Skip to main content

Use of the Classic Hallucinogen Psilocybin for Treatment of Existential Distress Associated with Cancer

  • Chapter
  • First Online:

Abstract

This chapter reviews the potential of a treatment approach that uses psilocybin, a novel psychoactive drug, to ameliorate the psychospiritual distress and demoralization that often accompany a life-threatening cancer diagnosis. The focus of cutting-edge research beginning in the 1950s, the investigation of classic hallucinogens had a major impact on the evolving field of psychiatry, contributing to early discoveries of basic neurotransmitter systems and to significant developments in clinical psychopharmacology. While published reports of therapeutic breakthroughs with difficult-to-treat and refractory patient populations were initially met with mainstream professional enthusiasm, by the late 1960s and early 1970s the growing association of hallucinogens with widespread indiscriminate use led to the temporary abandonment of this promising psychiatric treatment model. After a hiatus lasting several decades, however, regulatory and scientific support has grown for the resumption of clinical research investigations exploring the safety and efficacy of a treatment model utilizing the classic hallucinogen, psilocybin, in a subject population that had previously demonstrated positive therapeutic response, patients with existential anxiety due to a life-threatening cancer diagnosis.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Berringer K. Der mescalinrausch. Berlin: Springer; 1927.

    Google Scholar 

  2. Bleuler M. Comparison of drug-induced and endogenous psychoses in man. In: Breatly PB, Deniker R, Raduco-Thomas D, editors. Proceedings of the first international congress of neuropsychopharmacology. Amsterdam: Elsevier; 1958.

    Google Scholar 

  3. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8:417–28.

    Article  PubMed  CAS  Google Scholar 

  4. Breitbart W, Gibson C, Chochinov HM. Palliative care. In: Levenson JL, editor. The American psychiatric publishing textbook of psychosomatic medicine. Washington, DC: American Psychiatric Publisher; 2005.

    Google Scholar 

  5. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. J Am Med Assoc. 2000;284:2907–11.

    Article  CAS  Google Scholar 

  6. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Kosinski A, Berg A, Jacobson C, Sorger B, Abbey J, Olden M. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology. 2010;19:21–8.

    Article  PubMed  Google Scholar 

  7. Blinderman C, Cherny N. Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel. Palliat Med. 2005;19:371–80.

    Article  PubMed  Google Scholar 

  8. Bucke RM. Cosmic consciousness. Philadelphia, PA: Innes & Sons; 1901.

    Google Scholar 

  9. Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306:639–45.

    Article  PubMed  CAS  Google Scholar 

  10. Chandler AL, Hartman MA. Lysergic acid die­thylamide (LSD-25) as a facilitating agent in psychotherapy. Arch Gen Psychiatry. 1960;2:286–9.

    Article  Google Scholar 

  11. Chochinov HM, Wilson KG, Lander S. Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics. 1998;39:336–70.

    Article  Google Scholar 

  12. Chochinov HM, Hack T, Hassard T, Krisjanson L, McClemont S, Harlos M. Understanding the will to live in patients nearing death. Psychosomatics. 2005;46:7–10.

    Article  PubMed  Google Scholar 

  13. Chochinov HM, Cann BJ. Interventions to enhance the spiritual aspects of dying. J Palliat Med. 2005;8(Supplement 1):S103–15.

    Article  PubMed  Google Scholar 

  14. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClemont S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23:5520–5.

    Article  PubMed  Google Scholar 

  15. Cohen S. LSD and the anguish of dying. Harper’s. 1965 Sept: 69–78

    Google Scholar 

  16. Cohen SR, Mount BM, Tomas JN, Mount LF. Existential well-being is an important determinant of quality of life. Cancer. 1996;77:576–86.

    Article  PubMed  CAS  Google Scholar 

  17. Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky C, Schmale AM, Henrichs M, Carnicke CL. J Am Med Assoc. 1983;249:751–7.

    Article  CAS  Google Scholar 

  18. Doblin R. Pahnke’s Good Friday experiment: a ­long-term follow-up and methodological critique. J Transpersonal Psychol. 1991;23:1–28.

