During personal, guided, or group psychedelic sessions, people will often confront a range of issues, from trauma to depression to addiction (sometimes all three together since these problems are often linked). One of the most interesting aspects of the psychedelic experiences, to me personally, is how they can feature confrontations with the key existential concerns that we have as humans: death, meaninglessness, isolation, and freedom.
Much of the current research on psychedelic therapy directly deals with each of these concerns: terminally ill patients have reduced anxiety following a mystical experience with psilocybin; study participants rate the mystical experiences they had via psilocybin as one of the most meaningful experiences of their life; people feel more connected to nature, their emotions, and other people following psychedelic use; and psychedelics can potentially help foster authenticity, the freedom to be oneself. If we are to take seriously the notion, as many psychotherapists and philosophers do, that existential concerns underlie a bulk of psychological distress in society, then we should also take seriously the potential of psychedelics to help us address and resolve these concerns.
In this essay, I’d like to draw attention specifically to the issue of death anxiety, for this is the existential concern that has the propensity to instil the most terror in us, as evidenced by our aversion to talking about it, and the various philosophical and theological systems we construct to nullify the anxiety (it’s easier to face death if you have an unwavering belief in an eternal soul or indestructible consciousness). Much of the anxiety of death relates to its sense of unavoidability and ultimate finality. Patients with a life-threatening illness, understandably, are prone to struggle with death anxiety. Yet, as briefly mentioned, when these types of patients have a mystical experience induced by psilocybin, symptoms of existential distress are reduced.
So why are patients able to overcome their fear of death during a psychedelic experience? And what about the general population struggling with the fear of death – can psychedelics help the rest of us too?
Psychedelics and End-of-Life Anxiety
The psychotherapist James Hawkins has compiled many of the findings on psychedelics and existential distress, and as we can see from the research available, psychedelics are shown to consistently and effectively reduce the experience of depression and anxiety that cancer patients face.
In terms of how psychedelics work, the psychedelic researcher Robin Carhart-Harris has noted various scales of action:
from the molecular (serotonin 2A receptor agonism) through to the anatomical and functional (heightened plasticity) and up to the dynamic (increased brain entropy), systems level (network disintegration and desegregation) and experiential.
It is proposed that psychedelics initiate a cascade of neurobiological changes that manifest at multiple scales and ultimately culminate in the relaxation of high-level beliefs. The purpose of psychedelic therapy is to harness the opportunity afforded by this belief-relaxation to achieve a healthy revision of pathological beliefs.
But why should the different levels of brain changes stimulated by psychedelics help patients overcome their fear of death? What is it about the promotion of neural plasticity, increased brain entropy (chaos and uncertainty in the brain), and increased communication between brain regions that takes away – or at least, reduces – the anxiety about not existing anymore? And should we really regard death anxiety as ‘pathological’ – or is some death anxiety always likely to be expected, even in healthy individuals?
In terms of brain changes, it appears to me that one of the crucial reasons these brain changes can lead to changes in attitudes towards death is that they can lead to greater psychological flexibility (being able to adapt to, be present with, and accept the various struggles of life). Many of the brain changes caused by psychedelics are related to new and different connections and this is what allows patients to have a multiplicity of new perspectives, opening them up to ways of seeing that make psychological flexibility possible.
Psychedelics can allow a first-hand, direct experience of seeing death in a new way, with an attitude of acceptance and peace, rather than resistance and anxiety. It’s one thing to intellectualise a desire to accept death and quite another thing to experience that acceptance spontaneously and fully during a psychedelic experience. And once this doorway of flexibility opens, it can remain open, especially if psychological support is in place to help patients integrate the experience. One of the benefits of psychedelics, then, is that they allow for reframing, helping individuals to see a different angle, interpretation, and narrative to mortality. The heavy, gloomy story that patients repeat to themselves about death, it seems, is not inevitable and set in stone; death can be radically reframed in a way that makes the last moments of existence as enjoyable as possible.
Psychedelics Can Reduce the Fear of Death in the General Population
It’s not just terminally ill patients who feel they can overcome the fear of death thanks to psychedelics. Approaching death with equanimity is an experience that is available to all of us. After all, death is inevitable, whether we have a terminal illness or not. Death is a question of when, not if. There are countless anecdotal reports about healthy individuals who lost their fear of death following a psychedelic experience, as well as some scientific studies about the phenomenon, such as one study showing that LSD can lead to a sustained reduction in death anxiety in normal subjects after one year. In exploring the relationship between the psychedelic experience and death anxiety, researchers use the Death Transcendence Scale, a five-factor scale that measures how people transcend death through identification with phenomena more enduring than themselves.
Since psychedelics can disrupt habitual patterns of thinking in all kinds of populations, people who are struggling with death anxiety may find a psychedelic experience can unstick them from their ingrained attitudes about mortality. The same kind of disruptive and valuable changes in neurobiology, psychology, and subjective experience seen in terminally ill patients can be appreciated by non-terminally ill people who are nonetheless still filled with dread about the prospect of dying and non-existence. Hawkins states:
The Death transcendence scale explores the way people can transcend their self-focus & fear of death by asking about their links with five areas – mystical, religious, creative, nature & biosocial. Psychedelic experience is profoundly about connection – see the fine 2017 paper “Psychedelics and connectedness“ – and can deeply strengthen these five area links. It seems to me that our sense of being separate, individual, to an extent isolated, selves is a development in evolution that has successfully promoted survival. However it comes with several costs, and fear of death seems to be one of these costs. Psychedelic experience can allow us to feel deeply that this ‘separate self’ view is just one way of experiencing the world … and it isn’t the deepest or most profound way of being. This realisation changes our response to the dissolution of our separate ego.
Interestingly, we know that experiences induced by certain psychedelic drugs – such as DMT and ketamine – can closely resemble the near-death experience (NDE), the intense, mystical-like experience that many people have when close to death or in life-threatening situations. And we know that people who have had NDEs have a lower fear of death and view it more as a transition than as absolute annihilation. This speaks to this idea of altered states of consciousness leading to a reframing of death. If viewed as a transitional phase rather than the ultimate end, then much of the anxiety surrounding the event can be alleviated.
As well as different representations of death affecting death anxiety, researchers have found that the increases in self-esteem and mindfulness after an NDE also play a role. Since mystical experiences with DMT and ketamine can model the NDE, there is good reason to think that the kind of relief from death anxiety felt after an NDE can be experienced following a psychedelic trip as well. Nonetheless, whether reductions in death anxiety are comparable between the two experiences is a question that warrants further investigation. Anecdotally, at least, people who have had either an NDE or a mystical psychedelic experience often report that they’ve shaken off the fear of death they were previously burdened with.
With respect to this reframing of death, it does appear that many people who have had a mystical experience (whether related to an NDE or a psychedelic) come away from the experience convinced of an immaterial something (soul, energy, consciousness, divine essence) that survives the physical death. This can support the belief that bodily death is just a transition rather than the final chapter. As the late spiritual teacher Ram Dass often taught, death is “like taking off a tight shoe”. In this way, death can actually be approached with curiosity and contentment since it is a process whereby we transition from tension to release. If death is viewed as the continuation of consciousness, unbridled and tortured by the physicality of existence, then there is nothing to worry about (unless you take the more pessimistic stance that existing as eternal awareness is a kind of hell).
But while psychedelics can radically change people’s beliefs in this way, this doesn’t mean this particular reframing of death is the only way to overcome the fear of death. For example, you can view death as a transition within the context of philosophical naturalism – the belief that all that exists is natural. Philosophical naturalists reject the existence of an immaterial soul, as well as supernatural realms and entities. A philosophical naturalist can still feel a heightened sense of spirituality after a psychedelic experience, but their sense of spirituality (despite the implications of ‘spirit’ featured in the term) is grounded in the natural world only.
Naturalised spirituality is often defined by an increased sense of connection and an enlarged sense of self. Thus, a philosophical naturalist who had a mystical psychedelic experience might not be so troubled by their death because they include in their sense of self the other people who are connected to them, their community, society, the planet, and even the universe as a whole (everything is built out of the same fundamental material, after all). While their individual personality and body will pass away, these other connections won’t. A philosophical naturalist may feel that their life will have ripple effects through the lasting impact they have in the world and through existing people whom they were connected to and whom they influenced. In this way, the enlarged sense of self is not completely annihilated.
Moreover, in a naturalistic context, you can think of death as a transition of returning the matter and energy of your physical existence back to the Earth and the universe – and the knowledge that you will continue to exist in this form and through this process may help to reduce death anxiety. Lastly, a philosophical naturalist could take an Epicurean view of death, which says that it is irrational to fear death while existing because it has not come, and there is no reason to think of death as a harm because once you are dead, you do not exist to experience it as a deprivation of life. If the mind disappears upon death, as a philosophical naturalist would believe, then this can, on the one hand, feel like a tragic and dreadful loss, but with a kind of psychedelic reframing, you can also see death as nothing to fear – and more than that, as a final release from suffering. Without a mind, there is no suffering.
In reflecting on why psychedelic experiences and NDEs offer a relief from death anxiety, regardless of how such experiences alter beliefs, I think one vital reason is that they involve a ‘death before death’ or ‘dying before dying’. In the mystical experience, ego dissolution and loss of awareness of the physical body and the external world are common features. And these are monumental subjective changes. As a result of ego dissolution, out-of-body experiences, and the feeling of being in a different dimension, people who are tripping may be convinced that they have died. This is unsurprising, really, as they have in a sense died. Most of us usually associate our existence with our ego and so if that dies, then we might interpret that as true death, even if, of course, there is still some level of awareness present during the experience (for you would need to be aware to even think you had died in the first place).
Ego dissolution during a psychedelic experience is a way of dying that can help prepare us for the actual experience of dying. Surrendering to ego death can train us to gracefully accept our physical death. Or it should be said that ego death at least carries this potential (some people do not cope well with ego death, nor do they necessarily feel content with physical death after the experience).
Before a psychedelic ego death, people might have this intense fear of disappearing. It is the great unknown, after all. However, once they have an experience of ego death, they might come out of the experience feeling that it’s not so scary to dissolve. In fact, the experience is often accompanied by feelings of peace, contentment, bliss, ecstasy, joy, and euphoria. If you expect this kind of experience to precede physical death, then there is less reason to fear it. Instead, it is possible that psychedelics can make us more curious about what those final moments will be like.