just because it has an

antidepressant effect on top of many other

effects.That's too dangerous."Nora Vol-

kow, of NIDA,wrote me in an e-mail that

"the main concern we have at NIDA in

relation to this work is that the public

will walk away with the message that psi-

locybin is a safe drug to use. In fact, its

adverse effects are well known, although

not completely predictable." She added,

"Progress has been made in decreasing

use of hallucinogens, particularly in young

people. We would not want to see that

trend altered."The recreational use of psychedelics

is famously associated with instances of

psychosis, flashback, and suicide. But

these adverse effects have not surfaced in

the trials of drugs at N.Y.U. and Johns

Hopkins. After nearly five hundred ad-

ministrations of psilocybin, the research-

ers have reported no serious negative

effects. This is perhaps less surprising

than it sounds, since volunteers are self-

selected,carefully screened and prepared

for the experience, and are then guided

through it by therapists well trained to

manage the episodes of fear and anxiety

THE NEW YORKER, FE6RUARY 9, 2015 41

that many volunteers do report. Apartfrom the molecules involved, a psyche-delic therapy session and a recreationalpsychedelic experience have very little incommon.

The lab at Hopkins is currently con-ducting astudy of particular interest toGriffiths: examining the effect of psilo-cybin on long-term meditators.The studyplans touse fMRI—functional magnetic-resonance imaging—to study the brainsof forty meditators before, during, andafter they have taken psilocybin, to mea-sure changes in brain activity and con-nectivity and to see what these "trainedcontemplatives can tell us about the ex-perience." Griffiths's lab is also launch-ing astudy in collaboration with N.Y.U.that will give the drug to religious pro-fessionals in a number of faiths to seehow the experience might contribute totheir work. "I feel like a kid in a candyshop," GrifFiths told me. "There are somany directions to take this research. It'sa Rip Van Winkle effect—after three de-cades of no research, we're rubbing thesleep from our eyes."

"ineffability" is a hallmark of the mys-1 tical experience. Many struggle todescribe the bizarre events going on intheir minds during a guided psychedelicjourney without sounding like either aNew Age guru or a lunatic. The avail-ablevocabulary isn't always up to the taskof recounting an experience that seem-inglycan take someone out of body, acrossvast stretches of time and space, and in-clude face-to-face encounters with di-viniries and demons and previews of theirown death.

Volunteers in the N.Y.U. psilocybintrial were required to write a narrativeof their experience soon after the treat-ment,and Patrick Mettes, having workedin journalism, took the assignment seri-ously. His wife, Lisa, said that, after hisFriday session, he worked all weekendto make sense of the experience and writeit down.When Mettes arrived at the treatment

room, at First Avenue and Twenty-fifthStreet, Tony Bossis and Krystallia Kal-liontzi, his guides, greeted him, reviewedthe day's plan, and, at 9 A.1v~., presentedhim with a small chalice containing thepill. None of them knew whether it con-tained psilocybin or the placebo. Askedto state his intention, Mettes said that

he wanted to learn to cope better withthe anxiety and the fear that he felt abouthis cancer. As the researchers had sug-gested, he'd brought a few photographsalong—of Lisa and him on their wed-ding day, and of their dog, Arlo—andplaced them around the room.At nine-thirty, Mettes lay down on

the couch, put on the headphones andeye mask, and fell silent. In his account,he likened the start of the journey to thelaunch of a space shuttle, "a physically vi-

olent and rather clunky liftoff which even-tuallygave way to the blissful serenity ofweightlessness."

Several of the volunteers I interviewedreported feeling intense fear and arixietybefore giving themselves up to the expe-rience, as the guides encourage them todo.The guides work from a set of"flightinstructions" prepared by Bill Richards,a Baltimore psychologist who workedwith Stanislaw Grof during the nineteen-seventies and now trains a new genera-tion of psychedelic therapists. The doc-ument is a summary of the experienceaccumulated from managing thousandsof psychedelic sessions—and countlessbad trips—during the nineteen-sides,whether these took place in therapeu-tic settings or in the bad-trip tent atWoodstock.The "same force that takes you deep

within will, of its own impetus, returnyou safely to the everyday world," themanual offers at one point. Guides areinstructed to remind subjects that they'llnever be left alone and not to worryabout their bodies while journeying,since the guides will keep an eye onthem. If you feel like you're "dying, melt-ing, dissolving, exploding, going crazyetc.—go ahead," embrace it: "Climbstaircases, open doors, explore paths, flyover landscapes." And if you confrontanything frightening, "look the mon-ster in the eye and move towards it... .Dig in your heels; ask, ̀What are youdoing in my mind?' Or, ̀What can I

learn from you?'Look for the darkestcorner in the basement, and shine yourlight there."This training may help ex-plain why the darker experiences thatsometimes accompany the recreationaluse of psychedelics have not surfacedin the N.Y.U. and Hopkins trials.