    Google Scholar 

  19. Durkin I, Kearney M, O’Siorain L. Psychiatric disorder in a palliative care unit. Palliat Med. 2003;17: 212–8.

    Article  Google Scholar 

  20. Edwards A, Pang N, Shiu V, Chan C. The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliat Med. 2010;24(8):753–70.

    Article  PubMed  CAS  Google Scholar 

  21. Fernsler J, Klemm P, Miller M. Spiritual well-being and demands of illness in people with colorectal cancer. Cancer Nurs. 1999;22:134–40.

    Article  PubMed  CAS  Google Scholar 

  22. Field M, Cassel C, editors. Approaching death: improving care at the end-of-life. Washington, DC: National Academy Press; 1997.

    Google Scholar 

  23. Fisher G. Psychotherapy for the dying: principles and illustrative cases with special reference to the use of LSD. Omega. 1970;1:3–15.

    Google Scholar 

  24. Frankl VE. Man’s search for meaning. Boston, MA: Beacon; 1984.

    Google Scholar 

  25. Frankl VF. The will to meaning: foundations and applications of logotherapy. New York: Penguin; 1988.

    Google Scholar 

  26. Galfin JM, Walkins ER, Harlow T. Psychological distress and rumination in palliative care patients and their caregivers. J Palliat Med. 2010;13: 1345–8.

    Article  PubMed  Google Scholar 

  27. Greenberg L, Lantz MS, Likourezos A, Burack OR, Chichin E, Carter J. Screening for depression in nursing home palliative care patients. J Geriatr Psychiatry Neurol. 2004;17:212–8.

    Article  PubMed  Google Scholar 

  28. Griffiths RR, Grob CS. Hallucinogens as medicine. Sci Am. 2010;303(December):77–9.

    Google Scholar 

  29. Griffiths RR, Johnson MW, Richards WA, Richards BD, McCann U, Jesse R. Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects. Psychopharmacology (Berl). 2011;218:649–65.

    Article  CAS  Google Scholar 

  30. Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl). 2006;187:268–83.

    Article  CAS  Google Scholar 

  31. Griffiths RR, Richards WA, Johnson MW, McCann U, Jesse R. Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. J Psychopharmacol. 2008;22(6):621–32.

    Article  PubMed  CAS  Google Scholar 

  32. Grinspoon L, Bakalar JB. Psychedelic drugs reconsidered. New York: Basic Books; 1979.

    Google Scholar 

  33. Grinspoon L, Bakalar JB. Can drugs be used to enhance the psychotherapeutic process? Am J Psychother. 1986;40:393–404.

    PubMed  CAS  Google Scholar 

  34. Grob CS, Danforth AL, Chopra GS, Hagerty M, McKay CR, Halberstadt AL, Greer G. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatry. 2011;68:71–8.

    Article  PubMed  CAS  Google Scholar 

  35. Grof S, Goodman LE, Richards WA, Kurland AA. LSD-assisted psychotherapy in patients with terminal cancer. Int Pharmacopsychiatry. 1973;8:129–44.

    PubMed  CAS  Google Scholar 

  36. Hasler F, Grimberg U, Benz MA, Huber T, Vollenweider FX. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose effects study. Psychopharmacology (Berl). 2004;172:145–56.

    Article  CAS  Google Scholar 

  37. Henoch I, Danielson E. Existential concerns among patients with cancer and interventions to meet them: an integrative literature review. Psychooncology. 2009;18:225–36.

    Article  PubMed  Google Scholar 

  38. Henry M, Cohen R, Lee V, Sauthier P, Provencher D, Drouin P, Gauthier P, Gotlieb W, Lau S, Drummond N, Gilbert L, Stanimir G, Sturgeon J, Chasen M, Mitchell J, Nixon Huang L, Ferland M, Mayo N. The meaning making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study. Psychooncology. 2010;19:1340–7.

    Article  PubMed  Google Scholar 

  39. Hills J, Paice JA, Cameron JR, Shott S. Spirituality and distress in palliative care consultation. J Palliat Med. 2005;8:782–8.

