A terminal diagnosis can leave patients with anxiety, depression and countless questions. Could psychedelic therapy give them the answers they’re looking for?
Three years ago, Andrea Bird sat in a recliner in her living room near Mount Forest, Ontario and prepared to meet her cancer. Her legs were tucked into a blanket “super cozy” and music from a special playlist drifted through her headphones. Beside her sat a guide who would be acting as her support for the experience. Bird felt both nervous and excited as she drank a cup of tea containing four grams of what’s commonly known as magic mushrooms, mixed with ginger and honey.
Bird had heard about so-called “bad trips.” What would she find beneath the hood of her psyche? Was there a hidden darkness inside her that she might unearth? She covered her eyes with an eyeshade and turned inward, ambient music filling her ears. As the mushrooms took hold, Bird’s legs began to shake. After the shaking stopped, she noticed her left hand was no longer her own, but her husband Daniel’s, who had gone out for a few hours with their two dogs. “His hand was holding my hand where he would hold it and comforting me,” Bird says. Her fear dissipated and she relaxed, surrendering to the unknown.
Bird is an artist, art teacher, mother of two and grandmother of two. She has an open face and a gentle demeanour; when she speaks, she weighs every word carefully. The first time we meet it’s April, and we talk about how the change of season brings new perspectives. This reminds her of a poem she thinks I would love and she tells me she will send it to me later.
At the time of her first psilocybin trip, Bird was fifty-seven and had been living with terminal cancer for almost two years. It began as breast cancer in 2012, but after nearly five years in remission she was told the cancer was back, and it had spread to her bones and lungs. The news that the cancer had metastasized completely upended her world. “It was indescribably devastating to imagine oneself dying in the near future,” she says.
At first she kept to her normal routine, but eventually the pain in her knees, hips and spine forced her to slow down. She continued to make art, but she had to give up her beloved teaching. “That was a very unusual experience,” she says. “It’s the first time in my adult life that I’ve had this kind of expanse of time.” Bird doesn’t know how long she has left, but she has the general sense that time is running out. “My symptoms are becoming more and my energy is becoming less.”
Bird feels an obligation to be involved in what she calls her “dying time,” so after her diagnosis she got to work organizing her own memorial and a treatment plan. She qualifies for medically assisted death in Ontario and has done all of the preliminary paperwork should her illness deteriorate fast. She has had emotional discussions with her friends and family about what this time means for them and how they will get through it. Bird quotes poet David Whyte: “We must apprentice ourselves to the curve of our own disappearance.”
But despite her efforts to cope, there was still part of her, on a psychospiritual level, that was floundering. “I was being swept away pretty often by tsunamis of grief,” she says. “I just did not want to die. And I still don’t want to die.”
One day, Daniel handed her the book How to Change Your Mind by Michael Pollan and told her to read the chapter on psilocybin (the active ingredient in magic mushrooms) and dying. In his book, Pollan explores the power of psychedelics to open the mind to new perspectives and interrupt harmful patterns of thinking. Up until that point, Bird’s opinions on mushrooms had been pretty neutral; she thought of them as something young people did beside a campfire or at a party. “I finished reading a chapter and thought, I would love to do this,” she says. “If not now, when?”
Bird’s options for receiving therapeutic assistance in Canada were limited. The classic psychedelics—LSD, DMT, mescaline and psilocybin—are listed as schedule III controlled substances under the Canadian Controlled Drugs and Substances Act. This means it is prohibited to possess mushrooms, but people have often walked away with a fine or a smudge on their criminal record rather than doing jail time. There’s currently no legal way to acquire mushrooms in Canada, although there are no rules against buying spores and growing them yourself (the mushrooms are only illegal to possess once they germinate).
Finding the right person to guide the experience is even more difficult when you tack on the illegality and stigma of using psychedelics to treat people. Ideally, a guide would be a therapist or a professional who is familiar with mushrooms and has experienced a psilocybin trip themselves. A guide is there to act as a support and comfort to the patient, but also to make sure nothing goes wrong. If someone goes to a dark place during the trip, which can last between five to seven hours, their guide will help steer them out of it. Building a trusting relationship before the trip is important, since having a rapport with a guide helps the individual to go into the psilocybin session without holding anything back. Luckily, a friend connected Bird to a guide who was willing to assist her “underground” on her journey, and that guide was also able to procure the mushrooms.
Bird is now one of a growing number of people using psilocybin as a way to live with death. After decades in the shadows, psychedelics are re-emerging as a therapeutic tool to help patients delve deep into their minds and begin to heal. Psilocybin trips, in particular, can facilitate powerful spiritual experiences and can be used alongside psychotherapy to relieve “end-of-life distress”—the enduring anxiety, hopelessness and depression that is common in people facing a terminal diagnosis. Following in the footsteps of the legalization of cannabis and medical assistance in dying, the growing number of people advocating for access to mushrooms have the power to destigmatize psilocybin and add it to the rainbow of treatments available to Canadians suffering at end of life.
The idea of giving psychedelic drugs to cancer patients began in the 1950s, when the novelist Aldous Huxley proposed the idea to English psychiatrist Humphry Osmond. Eventually, Osmond accepted a job at the Weyburn Mental Hospital in Saskatchewan, where he and fellow psychiatrist Abram Hoffer began using LSD to successfully treat patients with alcohol use disorders. (Osmond would later coin the term “psychedelic,” meaning mind-manifesting.)
In the sixties, psychiatrist Stanislav Grof began giving LSD to cancer patients and noting its effects at the Spring Grove State Hospital near Baltimore. He found that patients who were terrified of death experienced immense relief during and after their sessions. Grof was famously quoted as saying psychedelics “would be for psychiatry what the microscope is to the study of biology and medicine or the telescope for astronomy.”
Yet by the mid-sixties, psychedelics had effectively “escaped from the laboratory” and Harvard psychologist Timothy Leary had fuelled a developing counter-culture by encouraging the use of psychedelics with the line: “Turn on, tune in, and drop out.” Psychedelics became increasingly associated with anti-war protests and misuse. By 1970, psychedelics were classified as a schedule I drug as part of President Richard Nixon’s emerging war on drugs, and research dried up on both sides of the border.
The fear and politics surrounding psilocybin represent a small moment in the history of its use. Magic mushrooms have been used for thousands of years by Indigenous people in some parts of Africa and Central and South America, including the Maya and Aztecs. The altered state of consciousness conjured by the plant was used to promote mysticism and religious experiences. Shamans, respected religious leaders in the community, would guide people as they moved between physical and spiritual worlds. When Spanish conquistadors invaded the Americas, they squashed the use of mushrooms out of fear, seeing it as a pagan practice. By the 1960s, history was repeating itself.
In the decades since, magic mushroom use went underground, reinforcing its recreational image. The therapeutic possibilities of psychedelics evaporated from public consciousness. Slowly, though, a renewed interest in psychedelic drugs has been beginning to take hold among researchers and psychologists.
In October 2019, Spencer Hawkswell had just returned to Toronto after travelling to India and Southeast Asia. That’s when he heard about Bruce Tobin, a psychotherapist on the west coast who was threatening to take the Canadian government to court over access to psilocybin. Tobin had submitted an application to Health Canada to use the substance to treat cancer patients with end-of-life distress. He vowed to go to federal court if he didn’t get a response.
Hawkswell’s mother works in palliative care, and conversations about end of life had floated around the family dinner table when he was growing up. Armed with a business degree and a few emails with Tobin, Hawkswell hopped into his mom’s car and drove across the country to Victoria. Tobin was about to leave for Baja, Mexico for the winter, and was more interested in being involved in the treatment part of the venture than the business side of things. Hawkswell took over as CEO of what would become TheraPsil, developing it from a website into Canada’s first and only nonprofit organization that advocates for Canadians experiencing end-of-life distress to legally access psilocybin-assisted psychotherapy.
Hawkswell stresses the importance of the psychotherapy part of the experience. Although taking mushrooms can be fun (or the very opposite), psychedelics like psilocybin taken on their own are not as effective. “When you give [a patient] a psychedelic substance, all of a sudden it opens them up and allows a therapist to do really, really good work with them,” he says.
The psychotherapy work begins in the weeks leading up to the trip, and on the day of, patients must be encouraged to turn inward, hence the eyeshade and headphones. The concept of what is known as “set and setting” plays an important role in psychedelic experiences; the individuals’ expectations, mindset and comfort level help determine what type of trip they will have.
At the moment, the only way to legally access psilocybin for this purpose is to ask the federal health minister, Patty Hajdu, herself. The application process involves writing a letter to the minister detailing why you want the exemption and providing a doctor’s note. In August 2020, Hawkswell and his team successfully helped four terminally ill Canadians receive the first of these exemptions from section 56 of the Controlled Drugs and Substances Act, allowing them to use psilocybin on compassionate grounds. (While a progressive move for Canada, mushrooms have been decriminalized in some states in the US, and Oregon recently became the first state to legalize psilocybin in therapeutic settings.)
Laurie Brooks and Thomas Hartle were two of the Canadians exempted last summer. Hartle has said that before taking psilocybin it felt as if he were being dragged by a horse, but afterwards, it felt like he was riding that horse. According to Hawkswell, Brooks has described her cancer and its associated fears as a dark cloud that she can now place in a box.
Since those initial exemptions, TheraPsil has helped thirty-five patients access psilocybin without fear of prosecution, including Bird, who received an exemption in December 2020. The organization has also helped nineteen health-care professionals—future guides—
receive exemptions for training purposes: “What is going to bring us into the future is where we’ve really got a bunch of skilled therapists who are able to deliver psilocybin-assisted psychotherapy,” says Hawkswell.
The distress experienced by a terminal patient is no different from typical anxiety and depression (and has previously been treated in the same way, with therapy and medication). The hope for Hawkswell, and TheraPsil, is that one day the decision to use psilocybin will be made exclusively between an individual and their doctor or therapist, no exemption necessary.
Dave Phillips is a psychotherapist who treated Brooks. Last year, he was one of the first health-care practitioners to receive an exemption. He is also TheraPsil’s principal trainer of nurses, therapists and doctors. Future guides spend about 150 hours receiving training in psilocybin-assisted psychotherapy, which includes experiencing a session themselves. Phillips hopes to have seventy-five health-care workers trained by the end of 2021.
“I think everyone has a story that particularly informs why they are afraid of dying,” he says. For some people, it’s guilt or regrets, and for others, it’s the gaping unknown. Whatever the cause of anxiety, it can be impossible to get out of fearful cycles of thinking. Psilocybin is the pause button that makes room for new perspectives. “All of us have within us a deep knowledge or wisdom that is useful for our lives,” Phillips says. “It’s just really hard to access.”
The mind on psychedelics is a fantastical place. The brain is made up of a set of regions that interact in complex ways, working together to form networks. These networks retrieve memories, process information from our senses and problem solve. But even when we are not engaged in a task, the mind is still at work—particularly one group of brain regions called the default mode network (DMN). It’s here that a lot of complex thought occurs: who we are, why we’re here, what we believe.
“Our ability to make sense of the world is largely related to the default mode network,” says Manesh Girn, a PhD student in neuroscience at McGill University who studies psychedelics and the DMN (he also hosts a YouTube channel called The Psychedelic Scientist). Girn says the DMN is where we go to daydream, worry, think about the past or present, and reflect on ourselves and our position in the universe. “It’s the thing that makes us human.”
The default mode network is linked to the formation of the ego, or the construct of the self. Brain imaging technologies have shown that when a person takes psilocybin, activity in this particular network decreases, which leads to the sense of dissolution, or the more extreme “ego death.” As Pollan writes in How to Change Your Mind, “It appears that when activity in the default mode network falls off precipitously, the ego temporarily vanishes, and the usual boundaries we experience between self and world, subject and object, all melt away.”
“This temporary evaporation of sense of self also involves the relaxation of our habitual belief frameworks and emotional holding patterns,” says TheraPsil founder Bruce Tobin. “For many people, that belief system gets fairly rigid, defined over the course of life. And what we find with psychedelic therapy is that those belief systems are relaxed.”
Researchers have mapped out the increased connectivity between brain networks during a psilocybin trip. Regions that wouldn’t usually communicate were exchanging information, which, according to some studies, could indicate the formation of new connections and the possibility of rewiring. The Netflix show The Mind, Explained describes these new thought pathways using Dutch neuroscientist Mendel Kaelen’s depiction of the mind as a snow-covered hill. If thoughts are sleds, over time, certain pathways are pressed into the snow. A psychedelic trip, says the narrator, is the fresh snowfall that allows your sleds to explore new paths.
“The increase in entropy allows a thousand mental states to bloom,” writes Pollan, “many of them bizarre and senseless, but some number of them revelatory, imaginative, and at least potentially, transformative.” Most importantly, these new connections are able to form without the judgement of the ego, so revelations that come during a trip can feel objectively true. The clouds part and people might realize they knew all along death was not something to feel guilty over, or suddenly it’s clear that life is a gift. They feel as if they’ve come home to an original place of understanding and are able to discern new meaning with less fear.
This isn’t to say every trip is a breeze. “For some people, it’s just really hard slogging,” Tobin says. The point is to get to the root of the issue, and patients often confront their fear or trauma head-on. One person might encounter a dark forest or staircase, or another person could meet a terrifying dragon. This is where the guide comes in—they would tell their patient to take a deep breath, try to relax, and encourage them, as Tobin says, to “dance” with whatever shows up.
For Bird, death showed up in different ways. She first found herself in front of an old, dark green cedar tree. Emerging from one of the branches was a hand, outstretched and waiting as if for a baton in a relay race. “My life was the baton,” Bird says. “It was the thing that I’ve been carrying and holding on to, and I was going to have to give it back, as we all do, at some point.” It occurred to her that this was not personal: “This is not about Andrea, this is what happens to everybody.”
A little while later, she was getting ready for a wedding ceremony, and she understood that she was marrying herself. All the times in her life when she had been unkind to herself flashed before her, and Bird clasped her hands together as if the other was her beloved’s and made a vow to never do that again. “Loving ourselves is really what we’re here to do,” she says. “Embracing the full catastrophe.”
Not every psychedelic experience is the same, but individuals at end of life often describe experiences akin to being reborn. Or, like Bird, they recount meeting their cancer or a physical manifestation of their fear of death. People report a feeling of connectedness to the rest of the world, or to some greater power or knowledge.
In 2006, Roland Griffiths, a psychopharmacologist at Johns Hopkins School of Medicine, led a double-blind study that found that “when administered to volunteers under supportive conditions, psilocybin occasioned experiences similar to spontaneously occurring mystical experiences.”
Subsequent research at the University of California, Los Angeles and New York University (NYU) examined the use of psilocybin for treating cancer patients.Two 2016 landmark studies from Johns Hopkins and NYU—led by Griffiths and psychiatry professor Stephen Ross, respectively—followed. Both trials found that patients with end-of-life distress experienced improvements in mood, relationships, spirituality and attitudes about life that continued at least six months after their psilocybin trip and psychotherapy sessions. Notably, researchers concluded that the intensity of a patient’s “mystical-type” experience directly correlated with the degree to which their depression and anxiety decreased.
Although the research confirms the efficacy of psilocybin as a treatment for end-of-life distress (other trials also suggest psilocybin shows promise for treating PTSD, addiction and cluster headaches), nobody claims to completely understand psychedelics and the brain. Tobin points to the philosophical idea known as “the hard problem” of human consciousness. “We will never be able, in principle, to understand how a certain configuration of brain states or events results in a conscious experience of, say, the colour yellow or the sound of an oboe,” Tobin says. He once wrote: “Isn’t it a delightful paradox that the ingestion of a particular molecule that affects certain neurons can lead to the deep conviction that the world consists of so much more than just molecules and neurons!”
In the weeks after her trip, Bird and her guide tried to make sense of what she had experienced. They drew out, as Bird says, “these beautiful little gems into the light of day and looked at them together.” For the trip to have a lasting impact, these new ideas and perspectives need to be integrated into the patient’s life. This phase of the psilocybin experience is perhaps the most important.