Early on, Mettes encountered hisbrother's wife, Ruth, who died of cancermore than twenty years earlier, at forty-three. Ruth "acted as my tour guide," hewrote, and "didn't seem surprised to seeme. She ̀wore' her translucent body so Iwould know her."Michelle Obama madean appearance. "The considerable femi-nine energy all around me made clearthe idea that a mother, any mother, re-gardless of her shortcomings ...couldnever NOT love her offspring. This wasvery powerful. I know I was crying." Hefelt as if he were coming out of the womb,"being birthed again."

Bossis noted that Mettes was cryingand breathing heavily. Mettes said, "Birthand death is a lot of work,"and appearedto be convulsing. Then he reached outand clutched Kalliontzi's hand while pull-ing his knees up and pushing, as if hewere delivering a baby."Oh God," he said, "it all makes sense

now, so simple and beautiful."Around noon, Mettes asked to take a

break. "It was getting too intense," hewrote.They helped him to the bathroom."Even the germs were beautiful, as waseverything in our world and universe."Afterward, he was reluctant to "go backin." He wrote, "The work was consider-able but I loved the sense of adventure."He put on his eye mask and headphonesand lay back down.

"From here on, love was the only con-sideration. Itwas and is the only purpose.Love seemed to emanate from a singlepoint of light. And it vibrated."He wrotethat "no sensation, no image of beauty,nothing during my time on earth has feltas pure and joyful and glorious as theheight of this journey."

Then, at twelve-ten, he said some-thing that Bossisjotted down: "O.K.,wecan all punch out now I get it."He went on to take a tour of his lungs,

where he "saw two spots."They were "nobig deal." Mettes recalled, "I was beingtold (without words) not to worry aboutthe cancer ...it's minor in the schemeof things ...simply an imperfection ofyour humanity."

42 THE NEW YORKER, FEDRUARY 9, 2015

Then he experienced what he called

"a brief death.""I approached what appeared to be a

very sharp, pointed piece of stainless steel.

It had a razor blade quality to it. I con-

tinued up to the apex of this shiny metal

object and as I arrived, I had a choice, to

look or not look, over the edge and into

the infinite abyss." He stared into "the

vastness of the universe,"hesitant but not

frightened. "I wanted to go all in but felt

that if I did, I would possibly leave my

body permanently," he wrote. But he

"knew there was much more for me here."Telling his guides about his choice, heexplained that he was "not ready to jump

off and leave Lisa."Around 3 P1v~., it was over. "The tran-

sition from a state where I had no sense of

time or space to the relative dullness ofnow, happened quickly. I had a headache."When Lisa arrived to take him home,

Patrick "looked like he had run a race,"

she recalled. "The color in his face was

not good, he looked tired and sweaty, but

he was fired up." He told her he had

touched the face of God.Bossis was deeply moved by the ses-

sion. "You're in this room, but you're in

the presence of something large," he re-

called. "It's humbling to sit there. It's the

most rewazding day of your career."

Every guided psychedelic journey isdifferent, but a few themes seem to

recur. Several of the cancer patients I in-terviewed at N.Y.U. and Hopkins de-

scribed an experience of either giving

birth or being born. Many also described

an encounter with their cancer that had

the effect of diminishing its power over

them. Dinah Bazer, a shy woman in her

sixties who had been given a diagnosisof ovarian cancer in 2010, screamed atthe black mass of fear she encountered

while peering into her rib cage: "Fuck

you, I wont be eaten alive!" Since her ses-sion, she says, she has stopped worrying

about arecurrence—one of the objec-tives of the trial.

Great secrets of the universe oftenbecome clear during the journey, suchas "We are all one" or "Love is all thatmatters."The usual ratio of wonder tobanality in the adult mind is over-turned, and such ideas acquire the forceof revealed truth. The result is a kindof conversion experience, and the re-searchers believe that this is what is

responsible for the therapeutic effect.

Subjects revelled in their sudden abil-

ity to travel seemingly at will through

space and time, using it to visit Elizabe-

than England, the banks of the Ganges,

or Wordsworthian scenes from their

childhood. The impediment of a body is

gone, as is one's identity, yet, paradoxi-

cally, aperceiving and recording "I" still

exists. Several volunteers used the met-

aphor of a camera being pulled back on

the scene of their lives, to a point where

matters that had once seemed daunting

now appeared manageable—smoking,cancer, even death. Their accounts are

reminiscent of the "overview effect" de-

scribed byastronauts who have glimpsed

the earth from a great distance, an expe-

rience that some of them say permanently

altered their priorities. Roland Griffiths

likens the therapeutic experience of psi-

locybin to a kind of "inverse P.T. S.D."—"adiscrete event that produces persisting

positive changes in attitudes, moods, andbehavior, and presumably in the brain."