    Article  PubMed  Google Scholar 

  40. Hofmann A. LSD—my problem child: reflections on sacred drugs, mysticism and science. Los Angeles, CA: J.P. Tarcher; 1985.

    Google Scholar 

  41. Hotoph M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding. Palliat Med. 2002;16:81–97.

    Article  Google Scholar 

  42. Hotopf M, Price A. Palliative care psychiatry. Psychiatry. 2009;8:212–5.

    Article  Google Scholar 

  43. Huxley A. The perennial philosophy. New York: Harper & Brothers; 1945.

    Google Scholar 

  44. Isbell H. Comparison of the reactions induced by psilocybin and LSD-25 in man. Psychopharmacologia. 1959;1:29–38.

    Article  PubMed  CAS  Google Scholar 

  45. Jacob P, Shulgin AT. Structure-activity relationships of the classic hallucinogens and their analogs. NIDA Res Monogr. 1994;146:74–91.

    PubMed  Google Scholar 

  46. James W. The varieties of religious experience. New York: Longman’s Green, and Co.; 1919.

    Google Scholar 

  47. Johnson MW, Richards WA, Griffiths RR. Human hallucinogen research: guidelines for safety. J Psychopharmacol. 2008;22:603–20.

    Article  PubMed  CAS  Google Scholar 

  48. Jones JM, Huggins MA, Rydall AC, Rodin GM. Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. J Psychosom Res. 2003;55:411–8.

    Article  PubMed  Google Scholar 

  49. Jung C. Psychology and religion. New Heaven, CT: Yale University Press; 1938.

    Google Scholar 

  50. Kandasamy A, Chaturvedi S, Desai G. Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer. Indian J Cancer. 2011;48:55–8.

    Article  PubMed  CAS  Google Scholar 

  51. Kast EC. The measurement of pain, a new approach to an old problem. J New Drugs. 1962;2:344–51.

    PubMed  CAS  Google Scholar 

  52. Kast EC, Collins VJ. Lysergic acid diethylamide as an analgesic agent. Anesth Analg. 1964;43:285–91.

    Article  PubMed  CAS  Google Scholar 

  53. Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robertson M. Terminally ill cancer patients’ wish to hasten death. Palliat Med. 2002;16:339–45.

    Article  PubMed  CAS  Google Scholar 

  54. Kissane D, Clarke DM, Street AF. Demoralization syndrome-A relevant psychiatric diagnosis for palliative care. J Palliat Care. 2001;17:12–21.

    PubMed  CAS  Google Scholar 

  55. Kluver H. Mescal: the ‘Divine’ plant and its psychological effects. London: Keegan Paul; 1928.

    Google Scholar 

  56. Lajoie DH, Shapiro SI. Definitions of transpersonal psychology: the first twenty-three years. J Transpersonal Psychol. 1992;24:79–98.

    Google Scholar 

  57. Lee V. The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer. 2008;16:779–85.

    Article  PubMed  Google Scholar 

  58. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: a review of manualized interventions. Clin Psychol Rev. 2008;28: 472–93.

    Article  PubMed  Google Scholar 

  59. Lethborg C, Aranda S, Cox S, Kissane D. To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care. 2007;5:377–88.

    Article  PubMed  Google Scholar 

  60. Lin HR, Bauer-Wu SM. Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature. J Adv Nurs. 2003;44:69–80.

    Article  PubMed  Google Scholar 

  61. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.

    Article  PubMed  Google Scholar 

  62. Maslow AH. Religions, values, and peak experience. Columbus, OH: Ohio State University Press; 1964.

    Google Scholar 

  63. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361:1603–7.

    Article  PubMed  Google Scholar 

  64. McMillan SC, Weitzner M. How problematic are various aspects of quality of life in patients with cancer at the end of life? Oncol Nurs Forum. 2000;27:817–23.

    PubMed  CAS  Google Scholar 

  65. Metzner R. Teonanacatl: sacred mushroom of visions. Verona, CA: Four Trees Press; 2004.

    Google Scholar 

  66. Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, Skummy A, Dutcher J. Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer population. Psychooncology. 1999;8:378–85.

