Famed neurologist and author Oliver Sacks said an unexpected source made him a better doctor: hallucinogens.
"I think [hallucinogens] made me more open to some of my patients' experiences," Sacks, who died on Sunday at the age of 82, told New Scientist magazine, describing some of the bizarre symptoms patients would come to him with. "I'm glad I had the experience. It taught me what the mind is capable of."
Sacks was well-known for his ability to pen deep, moving stories about his patients' struggles with everything from migraines to Tourette's syndrome and colorblindness. So if psychedelics contributed to his ability to relate to patients, that's big.
But Sacks also recalled a darker side to drugs, both hallucinogenic and not. In the New Yorker, he wrote about how his youthful experimentation and drug abuse caused problems — leading to negative experiences with friends and peers, unwanted hallucinations, and psychotic episodes. "I've gone mad, psychotic, insane," he once told a friend while experiencing delirium tremens due to withdrawal from chloral hydrate, which isn't a hallucinogen. "It started this morning and it's getting worse all the while."
Sacks's experiences reflect the double-edged nature of psychedelics: Although these drugs can be dangerous if used excessively or improperly, a growing body of research suggests they could help people significantly — not just medically, but in other personal and therapeutic ways. And that's why drug policy experts and doctors are now beginning to consider how, exactly, these drugs should be allowed for legal use — in a way that maximizes their benefits, but also tames their drawbacks.
The big benefit of psychedelics: a sense of perspective
In basic terms, the potential benefit of psychedelics is that they give you perspective — about other people, ego, life, death, and so on. That's part of the benefit Sacks communicated: LSD allowed him to see how the mind works, and what some of his patients complained about. Other hallucinogenic drugs, like psilocybin from magic mushrooms, can produce similar outcomes.
The most remarkable potential benefit is what's called "ego death," an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.
When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a heightened perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.
That may sound like pseudoscience. And the research on hallucinogens is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried hallucinogens can vouch for experiencing. It's one of the reasons why preliminary, small studies and research from the 1950s and '60s found hallucinogens can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.
Mark Kleiman, a drug policy expert at New York University's Marron Institute, noted that these benefits don't apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone: a reduced fear of death, greater psychological openness, and increased life satisfaction.
"It's not required to have a disease to be afraid of dying," Kleiman told me in July. "But it's probably an undesirable condition if you have the alternative available. And there's now some evidence that these experiences can make the person less afraid to die."
Kleiman added, "The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people's lives might be better if they live out of the shadow of the valley of death."
These drugs aren't without dangers. There's a substantial risk of a bad hallucinogenic experience — which can lead to psychological trauma, particularly among people predisposed to mental health issues — and accidents. But if psychedelics pose the kind of benefit that Kleiman and other researchers think they do, perhaps it would be a good idea for the government to allow their use in some way. The question is how.
If psychedelics are legalized, a big question is how to minimize the risks
So how can you maximize the benefits and minimize the risks? The most supported idea so far is letting people take psychedelics in a controlled setting, in which multiple participants can be watched over by trained supervisors who ensure the experience doesn't go poorly.
So far, this is what the medical side has focused on: The typical medical trial involves doctors watching over a deathly ill patient or someone dealing with addiction who takes psilocybin. But if the concept is expanded to allow nonmedical users, then perhaps professionals who aren't doctors but are trained in guiding someone through a trip could take up the role. "I imagine someone who has training in managing that experience, and a license, and liability insurance, and a facility," Kleiman said.
Here's how it would work: A psychedelic user would go through some sort of preparation period to make sure she knows what she's getting into. Then she could make an appointment at a place offering these services. She would show up at this appointment, take the drug of her choice (or whatever the facility provides), and wait to allow it to kick in. As the trip occurs, a supervisor would watch over the user — not being too pushy, but making sure he's available to guide her through any rough spots. In some studies, doctors have also prepared certain activities — a soundtrack or food, for example — that may help create the right mood and setting for someone on psychedelics. Different places will likely experiment with different approaches, including how many people can participate at once and how a room should look.
Kleiman also envisions a potential system in which people can eventually graduate to using the drug solo. "It's like Red Cross water safety instruction," he said. "You start out, you're a newbie. You don't go into the pool without a trained, certified person to watch you, guide you, and keep you safe. After a while, your teacher gives you a test to certify that you're safe to be in the water alone. And you might even get certified to become a trainer, so you can guide newbies yourself."
If pulled off correctly, this would maximize the best possible outcomes and minimize the worst. Supervisors could help prevent accidents, and walk people through good and bad trips, letting users relax and get something meaningful out of the experience.
There are risks to the controlled setting. If a supervisor is poorly trained or malicious, it could lead to a horrific trip that could actually worsen someone's mental state. This is why regulation and licensing will be crucial to getting the idea right.
This isn't the environment in which Sacks used drugs, based on his writings. But through this controlled model, hallucinogens could lead to more beneficial psychedelic trips he had — and fewer of the scary experiences he also went through.