Death looms large in the journeystaken by the cancer patients. A womanI'll call Deborah Ames, abreast-cancersurvivor in her sixties (she asked not to

be identified), described zipping through

space as if in a video game until she ar-

rived at the wall of a crematorium and

realized, with a fright, "I've died and nowI'm going to be cremated.The neact thing

I know, I'm below the ground in this gor-

geous forest, deep woods, loamy and

brown.There are roots all around me andI'm seeing the trees growing, and I'm partof them. It didn't feel sad or happy, justnatural, contented, peaceful. I wash t gone.I was part of the earth." Several patientsdescribed edging up to the precipice of

death and looking over to the other side.

Tammy Burgess, given a diagnosis of

ovarian cancer at fifty-five, found herself

gazing across "the great plain of con-

sciousness. Itwas very serene and beau-tiful. Ifelt alone but I could reach outand touch anyone I'd ever known. When

my time came, that's where my life wouldgo once it left me and that was O.K."

I was struck by how the descriptionsof psychedelic journeys differed from thetypical accounts of dreams. For one thing,most people's recall of their journey isnot just vivid but comprehensive, thenarratives they reconstruct seamless andfully accessible, even years later. Theydon't regard these narratives as "just adream," the evanescent products of fan-tasy or wish fulfillment, but, rather, asgenuine and sturdy experiences. This is

the "noetic"quality that students of mys-ticism often describe: the unmistakable

sense that whatever has been learned

or witnessed has the authority and thedurability of objective truth. "You don't

get that on other drugs," as Roland

Griffiths points out; after the fact, we're

fully aware of, and often embarrassed by,the inauthenticity of the drug experience.

This might help eacplain why so many

M

M

-__

~p ------

"I've been thinking. Maybe we justgot o~'to a bad start. "

cancer patients in the trials reported thattheir fear of death had lifted or at leastabated: they had stared directly at deathand come to know something about it,in a kind of dress rehearsal. "A high-dosepsychedelic experience is death practice,"Katherine MacLean, the former Hop-kins psychologist, said. "You're losing ev-erything you know to be real, letting goof your ego and your body, and that pro-cess can feel like dying." And yet youdon't die; in fact, some volunteers becomeconvinced by the experience that con-sciousness may somehow survive thedeath of their bodies.

In follow-up discussions with Bossis,Patrick Mettes spoke of his body and hiscancer as a "type of illusion" and how theremight be "something beyond this physi-cal body." It also became clear that, psy-chologically, at least, Mettes was doingremarkably well: he was meditating reg-ularly, felt he had become better able tolive in the present, and described lovinghis wife "even more."In a session in March,two months after his journey, Bossis notedthat Mettes "reports feeling the happiestin his life."

How are we to judge the veracity ofthe insights gleaned during a psy-

chedelic journey? It's one thing to con-clude that love is all that matters, butquite another to come away from a ther-

apy convinced that "there is another re-ality" awaiting us after death, as one vol-unteerput it, or that there is more to theuniverse—and to consciousness—than apurely materialist world view ~vould haveus believe. Is psychedelic therapy simplyfoisting a comforting delusion on the sickand dying?

"That's above my pay grade," Bossissaid, with a shrug, when I asked him. BillRichards cited William James, who sug-gested that we judge the mystical expe-rience not by its veracity, which is un-knowable, but by its fruits: does it turnsomeone's life in a positive direction?Many researchers acknowledge that

the power of suggestion may play a rolewhen a drug like psilocybin is admin-istered by medical professionals withlegal and institutional sanction: undersuch conditions, the expectations of thetherapist are much more likely to befi,lfilled by the patient. (And bad tripsare much less likely to occur.) But whocares, some argue, as long as it helps?David Nichols, an emeritus professorof pharmacology at Purdue University—and afounder, in 1993, of the HeffterResearch Institute, a key fonder of psy-chedelic research—put the pragmaticcase most baldly in a recent interviewwith Science: "If it gives them peace, ifit helps people to die peacefully withtheir friends and their family at their

"Yourfirstperp walk, YourHonor2"

side, I don't care if it's real or an illusion."Roland Griffiths is willing to consider

the challenge that the mystical experi-ence poses to the prevailing scientific par-adigm. He conceded that "authenticityis a scientific question not yet answered"and that all that scientists haee to go byis what people tell them about their ex-periences. But he pointed out that thesame is true for much more familiar men-tal phenomena."What about the miracle that we are

conscious? Just think about that fora sec-ond, that we are aware we're aware!" In-sofar as I was on board for one miraclewell beyond the reach of materialist sci-ence, Griffiths was suggesting, I shouldremain open to the possibility of others.

"I'm willing to hold that there's a mys-teryhere we don't understand, that theseexperiences mayor may not be ̀true,"' hesaid. "What's exciting is to use the toolswe have to explore and pick apart thismystery."

erhaps the most ambitious attemptto pick apart the scientific mystery

of the psychedelic experience has beentaking place in a lab based at ImperialCollege, in London.There a thirty-four-year-old neuroscientist named RobinCarhart-Harris has been injectinghealthy volunteers with psilocybin andLSD and then using a variety of scan-ning tools—including fMRI and mag-netoencephalography (MEG)—to ob-serve what happens in their brains.

Carhart-Harris works in the labora-tory ofDavid Nutt, a prominent Englishpsychopharmacologist. Nutt served asthe drug-policy adviser to the LabourGovernment until 2011, when he wasfired for arguing that psychedelic drugsshould be rescheduled on the groundthat they are safer than alcohol or to-bacco and potentially invaluable to neu-roscience. Carhart-Harris's own path toneuroscience was an eccentric one. First,he took a graduate course in psychoanal-ysis—afield that few neuroscientists takeseriously, regarding it less as a sciencethan as a set of untestable beliefs. Car-hart-Harris was fascinated by psycho-analytic theory but frustrated by the pau-city of its tools for exploring what itdeemed most important about the mind:the unconscious.

"If the onlywaywe can access the un-conscious mind is via dreams and free

association, we aren't going to get any-where," he said. "Surely there must besomething else." One day, he asked hisseminar leader if that might be a drug.She was intrigued. He set off to searchthe library catalogue for "LSD and theUnconscious" and found ̀Realms of theHuman Unconscious," by Stanislav Grof."I read the book cover to cover. That setthe course for the rest of my young life."

Carhart-Harris, who is slender andintense, with large pale-blue eyes thatseldom blink, decided that he would usepsychedelic drugs and modern brain-imaging techniques to put a foundationof hard science beneath psychoanalysis."Freud said dreams were the royal roadto the unconscious," he said in our firstinterview. "LSD may turn out to be thesuperhighway." Nutt agreed to let himfollow this hunch in his lab. He ran bu-reaucraticinterference and helped securefunding (from the Beckley Foundation,which supports psychedelic research).When, in 2010, Carhart-Harris first

began studying the brains of volunteerson psychedelics, neuroscientists assumedthat the drugs somehow excited brainactivity—hence the vivid hallucinationsand powerful emotions that people re-port. But when Carhart-Harris lookedat the results of the first set of fMRIscans—which pinpoint areas of brain ac-tivity by mapping local blood flow andoxygen consumption—he discovered thatthe drug appeared to substantially re-duce brain activity in one particular re-gion: the "default-mode network."

The default-mode network was firstdescribed in 2001, in a landmark paperby Marcus Raichle, a neurologist atWashington University, in St. Louis, andit has since become the focus of muchdiscussion in neuroscience.The networkcomprises a critical and centrally situ-atedhub of brain activity that links partsof the cerebral cortex to deeper, olderstructures in the brain, such as the lim-bic system and the hippocampus.

The network, which consumes a sig-nificantportion of the brain's energy, ap-pears to be most active when we are leastengaged in attending to the world or toa task. It lights up when we are day-dreaming, removed from sensory pro-cessing, and engaging in higher-level"meta-cognitive" processes such as self-reflection, mental time travel, rumina-tion, and "theory of mind"—the ability

to attribute mental states to others.Carhart-Harris describes the default-mode network variously as the brain's"orchestra conductor" or "corporate ex-ecutive" or "capital city," charged withmanaging and "holding the entire sys-tem together." It is thought to be thephysical counterpart of the autobiograph-ical self, or ego."The brain is a hierarchical system,"

Carhart-Harris said. "Thehighest-level parts"—suchas the default-mode net-work—"have an inhibitoryinfluence on the lower-levelparts, like emotion and mem-ory." He discovered thatblood flow and electrical ac- ntivity in the default-modenetwork dropped off precip-itously under the influenceof psychedelics, a finding thatmay help to explain the loss of the senseof self that volunteers reported. (Thebiggest dropoffs indefault-mode-networkactivity correlated with volunteers' re-ports of ego dissolution.) Just before Car-hart-Harris published his results, in a2012 paper in Proceedings of the National1~cademy of Sciences, a researcher at Yalenamed Judson Brewer, who was usingfMRI to study the brains of experiencedmeditators, noticed that their default-mode networks had also been quietedrelative to those of novice meditators. Itappears that, with the ego temporarilyout of commission, the boundaries be-tweenself and world, subject and object,all dissolve. These are hallmarks of themystical experience.

If the default-mode network func-tions as the conductor of the symphonyof brain activity, we might expect its tem-porary disappearance from the stage tolead to an increase in dissonance andmental disorder—as appears to happenduring the psychedelic journey. Car-hart-Harris has found evidence in scansof brain waves that, when the default-mode network shuts down, other brainregions "are let off the leash." Mentalcontents hidden from view (or sup-pressed) during normal waking con-sciousness come to the fore: emotions,memories, wishes and fears. Regions thatdon't ordinarily communicate directlywith one another strike up conversations(neuroscientists sometimes call this"crosstalk"), often with bizarre results.

Carhart-Harris thinks that hallucina-tions occur when the visual-processingcenters of the brain, left to their own de-vices,become more susceptible to the in-fluence of our beliefs and emotions.

Carhart-Harris doesn't romanticizepsychedelics, and he has little patiencefor the sort of "magical thinking" and"metaphysics" they promote. In his view,the forms of consciousness that psyche-

delics unleash are regressionsto a more "primitive style ofcognition." Following Freud,he says that the mysticalexperience—whatever its

S source—returns us to the' psychological condition of

the infant, who has yet to

` ~ ~develop a sense of himself asabounded individual. The

~. pinnacle of human develop-ment is the achievement of

the ego,which imposes order on the an-archy of a primitive mind buffeted bymagical thinking. (The developmentalpsychologist Alison Gopnik has specu-lated that the way young children per-ceive the world has much in commonwith the psychedelic experience. As sheputs it, "They're basically tripping all thetime.")The psychoanalytic value ofpsy-chedelics, in his view, is that they allowus to bring the workings of the uncon-scious mind "into an observable space."

In "The Doors of Perception," Al-dous Htixley concluded from his psy-chedelic experience that the consciousmind is less a window on reality than afurious editor of it. The mind is a "re-ducing valve," he wrote, eliminating farmore reality than it admits to our con-scious awareness, lest we be overwhelmed."What comes out at the other end is ameasly trickle of the kind of conscious-ness which will help us to stay alive."Psychedelics open the valve wide, re-moving the filter that hides much of re-ality, as well as dimensions of our ownminds, from ordinary consciousness. Car-hart-Harris has cited Htixley's metaphorin some of his papers, likening the de-fault-mode network to the reducing valve,but he does not agree that everythingthat comes through the opened doors ofperception is necessarily real. The psy-chedelic experience, he suggests, can yielda lot of "fooPs gold."

Nevertheless, Carhart-Harris believesthat the psychedelic experience can help

THE NEW YORKER, FE6RUARY 9, 2015 45

people by relaxing the grip of an over-bearingego and the rigid, habitual think-ing it enforces. The human brain is per-haps the most complex system there is,and the emergence of a conscious self isits highest achievement. By adulthood,the mind has become very good at ob-serving and testing reality and develop-ing confident predictions about it thatoptimize our investments of energy (men-tal and otherwise) and therefore our sur-vival. Much of what we think of as per-ceptions of the world are really educatedguesses based on past experience ("Thatfractal pattern of little green bits in myvisual field must be a tree"),and this kindof conventional thinking serves us well.

But only up to a point. In Carhart-Harris's view, a steep price is paid for theachievement of order and ego in the adultmind. "We give up our emotional labil-ity," he told me, "our ability to be opento surprises, our ability to think fle~bly,and our ability to value nature."The sov-ereign ego can become a despot. This isperhaps most evident in depression, whenthe self turns on itself and uncontrolla-ble introspection gradually shades out re-ality. In "The Entropic Brain," a paperpublished last year in Frontiers in HumanNeuroscience, Carhart-Harris cites researchindicating that this debilitating state,sometimes called "heavy self-conscious-ness,"may be the result of a "hyperactive"default-mode network. The lab recentlyreceived government funding to conducta clinical study using psychedelics to treatdepression.

Carhart-Harris believes that peoplesuffering from other mental disorderscharacterized by excessively rigid patternsof thinking, such as addiction and obses-sive-compulsive disorder, could benefitfrom psychedelics, which "disrupt stereo-typedpatterns of thought and behavior."In his view, all these disorders are, in asense, ailments of the ego. He also thinksthat this disruption could promote morecreative thinking. It may hat somebrains could benefit from a h e ess order.

E~ustential distress at the end of lifebears many of the psychological

hallmarks of a hyperactive default-modenetwork, including excessive self-reflec-tion and an inability to jump the deep-ening grooves of negative thought. Theego, faced with the prospect of its owndissolution,becomes hypervigilant,with-

drawing its investment in the world andother people. It is striking that a singlepsychedelic experience—an interventionthat Carhart-Harris calls "shaking thesnow globe"—should have the power toalter these patterns in a lasting way.

This appears to be the case for manyof the patients in the clinical trial ofpsilocybin just concluded at Hopkinsand N.Y.U. Patrick Mettes lived forseventeen months after his psilocybinjourney, and, according to Lisa, he en-joyed many unexpected satisfactions inthat time, along with a dawning accep-tance of death."We still had our arguments," Lisa re-

called. "And we had a very trying sum-mer," as they endured a calamitous apart-mentrenovation. But Patrick "had a senseof patience he had never had before, andwith me he had real joy about things,"she said. "It was as if he had been relievedof the duty of caring about the details oflife. Now it was about being with peo-ple, enjoying his sandwich and the walkon the promenade. It was as if we liveda lifetime in a year."

After the psilocybin session, Mettesspent his good days walking around thecity. "He would walk everywhere, tryevery restaurant for lunch, and tell meabout all these great places he'd discov-ered. But his good days got fewer andfewer." In March, 2012, he stoppedchemo. "He didn't want to die," she said."But I think he just decided that this isnot how he wanted to live."

In April, his lungs failing, Metteswound up back in the hospital. "He gath-ered everyone together and said good-bye, and explained that this is how hewanted to die. He had a very consciousdeath."

Mettes's equanimity exerted a power-ful influence on everyone around him,Lisa said, and his room in the palliative-care unit at Mt. Sinai became a center ofgravity. "Everyone, the nurses and thedoctors,wanted to hang out in our room—theyjust didntwant to leave. Patrick wouldtalk and talk. He put out so much love."When Tony Bossis visited Mettes theweek before he died, he was struck byMettes's serenity. "He was consoling me.He said his biggest sadness was leavinghis wife. But he was not afraid."

Lisa took a picture of Patrick a fewdays before he died, and when it poppedopen on my screen it momentarily took

my breath away: a gaunt man in a hos-pital gown, an oarygen clip in his nose,but with shining blue eyes and a broadsmile.

Lisa stayed with him in his hospitalroom night after night, the two of themoften tallcing into the morning hours. "Ifeel like I have one foot in this world andone in the next," he told her at one point.Lisa told me, "One of the last nights wewere together, he said, ̀Honey, don't pushme. I'm finding my way."'

Lisa hadn't had a shower in days, andher brother encouraged her to go homefor a few hours. Minutes before she re-turned, Patrick slipped away. "He wasn'tgoing to die as long as I was there," shesaid. "My brother had told me, ̀You needto let him go."'

Lisa said she feels indebted to the peo-ple running the N.Y.U. trial and is con-vincedthat the psilocybin experience "al-lowed him to tap into his own deepresources. That, I think, is what thesemind-altering drugs do."

Despite the encouraging results fromthe N.Y.U. and Hopkins trials,

much stands in the way of the routineuse of psychedelic therapy. "We don'tdie well in America,"Bossis recenfly saidover lunch at a restaurant near the N.Y.U.medical center. "Ask people where theywant to die, and they will tell you athome, with their loved ones. But mostof us die in an I.C.U. The biggest tabooin American medicine is the conversa-tion about death. To a doctor, it's a de-feat to let a patient go." Bossis and sev-eral of his colleagues described theconsiderable difficulty they had recruit-ing patients from N.Y.U.'s cancer cen-ter for the psilocybin trials. "I'm busytrying to keep my patients alive," oneoncologist told Gabrielle Agin-Liebes,the trial's project manager. Only whenreports of positive experiences began tofilter back to the cancer center did nursesthere—not doctors—begin to tell pa-tients about the trial.

Recruitment is only one of the manychallenges facing a Phase III trial of psi-locybin, which would involve hundredsof patients at multiple locations and costmillions of dollars. The University ofWisconsin and the University of Cali-fornia, Los Angeles, are making plansto participate in such a trial, but F.D.A.approval is not guaranteed. If the trial

4G THE NEW YORKER, FE6RUARY 9, 2015

was successful, the government wouldbe under pressure to reschedule psilo-cybin under the Controlled SubstancesAct, having recognized a medical usefor the drug.

Also, it seems unlikely that the gov-ernment would ever fund such a study."The N.I.M.H. is not opposed to workwith psychedelics, but I doubt we wouldmake a major investment,"Tom Insel,the institute's director, told me. He saidthat the N.I.M.H would need to see "apath to development" and suspects that"it would be very difficult to get a phar-maceutical company interested in devel-oping this drug, since it cannot be pat-ented."It's also unlikely that Big Pharmawould have any interest in a drug that isadministered only once or twice in thecourse of treatment. "There's not a lot ofmoney here when you can be cured withone session," Bossis pointed out. Still,Bob Jesse and Rick Doblin are confidentthat they will find private money for aPhase III clinical trial, and several pri-vate fenders I spoke to indicated that itwould be forthcoming.Many of the researchers and thera-

pists Iinterviewed are confident that psy-chedelic therapy will eventually becomeroutine. Katherine MacLean hopes some-day to establish a "psychedelic hospice,"a retreat center where the dying and theirloved ones can use psychedelics to helpthem all let go. "If we limit psychedelicsjust to the patient, we're sticking with theold medical model," she said. "But psy-chedelics are so much more radical thanthat. I get nervous when people say theyshould only be prescribed by a doctor."

In MacLean's thinking, one hearsechoes of the excitement of the sixtiesabout. the potential of psychedelics tohelp a wide range of people, and the im-patiencewith the cumbersome structuresof medicine. It was precisely this exu-berance about psychedelics, and the frus-trationwith the slow pace of science, thathelped fuel the backlash against them.

Still, "the betterment of well people,"to borrow a phrase of Bob Jesse's, is verymuch on the minds of most of the re-searchers Iinterviewed, some of whomwere more reluctant to discuss it on therecord than institutional outsiders likeJesse and MacLean. For them, medicalacceptance is a first step to a broadercultural acceptance. Jesse would like tosee the drugs administered by skilled

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guides working in "longitudinal multi-generational contexts"—which, as hedescribes them, sound a lot like churchcommunities. Others envisage a timewhen people seeking a psychedelic ex-perience—whether for reasons of men-tal health or spiritual seeking or simplecuriosity—could go to something like a"mental-health club," as Julie Holland,a psychiatrist formerly at Bellevue, de-scribed it: "Sort of like a cross betweena spa retreat and a gym where peoplecan experience psychedelics in a safe,supportive environment." All spoke ofthe importance of well-trained guides(N.Y.U. has plans for a training programin psychedelic therapy) and the needto help people afterward "integrate" thepowerful experiences they have had inorder to render them truly useful. Thisis not something that happens whenthese drugs are used recreationally. Bossisparaphrases Huston Smith on this point:"A spiritual experience does not by it-self make a spiritual life."When I asked Rick Doblin if he wor-

ries about another backlash, he suggestedthat the culture has made much progresssince the nineteen-sixties. "That was avery different time," he said. "Peoplewouldn't even talk about cancer or deaththen. Women were tranquillized to givebirth; men weren't allowed in the deliv-ery room. Yoga and meditation were to-tally weird. Now mindfulness is main-stream and everyone does yoga, and thereare birthing centers and hospices all over.

We've integrated all these things into ourculture. And now I think we're ready tointegrate psychedelics." He also pointsout that many of the people in charge ofour institutions today have personal ex-perience with psychedelics and so feelless threatened by them.

Bossis would like to believe in Doblin'ssunny forecast, and he hopes that "thelegacy of this work" will be the routineuse of psychedelics in palliative care. Buthe also thinks that the medical use ofpsychedelics could easily run into resis-tance. "This culture has a fear of death,a fear of transcendence, and a fear of theunknown, all of which are embodied inthis work." Psychedelics maybe too dis-ruptive for our society and institutionsever to embrace them.The first time I raised the idea of"the

betterment of well people" with RolandGriffiths, he shifted in his chair and chosehis words carefully. "Culturally, right now,that's a dangerous idea to promote," hesaid. And yet, as we talked, it becameclear that he, too, feels that many of usstand to benefit from these moleculesand, even more, from the spiritual expe-riences they can make available."We are all terminal," Griffiths said.

"We're all dealing with death. Thiswill be far too valuable to limit to sickpeople." •

NEWYORKER.COAA/VIDEO

Inside N.Y.U.'s psilocybin-treatment room.

THE NEW YORKER, FE6RUARY 9, 2015 47

ONWARD AND UPWARD WITH THE ARTS

,. AL AI30UT THE AMILTONSA ne usical brings the Founding Fathe s back to life~zvith a lot ofhip-ho .

`~. [3Y RE[3EC A ME D

In April, 2 9, Lin-Man el iranda,a writer, c poser, an pe ormer,

received a call m the hite House.The new Preside t and t e Fir t Ladywere planning to h st an venin of liveperformances cente d n "the Amer-ican experience," and iranda as in-vited to participate. Mi nda, o wastwenty-nine, had spe t the p eviousyear starring in the B a ay usical"In the Heights," of hich e as thecomposer and lyricist. Set in a hing-ton Heights, the sh w incorp ratedsalsa and merengue ith rap an ip-hop,blending them ith more co n-tional Broadway tr pes, to wi nieffect. "Heights" h d won four onawards, including t ose for Best u-sical and Best Orig' al Score, and i-randa had accepte the latter wit aneffervescent rap th t invoked "Su dayin the Park with eorge": "Mr. So d-heim/Look, Imad a hat! /Where erenever was ahat! / I s a Latin hat at th t!"(He then pulled a Puerto Ricanfrom the pocket of his tu~cedo.) eWhite House li ly expected Mi n ato perform so ething invok' g t eLatin-America experience, a d he w stold that a numb r from "In e Height "would be welc e.

Miranda ha someth' g different inmind. A few m nths e rlier, he a 'sgirlfriend, Van sa N dal, w as sincebecome his wi e, h d be on vacationin Mexico, an ile obbing in thepool on an in ble to nger he startedto read a boo that he h bought onimpulse: R Chernow's eig t ~>>ndred-pag biography of AlexanderHamilto .Miranda was seized by thestory of amiltods early life. Born outof we ock, raised in poverty in St. Croix,aba oned by his father, and orphaneby 'smother as a child, Hamilton transp anted himself as an adolescent toew York City filled with revolution

ary fervor. An eloquent and prolifiwriter, he was the author of two-thirds

48 THE NEW YORKER, FE6RUARY 9, 2015

of the Federalis Papers; ter servingas George Was ngton's ai e during theRevolutionary ar, he be ame Amer-ica's firstTreas Secret Later, Ham-ilton achieve the dubio s distinctioof being at he center o the natio sfirst politic 1 sex scanda , after a ex-tramarital air became p blic. neveragain hel office, and b fore eachingthe age o fifty he was d a 'lied in aduel by aron Burr, the e-President,after a ersonal dispu escalated be-yond re ediation.

Mir nda saw mil n's relentless-ness, b illiance, ' guisti dexterity, andself-d structi~ stubbo nness throughhis o n idi syncratic 1 ns. It was, hethou t, 'p-hop story an immigrant'ss ory milton remin ed him of hisfa e uis A. Mirand Jr., who, as anam tious youth in pr incial Puerto'c ad graduated fr m college be-ore tur ing eighteen, hen moved toNe Yor to pursue gr duate studiesat N Y.U. L 's Miranda erved as a spe-cial dviser on ispanic airs to MayorEd och; he th co-fo nded a polit-ical onsulting co pany the MirRamGro p, advising Fern do Ferrer, amongoth s. On summer br during highsch ol, Lin-Manuel wo ed in his fa-ther office; later, he wro 'ingles forthe olitical ads of several i am cli-ent including E~,ot Spitze in 's 2006gu ernatori no 's de rip-ion oft cont~ tious e 'on seaof 18 the rigin of mod political m ni — esonated it -

as u st g of the i r wo -gs of oliti the kinds o d ate

that amilto' a i peers ha aboutthe urpose o~ o er ment still tookplac , on MS an Fox.

amilton al min ed Miranda ofTup c Shakur, t Wes Coast rapperwho~was shot to eath in,̀1996. Shakurwrot~ intricat~socially nuanced lyrics:Mirari~a pa cularly admi~ d "Brenda'sGot a Ba y,"averse narrative about a~ ,,_.

twely -year old gi 1 who turns to pros-ti ion of r givin birth to her molest-

s child. hakur as also extremely un-diplom ic, publi y calling out rappershe hate . Mirand recognized a similarrhetor' al talent i Hamilton, and a sim-ilar, f tal failure t know when enoughwas nough. Th re was extraordinarydra atic potenti in Hamiltods story:the characteristic that allowed him toris also insured is fall. When the or-g izers of the hite House eventc ed, Miranda oposed a rap about

amilton, and th y said yes.That evening i May, Miranda and

he other performe s—among them Es-eranza Spalding, he jazz b sist and

vocalist, and James arl Jone were in-troduced to the Pres ent. da askedhim to sign a copy o "Dre ms from MyFather" that he'd b ght t t e airport.Onstage, Miranda nno nc d that hewas working on a c ce al um aboutHamilton—"someo e I hi k embod-ies hip-hop," he said to e eral laugh-ter. He did not me ti at he hadwritten only one son er Mirandaexplained that Ham It n represented"the word's ability to a a difference,"he launched into co x lyrics thatcondensed the first twe ears of Ham-ilton's life into four m tes. Slight ofbuild, with dark cropp air and thickstubble, Miranda pace t e stage withcoiled energy, rapping f ̀the ten-dol-lar Founding Fathe thout a fa-ther/Got a lot farther orking a lotharder/Bybeingalot er/Bybeinga elf-starter." His p rformance igniteda ri ' ng murmur o delight among theau 'e ce, and t Obamas were rapt:Miran later eard that the President'sfirst reacti was to remark that Timo-thy Geithne ad to see this.

Six years 1 er, that song has be-come the first n ber of "Hamilton,"which opens at t Public Theatreon February 17th, wi Miranda in thetitle role. Rooted in hi hop, but also