    Article  PubMed  CAS  Google Scholar 

  67. Moreno FA, Wiegand CB, Taitano K, Delgado PL. Safety, tolerability and efficacy of psilocybin in patients with obsessive-compulsive disorder. J Clin Psychiatry. 2006;67:1735–40.

    Article  PubMed  CAS  Google Scholar 

  68. Morita T, Tsunoda J, Inoue S, Chihara S. An exploratory factor analysis of existential suffering in Japanese terminally ill cancer patients. Psychooncology. 2000;9:164–8.

    Article  PubMed  CAS  Google Scholar 

  69. Murata H. Spiritual pain and its care in patients with terminal cancer: construction of a conceptual framework by philosophical approach. Palliat Support Care. 2003;1:15–21.

    Article  PubMed  Google Scholar 

  70. National Institute for Clinical Excellence. Improving supportive and palliative care for adults with cancer. London: National Institute for Clinical Excellence; 2004.

    Google Scholar 

  71. The National Comprehensive Cancer Network: Distress Management Clinical Practice Guidelines in Oncology. www.NCCN.org(2009; 2010)

  72. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43:213–20.

    Article  PubMed  Google Scholar 

  73. Nichols DE. Hallucinogens. Pharmacol Ther. 2004;101:131–81.

    Article  PubMed  CAS  Google Scholar 

  74. Osmond H. A review of the clinical effects of psychotomimetic agents. Ann N Y Acad Sci. 1957;66:418–34.

    Article  PubMed  CAS  Google Scholar 

  75. Otto R. The idea of the holy. London: Oxford University Press; 1923.

    Google Scholar 

  76. Pahnke W. Drugs and mysticism: an analysis of the relationship between psychedelic drugs and the mystical consciousness. Thesis presented to the President and Fellows of Harvard University for the Ph.D. in Religion and Society; 1963

    Google Scholar 

  77. Pahnke WN. The psychedelic mystical experience in the human encounter with death. Harvard Theol Rev. 1969;62:1–21.

    Google Scholar 

  78. Passie T. A history of the use of psilocybin in psychotherapy. In: Metzner R, editor. Teonanacatl: sacred mushroom of vision. El Verano, CA: Four Trees Press; 2004.

    Google Scholar 

  79. Passie T, Seifert J, Schneider U, Emrich HM. The pharmacology of psilocybin. Addict Biol. 2002;7:357–64.

    Article  PubMed  CAS  Google Scholar 

  80. Presti DE, Nichols DE. Biochemistry and neuropharmacology of psilocybin mushrooms. In: Metzner R, editor. Teonanacatl: sacred mushroom of vision. El Verano, CA: Four Trees Press; 2004.

    Google Scholar 

  81. Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, Chochinov M, Handzo G, Nelson-Becker H, Prince-Paul M, Pugliese K, Sulmasy D. Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med. 2009;12:885–904.

    Article  PubMed  Google Scholar 

  82. Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3:129–37.

    Article  PubMed  CAS  Google Scholar 

  83. Puchalski CM, Kilpatrick SD, McCullough ME, Larson DB. A systematic review of spiritual and religious variables in Palliative Medicine, American Journal of Hospice and Palliative Care, Hospice Journal, Journal of Palliative Care, and Journal of Pain and Symptom Management. Palliat Support Care. 2003;1:7–13.

    Article  PubMed  Google Scholar 

  84. Richards WA, Rhead JC, DiLeo FB, Yensen R, Kurland AA. The peak experience variable in DPT-assisted psychotherapy with cancer patients. J Psychedelic Drugs. 1977;9:1–10.

    Article  Google Scholar 

  85. Riedlinger TJ. The sacred mushroom seeker: essays for R. Gordon Wasson. Portland, OR: Dioscorides Press; 1990.

    Google Scholar 

  86. Rodin G, Lo C, Mikulincer M, Donner A, Gagliese L, Zimmermann C. Pathways to distress: the multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Soc Sci Med. 2009;68:562–9.

