Mio Yokoi is down the river, lined up on a raft, veiled, and covered in flowers — covered in beauty, she explains. Lord of the Ring.
she is dead
Yokoi sees her dead and shrouded on a raft, and in the river nature embraces her and welcomes her. She’s got some whimsical “Disney-esque” animals to reassure her from the riverbank and tell her that all is well. Obtained She and the universe have one interconnected support net to support her through stage 4 pancreatic cancer.
“When I was down this river, it was just a lot of this affirmation,” says Yokoi. She affirms that she will take care of all those who come before her, as all those who come after her will.
“It’s wisdom, it’s knowledge, and it’s been true for a long time,” she says.
Further downstream, the people in her life she loves and who love her, those in the room for psilocybin-supported therapy sessions, and psychedelic supportive therapy providers arrive to assist her. notice that the is participating in LoveI hope no one is scared anymore, and I want everyone to feel the love and support she feels right now.
Her body and raft then explode into millions of shimmering golden leaves, each one representing love, until she finally becomes a giant tree of golden branches upon which she comes to rest.
“It was so beautiful,” says Yokoi, who was a psychotherapist before being diagnosed. “And it gave me a feeling of like, ‘Oh, okay. this is beautiful I can’t believe this. ‘”
Verbora is the Medical Director of Field Trip, a psychedelic therapy provider. He was one of his on the riverbank.
Kawa was Yokoi’s second experience with psychedelic support therapy. Together with psychedelic physician Michael Belbora, she legally uses drugs to help treat patients’ unique mental and emotional concerns at the end of life through Canada’s Special Access Program. I’m here.
“When I was first diagnosed, I realized that I needed to do more than just take care of my body,” says Yokoi. “I also had to manage my mental and emotional health as well.”
Although she was engaged with many of the mental health support services available, she still felt a constant sense of anxiety, uncertainty and distress. I was there.
“For a little bit, I felt like I didn’t want to use whatever time I had left … in that struggle,” she says.
The unique struggles of mental health at the end of life
Many terminally ill patients experience common mental health issues such as depression, anxiety, and PTSD, but they can also grapple with their own issues.
“There’s a lot of existential, mental, or interpersonal pain in the sense that a relationship is coming to an end. Clearly everything is coming to an end,” says a psychiatrist and palliative care physician at the University of California, Davis. says Nathan Fairman of
For Yokoi, it represents not only anxiety about when he will die and how he should live in the present, but also an indescribable connection, reflecting on past family trauma and interactions with cancer. . As she worries about what will happen to the people she leaves behind.
Cicely Saunders, who helped shape the hospice movement in end-of-life care research and palliative care research, believed that physical and emotional pain share a relationship and should be considered together. “absolute pain”.
Unfortunately, our current mental health therapies are not always well equipped to treat the mental and emotional aspects of pain in terminally ill patients.
The “existential pain” that people face at the end of their lives is not mental illness. DSM-Vpoints out Paul Thielking, board-certified physician in palliative and hospice medicine and chief scientific officer of the psychedelic supportive therapy clinic Numinus.
Current treatments for major depressive disorder, generalized anxiety disorder, and PTSD “are not always transferable to the kinds of suffering people may experience near the end of life,” he said. says Fairman.
Some evidence suggests it works for terminally ill patients, but it’s important to make them available, Fairman says. It doesn’t look like it was designed.
There are practical pharmacological concerns. The side effects of common psychiatric drugs can cause more problems than the drugs are worth. Then there is effectiveness. For example, understanding which antidepressants are effective may require multiple trials, and each drug may take weeks to reach therapeutic doses.
Simply put, you may not have enough time.
Psychedelic compounds, which are fast-acting, generally have few long-term side effects, and tend to elicit an existential and psychic experience in the user, are particularly useful in helping terminally ill patients in combination with pre- and post-use treatments. It may be suitable.
Receiving psychedelic support therapy
While awaiting approval from Health Canada to incorporate psilocybin into their treatment, Yokoi and Verbora began with a single dose of ketamine.
Health Canada ultimately approved Yokoi for three courses of psilocybin-supported therapy.
The first thing she said was “all about the body.” She went in with the intention of calming her anxiety, but her experience became one focused on her body as soon as it began.
“It felt like a message: ‘You are not connected to your body,'” says Yokoi. Her psilocybin helped her reframe her relationship with her physical body as her unknown and terrible things were happening inside her.
“Every nerve in my body seemed to light up,” she says. She “felt like I really needed to move, so I just moved around for a couple of hours.”
She lay down on the ground and did some yoga stretches.
The trip was very unexpected, but a valuable experience, she says. It helped her understand the relationship between her mind and body.
Her second experience, The River, was more internal and narrative. It follows from this that she, although her love is invisible, truththat love could be a big event for the rest of her life. was given to her.
“I felt really, really fulfilled.”
psychedelic possibility
That sense of the importance of love echoes Tom’s experience as a 50-year-old man diagnosed with chronic myelogenous leukemia and participating in a trial of psilocybin-supported therapy with researchers at NYU and Palo Alto University.
During his travels, Tom reported “an overwhelming feeling of love…I felt an urge to stop being silly and let people know that only love matters.” The forefront of pharmacology.
He told researchers that although his experience was exhausting, it allayed his fear of death while also giving him a greater appreciation for life.
Psychedelic researchers have found through multiple small studies in life-threatening cancer patients that psilocybin can be safely tolerated and can improve patients’ quality of life, sometimes significantly.
Two studies published in the Journal of Psychopharmacology in 2016 seem to have sparked new thinking about psychedelic-assisted therapy for terminally ill patients.
Research by Steven Ross’ team new york university and a group of Roland Griffiths Johns Hopkins — including field trip advisor psychedelic expert Matthew W. Johnson — UCLA By Charles Grobb and colleagues.
Both of these studies included cancer patients, not all of whom were terminally ill. Both use psilocybin and have shown “very impressive positive signs that psilocybin can help improve mood and anxiety and improve quality of life for cancer patients,” Numinus’ he said. says Paul Thielking. A disease program for patients battling a variety of conditions.
The speed with which psychedelics act and their relatively strong safety profile make them attractive as potential end-of-life therapies, but so too is the science that makes psychedelics so difficult to explain.
“I don’t think we really understand it, and we can’t put it into words,” says Fairman, an expert in palliative psychiatry. we have to take it at face value. “
opportunities and concerns
Psychedelics are unlikely to be the balm for all terminally ill patients, or for all psychological challenges leading to death, and the studies most commonly cited by proponents of psychedelic therapy include small sample sizes. and have their own weaknesses, such as relatively difficult challenges. How to use effective placebos to test against compounds with very dramatic effects.
Because the study used a range of patients with early-stage cancer to end-stage disease, it was possible that the patient’s chemotherapy had weakened and the cancer went into remission, so that improvement could have been seen without psilocybin, and in which patients. Dr. Breitbart, chair of psycho-oncology at Memorial Sloan-Kettering Cancer Center, said: 2016 New York Times.
Both Verbora and Thielking say that various other drugs that terminally ill patients tend to take may prove to be complications.
According to Thielking, classic hallucinogens act at serotonin receptor sites, and many psychiatric drugs and some nausea drugs are also traded there, which could alter their effects. Before psilocybin, people needed to stay away from serotonin-site drugs, including traditional antidepressants, sleeping pills, and some nausea drugs like Zofran, which chemotherapy patients take.
It also makes it difficult to develop protocols for things that cannot be scientifically measured. This is especially true in terminally ill patients, a group that is difficult to study clinically.
What is the appropriate way to assess the risk of terminally ill patients? Screening to exclude patients with possible psychotic break in schizophrenia may not make much sense given the life expectancy of a particular patient. yeah.
If the patient is very physically ill or is in deep emotional distress, can the patient give full informed consent? , scammers, or unscrupulous researchers?
But first comes the biggest problem.
“The main question to be answered is whether these treatments are safe and effective for existential distress in patients near the end of life,” Fairmans says.
Changing Palliative Psychiatry
“I think the big part here is the whole conversation about end of life,” says Verbora, Yokoi’s psychedelic therapy provider.
Compared to other medical milestones such as childbirth, people facing death are essentially left to their own devices, especially unless they have access to a good palliative care doctor or therapist.
Palliative care is all about optimizing a person’s quality of life. Part of its mission is the alleviation of suffering, and the existential and spiritual crises that terminally ill patients may face certainly qualify.
Fairman points out that the field is still relatively new, and recognizes the different specialties that fall within its unique objectives.
“The field has done an amazing job of providing safe and effective treatments for most physical symptoms, and now, increasingly, to alleviate these other kinds of ‘mental distress’.” Morale demoralization, existential distress, and emotional distress.
Yokoi believes that suffering is not an inevitable part of challenge. He believes there are ways to make the most of his experience, including possibly facing his own death wrapped in a golden leaf.
We look forward to hearing from you! If you have any comments about this article, or tips for future Freethink stories, please email us at [email protected].