“The brain is very stubborn. It wants to fall back into its patterns,” says Girn. Post-trip, individuals need to make conscious, actionable steps in their day-to-day lives to hold on to what they learned. “Otherwise, it just fades into your memory, it becomes a memory of what’s possible.” Phillips, the psychotherapist, likes to refer to the mind that has just come out of a psychedelic trip as analogous to a freshly potted plant. It has a few leaves and maybe a flower or two, but needs to be tended for it to take root and grow.
After her trip, Bird spent the next six months in what she calls a “shadow winter.” She spoke with her guide, sorted through what she had learned, and worked on a piece of art she named This is love. What Bird discovered in the integration process was transformative. Although she had never connected to the discourse around “fighting” cancer as if it were a battle, even after her terminal diagnosis, there was still a part of her that was struggling against death. Perhaps she even hoped she could still control the outcome: “If I do everything right, if I eat everything right until the treatment, maybe I won’t have to die young.”
The mushrooms showed her that she could just let go. Her fear of death didn’t disappear, but rather became smaller. “It was really, really big for a long time after the diagnosis,” she says. “I would be lying if I said that I’m not scared of death, on some level still, but it’s not huge. It’s not overwhelming. It’s kind of like the human desire to stay in a body.”
Bird thought a lot about the cedar tree, and how the hand from the branch was in no hurry: life was a gift she had to give back, and it wasn’t in her control. During the trip, she let go, and it was cathartic. “The mushrooms showed me that I didn’t have to hold on so tightly and that I could actually really relax.” she says. “It’s so beautiful to think that life will just hold me, as it has been, since the day I drew my first breath.”
Not all scientists, or citizens, are ready for psychedelics to be legally used as a tool for treating mental illness. “A lot of people see the research as still in its early stages,” says Girn. “They’ll say, ‘It’s very promising, but I don’t believe it yet.’” This seems to be the attitude of the federal government, too. At the same time Health Minister Patty Hajdu celebrated the exemptions for compassionate use of psilocybin in 2020, she pointed out the need for more research and clinical trials.
Although clinical trials have found no sustained harmful physiological or psychological effects from the use of psilocybin, and no volunteers have become dependant on the substance, there are always risks. A predisposition for mental illness could hypothetically lead to a psychotic episode, although recent research in the US has found those who have used psychedelics were less likely to have severe mental health issues than those who haven’t. All-in-all, the classic psychedelics are not considered addictive and do not appear to cause organ damage. Ranked beside alcohol, heroin and methamphetamine, psilocybin is one of the safest drugs we know of.
Compared to other hallucinogens, psilocybin has re-emerged into the public sphere mostly because it’s the more palatable option. It’s natural, has been used for centuries and doesn’t have the same cultural baggage as LSD. Yet Phillips is wary of the societal climate for mushrooms and wants to learn from the sixties: “The popular culture kind of went hog wild, scared the shit out of everybody, and they shut it down,” he says. “And anyone that’s working in a psychedelic space understands, historically, it could happen again.”
As such, education is central to TheraPsil’s mandate, alongside access and advocacy, training and research. The team leads webinars and has curated a complete list of existing research on psilocybin and LSD, which is available on its website. In June, the nonprofit conducted a public opinion poll, which found that more than half of respondents supported changing regulations for psilocybin to become medically available in Canada for a range of therapeutic purposes. (TheraPsil polls from June and September 2020 show similar results.) By all indications, the time is ripe for change.
In June, TheraPsil staged a legal challenge to the federal government, declaring that the lack of safe and equitable access to psilocybin for Canadians who are in need is unconstitutional. The organization threatened court proceedings if Canada doesn’t move toward regulation. Eventually, regulation could allow eligible individuals to access psilocybin with their doctor’s support, using it to treat everything from end-of-life distress to depression, anxiety, addiction and cluster headaches. It would also allow health-care professionals to access training. “The anachronistic prohibition not only bars access to psilocybin-assisted psychotherapy for society’s most unwell, but it criminalizes the treatment such that it cannot be conducted in a safe and regulated manner,” reads the letter from TheraPsil’s legal challenge. “The status quo cannot continue.”
The letter comes on the heels of slowing exemptions from Health Canada. At one point, applicants were being granted exemptions every couple of weeks, but successful requests have slowed to a trickle without explanation. It’s unclear why some applicants are accepted while others are not because most people aren’t rejected—a bunch of applications are simply in limbo and haven’t received a response. (After three years, Bruce Tobin’s health-care professional application was officially denied in 2020—the only practitioner application supported by TheraPsil that has ever been rejected outright.)
When asked about the delays, a Health Canada spokesperson said, “In Canada, a clinical trial is the most appropriate pathway to access products with a possible medical benefit that are experimental and have not yet undergone the rigorous, science-based review process to be approved as marketed drugs.” As of August, TheraPsil knew of fifteen patient applications and forty health-care professional applications waiting for approval.
Robert, who lives in Montreal and wishes to remain anonymous, is one applicant who is awaiting an exemption. In 2014, he was diagnosed with prostate cancer. Following surgery, he was cancer-free for a few years before it returned in 2018. Now, after thirty-six radiation treatments, Robert is again cancer-free, but has to undergo blood tests every six months. Prostate cancer is known to metastasize to the bones, and as someone who has lived with anxiety and depression for much of his life, Robert says the ordeal has plunged him into a sustained and severe depression. “I’m constantly living with the fear that my cancer might return, most likely in a deadlier form,” he wrote in his application to Health Canada.
“I want to meet my cancer,” he tells me. “I want to find out if it’s still there ... how I can go about living my life without having to fear it.” With the help of TheraPsil, Robert submitted his application at the end of March and has not yet received a response. Robert and his psychiatrist of less than a year (who will act as his guide) have begun preparing for the session they will do as soon as his exemption comes in. To ready his brain for the mushrooms, his psychiatrist advised him to go off his antidepressants. Psilocybin activates serotonergic receptors in the brain—the same region affected by typical antidepressants. More research is needed, but many believe these medications reduce the impact of mushrooms.
As the weeks tick by without word from the health minister about his exemption, Robert is feeling increasingly agitated. “I’ve now been off my medications for over sixteen weeks,” he says. “The first nine to ten weeks, I was playing with fire. I would say the last six weeks I’ve been getting burnt.” He isn’t sleeping well, cries easily and has been feeling angry, which causes him to lash out.
Even with the delays, Robert wants to experience a psilocybin trip legally. “Not only am I helping my cause, but I’m potentially helping the cause of all the other people who have waited far too long for these exemptions to be granted,” he says. “In some ways, I feel this is my last and best hope.”
Almost a year to the day after her first trip, Bird went on a second psilocybin journey. She had been experiencing a bout of anger that she didn’t understand the source of. She wanted to know if there was more to learn from the mushrooms. This time, Bird found herself in a place of darkness and despair, like she was at the bottom of the ocean. She was grieving; death meant that everyone she loved would die to her, and the pain of saying goodbye was almost too much to bear. She cried in this dark place that was the depths of her being, harder than she ever had before.
Then, a small bubble of light emerged from the muck on the ocean floor and started making its way to the surface. Bird followed it. As she floated upwards, her sadness turned to bliss and she began to laugh. “I realized that despair and joy are not separate,” she says. “You can’t have one without the other.” It was hard to let go because she had so much to live for, and for that she was thankful. Bird came to a realization that has endured for months after the trip: “I have never been so in love with life as I am right now, because it’s winding down.”
In an email, Bird sends me the poem by Ada Limón that she had mentioned when we first met. “This is what we’re really talking about,” she writes, “taking it all. Unfurling like a fist to an open palm! Oh, how poetry undoes me.”
Patient, plodding, a green skin
growing over whatever winter did to us, a return
to the strange idea of continuous living despite
the mess of us, the hurt, the empty. Fine then,
I’ll take it, the tree seems to say, a new slick leaf
unfurling like a fist to an open palm, I’ll take it all.
Amy van den Berg is a writer based in Hamilton, Ontario. She has written for the Walrus, Broadview, Toronto Life and TVO.
This story was supported by Journalists for Human Rights and the Solutions Journalism Network and made possible by funding from the McConnell Foundation.