    Article  PubMed  Google Scholar 

  87. Rodin G, Zimmermann C, Rydall A, Jones J, Shepherd FA, Moore M, Fruh M, Donner A, Gagliese L. The desire for hastened death in patients with metastatic cancer. J Pain Symptom Manage. 2007;6: 661–75.

    Article  Google Scholar 

  88. Rousseau P. Spirituality and the dying patient. J Clin Oncol. 2000;18:2000–2.

    PubMed  CAS  Google Scholar 

  89. Saunders CM. The management of terminal malignant disease. London: Edward Arnold; 1978.

    Google Scholar 

  90. Saunders C. Spiritual pain. J Palliat Care. 1988;4: 29–32.

    PubMed  CAS  Google Scholar 

  91. Schultes RE, Hofmann A. Plants of the gods: their sacred, healing and hallucinogenic powers. Rochester, VT: Healing Arts Press; 1992.

    Google Scholar 

  92. Sinclair S, Pereira J, Raffin S. A thematic review of the spirituality literature within palliative care. J Palliat Med. 2006;9:464–79.

    Article  PubMed  Google Scholar 

  93. Storey P, Knight CF. UNIPAC Two: alleviating psychological and spiritual pain in the terminally ill. Gainesville, FL: American Academy of Hospice and Palliative Medicine; 1997.

    Google Scholar 

  94. Studerus E, Gamma A, Vollenweider FX. Psychometric evaluation of the altered states of consciousness rating scale (OAV). PLoS One. 2010;5: 1–19.

    Article  Google Scholar 

  95. Tanyi RA. Towards clarification of the meaning of spirituality. J Adv Nurs. 2002;39:500–9.

    Article  PubMed  Google Scholar 

  96. Vachon M, Fillion L, Achille M. A conceptual analysis of spirituality at the end of life. J Palliat Med. 2009;12:53–7.

    Article  Google Scholar 

  97. Vollenweider FX, Leenders KL, Scharfetter C, Maguire P, Stadelmann O, Angst J. Positron emission tomography and fluorodeoxyglucose studies of metabolic hyperfrontality and psychopathology in the psilocybin model of psychosis. Neuropsychopharmacology. 1997;16:357–72.

    Article  PubMed  CAS  Google Scholar 

  98. Vollenweider FX, Vollenweider-Scherpenhuyzen MF, Bäbler A, Vogel H, Hell D. Psilocybin induces schizophrenia-like psychosis in humans via a ­serotonin-2 agonist action. Neuroreport. 1998;9:3897–902.

    Article  PubMed  CAS  Google Scholar 

  99. Weisman AD. Early diagnosis of vulnerability in cancer patients. Am J Med Sci. 1976;271:187–96.

    Article  PubMed  CAS  Google Scholar 

  100. Weisman AD, Worden JW. The existential plight in cancer: significance of the first 100 days. Int J Psychiatry Med. 1976;7:1–15.

    Article  PubMed  Google Scholar 

  101. Wilson KG, Chochinov HM, de Faye BJ, Breitbart W. Diagnosis and management of depression in palliative care. In: Chochinov HM, Breitbart W, editors. Handbook of psychiatry in palliative medicine. New York: Oxford University Press; 2000. p. 25–49.

    Google Scholar 

  102. Wilson KG, Chochinov HM, Skirko MG, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O’Shea F, Kuhl D, Fainsinger RL, Clinch JJ. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage. 2007;33:118–29.

    Article  PubMed  Google Scholar 

  103. World Health Organization: WHO definition of ­palliative care. www.who.int/cancer/palliative/definition.en/(2011). Accessed Feb 2011

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Charles S. Grob M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Grob, C.S., Bossis, A.P., Griffiths, R.R. (2013). Use of the Classic Hallucinogen Psilocybin for Treatment of Existential Distress Associated with Cancer. In: Carr, B., STEEL, J. (eds) Psychological Aspects of Cancer. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-4866-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-4866-2_17

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-4865-5

  • Online ISBN: 978-1-4614-4866-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics