4 ways that older people can bolster or improve their mental health

By Jelena Kecmanovic

Older people generally have fewer psychological problems than the rest of the population. They also have shown the least increase in anxiety and depression during the pandemic, despite being most vulnerable to covid-19.

Resilience among the elderly has been attributed to their ability to better regulate emotions, higher acceptance of the ups and downs of life, and wisdom that comes from having learned to see the big picture.

But old age brings many challenges that can harm mental health.

Even after she lost her second husband to cancer, she kept engaged by providing relationship coaching, gardening, walking her dogs, hiking and doing house repairs. “But when my left knee started giving me more and more trouble, so that eventually I could hardly walk, I felt really discouraged and depressed,” Landrum said.

Many older people do suffer from considerable mental health problems. Among those living outside group settings, the rate of clinically significant depressive symptoms is 8 to 16 percent and anxiety disorders is 10 to 15 percent. The elderly living in nursing homes fare worse. Most older adults with depression and anxiety do not receive treatment for it.

Late life depression, in turn, has been found by researchers to increase self-neglect, cardiovascular problems, morbidity, and risk of suicide. It also leads to worse social and cognitive functioning and compromised quality of life. And geriatric anxiety has been linked to heart problems and high blood pressure, among other problems.

Studies have illuminated some risk factors for geriatric depression and anxiety.

Elderly people who deal with significant physical problems or cognitive decline, who are lonely, or who are grieving or dealing with multiple losses are more likely to experience psychological problems, especially depression. So are older people who have a lot of regret about a life not well-lived and who struggle to find meaning in their lives.

Many existential concerns come to the forefront of people’s minds as they near the end of their lives.

They confront questions such as, “Have I led a meaningful life?” “What has my role been in this world?” or “Am I leaving something behind?” How people perceive, explore, process, and talk about these questions can affect their emotional well-being.

Here are four approaches that psychologists like me find can facilitate these explorations and consequently bolster or improve mental health.

Engage in life review

It is a truism that the older people get, the more they reminisce about the events that took place in the past, sometimes very long ago. Psychologically, there is a purpose to looking back.

One of the most influential psychologists of the 20th century, Erik Erikson, considered the last stage of life to be focused on reviewing life, integrating positive and negative memories, and coming away with a coherent sense of a purposeful life. He postulated that people who had a particularly hard time with this process could end up feeling despair.

“In my work with older patients, we often engage with the question, ‘What has it all been about?’ ” said Herbert Rappaport, a clinical psychologist in the Philadelphia area and the author of “Marking Time.” “It is powerful to help them construct their life stories and to witness how this leads to a sense of peace and acceptance of whatever comes next.”

Research shows that life review improves mental health.

But depressed individuals have a hard time recalling positive events or reflecting back on their lives in ways that are not negative and self-critical. They also tend to remember things in a more general, abstract way, without much detail.

A strategy that counteracts this tendency is to intentionally remember positive situations and times in your life, recalling as much concrete and sensory information as possible.

“I worked with an older woman in my practice who was worried about her daughter’s well-being once she’s gone, and she questioned if she’s done anything to help the next generation, and now it was too late,” said Jason M. Holland, a clinical psychologist in Gallatin, Tenn. “Writing about and discussing these feelings and reviewing her life in totality helped her realize that it’s not all negative and that she’s leaving an important legacy with her grandkid.”

Autobiographical writing or recording, storytelling, scrapbooking, making art that honors your life, family genealogy, oral history interviews, arranging old photographs and creating legacy projects are all ways that promote life review.

Consider sources of meaning

Much of popular psychology and self-help urges us to discover or create meaning in life. “I fear that this just adds more pressure for people, that this can become another reason to feel guilty and ashamed — ‘I’ve failed because I haven’t found the meaning of my life,’ ” said psychologist Joel Vos, author of “Meaning in Life: An Evidence-Based Handbook for Practitioners.”

He suggested that people engage instead with the meaningful activities that they are already doing.

In my own psychology practice, I have found that, during the pandemic, many people have gained more clarity about what really matters in their lives. This often centers on going beyond oneself: connecting with others, with the past and future, with God or spiritual concepts, or with nature. Another source of transcendence includes creating something in the world, from a tenderly tended garden to a painting to a nonprofit organization.

“It is never too late to orient yourself toward what’s meaningful. At 90 years old, I am a living example,” said Irvin Yalom, emeritus professor of psychiatry at Stanford University and the author of “Existential Psychotherapy” and “Staring at the Sun: Overcoming the Terror of Death.

“I still see some patients, but just for a session each because my memory and energy are not what they used to be,” he said. “I connect with my children and play chess and talk with friends. Human connections make life worth living.”

Accept limitations

A common misconception I hear is that acceptance equals passive resignation or giving up. It actually means the opposite; it’s an active process of facing the limitations that come with age, employing courage and wisdom.

“One of the best predictors of successful aging is the ability to disengage from unattainable goals,” said Carsten Wrosch, a psychology professor at Concordia University in Montreal. “While grit and perseverance might be most important for younger people, the elderly with the best psychological outcomes let go of things they can’t do any more and shift toward things they can still do that are purposeful.”

Older adults often struggle with physical or cognitive limitations, with a loss of freedom, and with the ability to control their lives. “Losing control can be the most demoralizing. I suggest adjusting your expectations and finding anything, however small, that you can control,” Holland said.

Dealing with the hardships commonly faced in old age can even be a catalyst for growth. Illness, grief or another negative change sometimes results in an important reckoning. “Significant transition or change can lead to an existential crisis, a chance to reevaluate life and to eventually align it more with your values,” Rappaport said.

Deal with death anxiety

With the coronavirus death toll of at least 750,000 in the United States, many people here have faced death more immediately and more acutely than at any point in recent history. And yet, many still find it hard to talk about death and dying, avoiding news that could trigger death anxiety.

“Numerous studies show that people who have high death anxiety suffer from psychological problems and disorders,” said Rachel Menzies, clinical psychology postdoctoral research fellow at the University of Sydney and a co-author of “Mortals: How the Fear of Death Shaped Human Society.” “In general, death anxiety subsides later in life. But for some elderly, it can be very high and contribute to their depression and anxiety.”

To confront death anxiety, Menzies suggests reading obituaries or watching shows that involve death and dying, especially if these had been previously avoided.

“Visit cemeteries, nursing homes, or funeral homes — anything that will bring you in contact with death,” she said. “That way death becomes a normal part of life.”

Another often evaded topic is a discussion of one’s will and end-of-life preferences and directives. Tackling this now could decrease your fear of death, and provide a sense of dignity and control. And it will be a gift to the ones you are leaving behind.

An exercise I often use with patients, derived from Acceptance and Commitment therapy, a type of therapy which helps people to live with purpose and to stop being hostages of their anxiety and depression — is to have someone imagine their funeral and write their own eulogy and tombstone inscription. This may sound ghoulish, but it not only tends to reduce death anxiety, but also crystallizes the values that are important to people and urges them to put them in place before it is too late.

“Life well lived is the best antidote to death anxiety,” Yalom said.

Complete Article HERE!

Serving neighbors, supporting families, standing witness

Hospice volunteer reflects on his work


Many people are uncomfortable talking about death. Juneau resident and retired biologist Carl Schrader isn’t one of them.

For the better part of the last decade, Schrader has supported people as they live out their final days in comfort as a hospice volunteer with Catholic Community Service. As a long-time volunteer, he stands at the ready to help patients and their families through the complex death and dying process.

Earlier this month, he was honored for his work as one of seven recipients of the Volunteer of the Year award given each year by the first lady of Alaska.

“I could really see a need out there. Not everybody is attracted to this type of work,” he said in a recent phone interview.

Schrader does many different things as part of his work, from delivering hospital beds to supporting caregivers, talking with people in their last days, and offering support to grieving family members.

“In our culture we tend to avoid thinking about death and dying. Most everyone likes seeing babies and kids, but the elderly and dying tend to be invisible. Our death is inevitable, but we all try to deny or at least ignore it,” he said.

Schrader said his Buddhist faith makes it easier for him to approach the idea of death and work as a hospice volunteer.

“My approach is to really face it. Don’t deny it. Don’t run away from it. As a Buddhist, you go to those places that scare you. The more you run away the more it chases you,” he said.

Serving neighbors

Schrader, who moved to Juneau from Seattle about 30 years ago, said that the work allows him to serve and care for his neighbors.

“One of the things that attracted me to Juneau is that it’s a community. I know my neighbors. Just by Juneau being semi-isolated, you get a sense of community here. I really feel it, and my volunteer work with hospice really encourages me. We take care of each other. We take care of each other because we are a community,” he said.

Schrader said that being around sick and dying people is difficult for many people, but that he has a greater level of comfort, and he’s learned to be comfortable with being uncomfortable.

“When I make a house visit, I take a few really deep breaths. Often you don’t know what you are getting into. I’m just there to be a caring human being,” he said.

Schrader said the process is liberating because it relieves him from worrying about himself or focusing on his nerves or feelings.

“I realize that I’m capable of being there for someone, just as a human being. I’m not put off by the apparent ugliness of the dying process. It’s an opportunity for me to practice compassion and support my neighbors in Juneau,” he said.

Though, he admits the work can be draining.

“It’s a very heavy time and can be very emotionally taxing sometimes to be in the presence of a dying person,” he said,

He credits a strong personal meditation practice and walks with his dog, Luna, with helping him to restore his emotional energy.

Supporting families

Schrader said that as he meets families during these stressful times, he’s witness to the best in people.

“People show their true compassion and it’s really beautiful,” he said.

Often, he answers questions about the process of dying.

“I explain that the body is shutting down and help people understand the stages of what’s happening,” he said.

Schrader said that explaining the death process to friends and family members makes it less upsetting for them.

“It really helps people,” he said.

Sometimes he helps family members process their stress about the situation. In other cases, he helps people deal with feelings about complicated family relationships.

Helping caregivers

Schrader said that a lot of his work goes to support caregivers.

“This is something that really surprised me when I got into this work,” he said.

Schrader explained that when a person is sent to hospice care, family members and close friends step in to help with day-to-day care with support from a team.

“It’s often a 24-hour a day job,” he said. “It’s one of the more challenging things.”

He said he helps by showing family members how to deal with straightforward, daily things like getting the patient to the bathroom or keeping their loved one clean. He also helps set up equipment and provides training to help families use it.

“Much of what I do as a volunteer is to support the caregiver. Being a caregiver is incredibly demanding both physically and emotionally. Often the caregiver is also elderly and may have physical limitations,” he said. “I look for anything I can do to be helpful. It’s often just simple things like changing light bulbs, taking out the trash, picking up medications, maybe walking the dog.”

Schrader said that he often offers to stay with the patient so family members can take a break and recharge.

“That’s when I get to spend quality time with people and get to know them. I get people to talk about their lives. I’m amazed at how amazing people are,” he said.

Standing witness

Schrader said that hospice patients often feel better after returning home.

“They are often quite perky and happy to be back at home. They get a lot better as soon as they come home,” he said.

He said the process of dying unleashes a wide range of emotions that can include fear and anger. He said that he’s there to stand as a witness and validate their feelings.

Some patients are eager to talk about their lives. Others have spiritual questions, he said.

“It’s really good to get them to talk about it. Some are very afraid of dying and it’s good to be as reassuring as possible,” Schrader said, noting that he listens and encourages people to share their religious perspectives with him.

Perspective on living

Schrader said that his hospice works give him a new appreciation for his life and helps him face his mortality, as he grows older.

“It makes me more appreciative of my life and what I have,” he said. “Someday, someone will deliver a hospital bed to my house,” he said.

He said that knowledge compels him and his wife, Sue, to live life fully.

“We better do what we can,” he said, adding that he enjoys being active outdoors.

“My end is not so theoretical anymore,” he said.

The team

Schrader said that the people at Catholic Community Service make his work possible.

“It’s a real team with great staff, he said. “The entire team is just wonderful, and people are just incredibly caring people. People are so thankful and so grateful.”

Jessica Kinville, Catholic Community Service volunteer coordinator, said that Schrader is an important part of the team.

“Carl is a great person. He approaches his work with a sort of gentleness and is always an active, sympathetic listener,” she told the Empire in a phone interview Friday afternoon.

“A lot of people have felt very supported by him. He’s someone I can always count on. He always puts his heart into his work,” she added.

Schrader said that Catholic Community Service offers many senior services, and they are always looking for more volunteers.

“Here I am as a Buddhist, working for the Catholics,” he laughed.

“They have the organization and offer a lot of wonderful senior services,” he said. “We are all part of a compassionate team. We want to do what we can for people.”

Volunteer of the Year

According to the governor’s office, the First Lady of Alaska Rose Dunleavy chose Schrader as a recipient of the Volunteer of the Year award.

“Carl embodies the true Alaskan spirit and shares it through his camaraderie and passion,” the release said. “Carl is a compassionate ear for those in physical and spiritual pain, a warm presence for grieving families, and always on standby to set up a hospital bed in a living room. Carl has maintained consistent availability day-after-day, year-after-year; he is calm and patient in work that is unpredictable and emotionally taxing.”

Schrader is humble about receiving the Volunteer of the Year Award.

“I’m really accepting on behalf of the hospice team. It really felt like a shout-out to the nursing staff. I’m privileged to be a part of the team. The award really acknowledges the entire program,” he said.

Schrader was honored for his work at a ceremonial luncheon in Anchorage earlier this month.

“The reception was really good,” Schrader said. “It was nice to drop all the politics and just be there as people. We are all just people.”

Volunteers welcome

Schrader said several volunteer opportunities are available through Catholic Community Service, including Friends of Seniors, which helps senior citizens with basic needs like shopping and dog walking.

The 11 qualities of a good death

Opening up about death can make it easier for ourselves and our loved ones.

By Jordan Rosenfeld

Nearly nine years ago, I received a call from my stepmother summoning me to my grandmother’s house. At 92 years old, my Oma had lost most of her sight and hearing, and with it the joy she took in reading and listening to music. She spent most of her time in a wheelchair because small strokes had left her prone to falling, and she was never comfortable in bed. Now she had told her caregiver that she was “ready to die,” and our family believed she meant it.

I made it to my grandmother in time to spend an entire day at her bedside, along with other members of our family. We told her she was free to go, and she quietly slipped away that night. It was, I thought, a good death. But beyond that experience, I haven’t had much insight into what it would look like to make peace with the end of one’s life.

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:

  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous “other” category (cultural specifics, having pets nearby, health care costs, etc.)

In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones—and for our own.

Choosing the way we die

Americans don’t like to talk about death. But having tough conversations about end-of-life care well in advance can help dying people cope later on, according to Emily Meier, lead author of the study and a psychologist who worked in palliative care at the University of California San Diego’s Morres Cancer Center. Her research suggests that people who put their wishes in writing and talk to their loved ones about how they want to die can retain some sense of agency in the face of the inevitable, and even find meaning in the dying process.

Natasha Billawala, a writer in Los Angeles, had many conversations with her mother before she passed away from complications of the neurodegenerative disease ALS (amytropic lateral sclerosis) in December 2015. Both of her parents had put their advanced directives into writing years before their deaths, noting procedures they did and didn’t want and what kinds of decisions their children could make on their behalf. “When the end came it was immensely helpful to know what she wanted,” Billawala says.

When asked if her mother had a “good death,” according to the UCSD study’s criteria, Billawalla says, “Yes and no. It’s complicated because she didn’t want to go. Because she lost the ability to swallow, the opportunity to make the last decision was taken from her.” Her mother might have been able to make more choices about how she died if her loss of functions had not hastened her demise. And yet Billawalla calls witnessing her mother’s death “a gift,” because “there was so much love and a focus on her that was beautiful, that I can carry with me forever.”

Pain-free status

Dying can take a long time—which sometimes means that patients opt for pain medication or removing life-support systems in order to ease suffering. Billawala’s mother spent her final days on morphine to keep her comfortable. My Oma, too, had opiate pain relief for chronic pain.

Her death wasn’t exactly easy. At the end of her life, her lungs were working hard, her limbs twitching, her eyes rolling behind lids like an active dreamer. But I do think it’s safe to say that she was as comfortable as she could possibly be—far more so than if she’d been rushed to the hospital and hooked up to machines. It’s no surprise that many people, at the end, eschew interventions and simply wish to go in peace.

Emotional well-being

Author and physician Atul Gwande summarizes well-being as “the reasons one wishes to be alive” in his recent book Being Mortal. This may involve simple pleasures like going to the symphony, taking vigorous hikes or reading books He adds: “Whenever serious sickness or injury strikes and your body or mind breaks down … What are the trade-offs you are willing to make and not willing to make?”

Kriss Kevorkian, an expert in grief, death and dying, encourages those she educates to write advance directives with the following question in mind: “What do you want your quality of life to be?”

The hospital setting alone can create anxiety or negative feelings in an ill or dying person, so Kevorkian suggests family members try to create a familiar ambience through music, favorite scents, or conversation, among other options, or consider whether it’s better to bring the dying person home instead. Billawalla says that the most important thing to her mother was to have her children with her at the end. For many dying people, having family around can provide a sense of peace.

Opening up about death and dying

People who openly talk about death when they are in good health have a greater chance of facing their own deaths with equanimity. To that end, Meier is a fan of death cafés, which have sprung up around the nation. These informal discussion groups aim to help people get more comfortable talking about dying, normalizing such discussions over tea or cake. It’s a platform where people can chat about everything from the afterlife (or lack thereof) to cremation to mourning rituals.

Doctors and nurses must also confront their own resistance to openly discussing death, according to Dilip Jeste, a coauthor of the study and geriatric psychiatrist with the University of California San Diego Stein Institute for Research on Aging. “As physicians we are taught to think about how to prolong life,” he says. That’s why death becomes [seen as] a failure on our part.” While doctors overwhelmingly believe in the importance of end-of-life conversations, a recent US poll found that nearly half (46%) of doctors and specialists feel unsure about how to broach the subject with their own patients. Perhaps, in coming to a better understanding of what a good death looks like, both doctors and laypeople will be better prepared to help people through this final, natural transition.

Complete Article HERE!

More people are dying at home, but the quality of their deaths matters most

Did they receive care and compassion from loved ones or did they die alone, fearful of getting infected in hospital?

By and

From the start of the pandemic to 24 September 2021, deaths at home in England and Wales have been 37% higher than the 2015-2019 average, according to the Office for National Statistics.

For every three people who used to die at home, four now do. That’s more than 71,000 “excess” deaths, only 8,500 of which involved Covid. Even as mortality elsewhere fell back to past levels, dying in private homes has persistently remained above average. A natural question arises: are these “extra” deaths or a shift from other locations?

Fortunately, National Records of Scotland publishes excess death calculations by location and major causes of death. Its most recent data shows the leading causes of death were cancer, heart disease and stroke. In 2021, the combined total for these causes was only about 1% above the 2015-2019 average, with around 260 extra deaths. However, deaths from these causes at home were 36% higher than recent years, with a corresponding decrease in care homes and hospitals. These additional deaths at home were not “extra”, but resulted from a major, systematic change in where people were dying.

So what’s the reason for this change and, perhaps more importantly, what was the quality of these deaths? How many were free of pain and experienced intimate care and compassion from loved ones and how many have died at home alone, fearful of getting infected in hospital? Existing statistics struggle to answer these important questions.

NHS England has sought to “personalise” end-of-life care in its long-term plan. Reported statistics from surveys and patient records about where people wish to die can exclude “missing” responses, such as when no preference is forthcoming. It is unclear if the shift towards dying at home is, on balance, a positive or negative development.

Every family has to deal with a death and live with its aftermath. In the words of Sam Royston, director of policy and research at Marie Curie: “It is critical that we ensure that those who die at home have all of the support and assistance they need for the best possible death.”

Complete Article HERE!

Death and psychedelics

— How science is reviving this ancient connection


In November 1963, the writer and psychedelic explorer Aldous Huxley laid in bed, unable to speak. He was dying of cancer. One of his final acts was to pass a handwritten note to his wife Laura. 

His famous last words: “LSD, 100 µg, intramuscular.”

It was Huxley’s dying wish: a large dose of acid, please. Laura Huxley fulfilled the request twice during her husband’s final hours.

First synthesized 25 years before Huxley’s death, LSD was still legal in 1963. Scientists were studying it as a potential treatment for alcoholism and other ailments, as well as investigating its similarity to other psychedelics. It wasn’t until 1968 that the federal government outlawed these drugs due to their association with the cultural turbulence of the 1960s.

Today, several decades later, terminal cancer patients are once again taking psychedelics. This time around the drugs are being administered by doctors and scientists in controlled settings—and they are not microdoses. The results of this research have been nothing short of remarkable.

Laura Archera Huxley, 40-year-old musician and filmmaker, and husband Aldous Huxley, 61-year-old British novelist, pictured at their Hollywood home in Hollywood in 1956. On his deathbed seven years later, Huxley asked his wife for a massive dose of LSD.

Alleviating anxiety and despair

Terminal patients often suffer from feelings of intense anxiety and despair after receiving their diagnoses. For many, this is just too much to bear. The overall suicide risk for these patients is double or more compared to the general population, with suicide typically occurring in the first year after diagnosis.

Terminal patients have twice the suicide risk of the general public. Psychedelics may help reduce their fear and suffering.

That’s where psychedelic therapy may help. After a single large dose of psilocybin, taken in a curated space and supervised by a pair of doctors, many patients report feeling reborn. It’s not that the underlying physical disease has been cured. Rather, the drug prompts a shift in the theme of their emotional self-narrative—from anxiety and despair to acceptance and gratitude.

It may seem curious to think about psychedelic drugs, often associated with hippies and the Grateful Dead, as clinical-grade tools for overcoming our primordial aversion to death. But maybe it shouldn’t be. Maybe this is only surprising if your window of historical perspective is too narrow. Maybe these “novel findings” are, in a sense, a return to somewhere we’ve been before.

Psychedelics at the dawn of civilization

In late 2020 I spoke to Brian Muraresku, author of The Immortality Key: The Secret History of the Religion With No Name, about the use of psychoactive plant medicine throughout antiquity. Our podcast conversation covers this history in more detail, but it’s clear that humanity’s relationship with psychoactive plants extends back at least to ancient Greece—if not further. It’s hard to look at prehistoric cave paintings like the Tassili mushroom figure and not wonder if psychedelics played a part in their creation.

Western philosophy may have developed with help from psychedelics as well. In Plato’s well-known allegory of the cave, a group of prisoners live chained to a cave wall, seeing nothing but the shadows of objects projected onto it by fire. The shadows are their reality; they know nothing outside of it. Philosophers, Plato states, are like prisoners freed from the cave. They know the shadows are mere reflections, and they aim to understand deeper levels of reality.

Plato’s philosophical ideas might have been influenced by psychedelic experiences.

Was Plato tripping?

If that sounds like someone who’s explored those deeper levels with psychedelic assistance…well, maybe it was. In his book, Brian Muraresku explores the significance of the Eleusinian Mysteries, secret ceremonies that involved death and rebirth. For centuries, philosophers and mystics traveled to the Greek town of Eleusis to partake in a ritual that involved an elixir known as pharmakon athanasias, “the drug of immortality.”

“Within the toolkit of the archaic techniques of ecstasy–plant medicine just being one among many–something you find again and again, in Ancient Greece and other traditional societies, is this sense that to ‘die’ in this lifetime, or achieve a sense of timelessness in the here and now, is the real trick.” -Brian Muraresku

Contemporary archaeologists, digging outside Eleusis, have unearthed ancient chalices containing a residue of beer and Ergotized grain. Ergot is a fungus that grows on grain. It produces alkaloids similar to LSD. It’s possible, then, that influential thinkers like Plato were inspired by genuine psychedelic experiences.

This connection between psychedelics and death didn’t end with Eleusis. It survived, often repressed and hidden from view, right through the time of Aldous Huxley.

The connection re-emerges in the 1960s

In the 1960s, Timothy Leary co-wrote a book called The Psychedelic Experience: A manual based on the Tibetan Book of the Dead. Leary, the exiled Harvard professor and psychedelic guru, dedicated the book, “with profound admiration and gratitude,” to Aldous Huxley. It opens with a passage from The Doors of Perception, Huxley’s essay on the psychedelic experience. Huxley is asked if he can fix his attention on what the Tibetan Book of the Dead calls the Clear Light. He answers yes, “but only if there were somebody there to tell me about the Clear Light.”

It couldn’t be done alone. That’s the point of the Tibetan ritual, he says: You need “somebody sitting there all the time telling you what’s what.”

Huxley was describing a trip sitter, someone who guides a person along their psychedelic journey. Sometimes it’s an ayauasquero in the heart of the Amazon. Sometimes it’s a doctor holding your hand in a hospital.

Timothy Leary, shown at home in California in 1979, was deeply influenced by Huxley’s work.

Seeking rebirth within the mind

In his book, Leary grounded Eastern spiritual concepts in the understanding of neurology we had at the time. The states of consciousness achieved by meditation masters and those induced by three hits of Orange Sunshine, he wrote, may actually be the same. Both involve dissolving the ego (“death”) and allowing it to recrystallize as the default mode of consciousness returns (“rebirth”). 

Leary wasn’t talking about magic. Scientists know these as “non-ordinary brain states,” inducible by rigorous attentional practice (meditation), pharmacological intervention (psychedelics), and organic decay (dying).

The ability of psychedelics to induce these remarkable brain states may also be why they’re showing such promise in alleviating the very ordinary fear of death.

Today’s psychedelic treatments: Coping with death

So what, exactly, has recent research on psilocybin as an end-of-life anxiety treatment involved?

A few small studies have seen psilocybin administered to dozens of cancer patients. They’ve been conducted in a randomized, double-blind, placebo-controlled fashion. In general, a large majority of patients showed sustained, clinically significant reductions in measures of psychosocial stress and increased levels of overall well-being.

For example, in one study, 80% of the patients found that a single dose of psilocybin quickly relieved their distress. Remarkably, in some patients that positive effect lasted for more than six months.

Sprouting new physical connections

What’s going on at the neuronal level to produce those changes? We don’t know for sure, but some preclinical research has given us a hint. Both psilocybin and LSD have been shown to induce rapid and lasting antidepressant effects in lab animals.

Early studies hint at how psychedelics may produce positive changes in the brain.

Early indications are that psychedelics may allow brain circuits to rapidly sprout new physical connections. This is exciting, but again: These are non-human studies, and it’s early.

It’s gratifying to see any of these studies happening, frankly. This is research that’s been stalled by the Schedule I status of psychedelics for half a century. Much of this work requires obtaining a special federal waiver to study banned substances, which slows progress.

Potential help for end-of-life patients

Fortunately, the FDA recently designated psilocybin therapy as a “breakthrough therapy” and the DEA has proposed increasing the supply of psilocybin for research. This should speed up the rate at which we understand the clinical efficacy of psilocybin and related psychedelics.

Here’s more good news: In terms of psilocybin’s efficacy as a treatment for end-of-life anxiety, larger human trials are already underway.

Dr. Stephen Ross, one of the field’s leading researchers, has described the significance of this work: “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”

Huxley: Ahead of his time

In one sense, Aldous Huxley was ahead of his time. More than a half-century before today’s renaissance in psychedelic research, his own experiences had evidently brought him to the conclusion that the best way to experience death was in a psychedelic trance.

In another sense, though, Huxley was one in a long line of creators stretching back to ancient Greek philosophers and perhaps even to prehistoric cave artists. They may all have used psychedelics to catalyze their outward creativity and comfort their inner distress.

Huxley titled his famous introspective essay, The Doors of Perception, after a quote from the English poet, William Blake: “If the doors of perception were cleansed everything would appear to [us] as it is, infinite.”

We will never know what he experienced in the final hours before his death, after handing that note to his wife. I like to think that for him, the last breath seemed to last forever.

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A woman on TikTok wasn’t afraid to show her death.

In the process, she helped others live.

By Alia E. Dastagir

In a TikTok video on August 25th, Kassidy Pierson, who had been using the platform to document her life with terminal cancer, told followers she was hopeful it would be a good day. She spent the previous one nauseous, sweating and lethargic. But she was better on this day, and remarked how lovely the weather felt, and how she wished others could feel it, too. She told her followers she wouldn’t be posting every day. That wasn’t realistic anymore, she said.

The video was Pierson’s last. On September 9th, Pierson’s older sister Kasey Metzger posted from her account telling her more than 200,000 followers that the 27-year-old had died.

“I can’t tell you the amount of times that she would just break down crying because she couldn’t believe how many people just loved her from this platform,” Metzger said. “Thank you so much for all that you’ve done for her.”

Pierson, who was diagnosed with melanoma six years ago, used her popularity to raise awareness about skin cancer, but her earnestness, quirkiness and vulnerability made her account more than advocacy. Pierson, whose username was @ohhkayypee, offered a window into what it looks like to die – the grief and regret, the insistence that life isn’t over until it is.

She posted intimate videos – of the tumors protruding from her small frame, on her decision to enter hospice, on how she talked to her son Hunter, 8, about the inevitability ahead. In the process, she developed a captive community that watched with curiosity and awe as she lived the final days of her life.

“We need to know our life matters and we want our life, our death and our grief witnessed,” said David Kessler, grief expert and author of “Finding Meaning: The Sixth Stage of Grief.” “Our worst fear is dying alone. We always wanted someone at our bedside – to know someone will be there. … What’s new is the Internet.”

People want to be seen – in life and in death. The short-form video app TikTok offers users an unexpectedly intimate space to navigate and narrate experiences with terminal illness, which grief experts say offers myriad benefits to people on both sides of the screen. The hashtag #terminalillness has nearly 40 million views on the app.

The person posting acquires social connection, which science shows may allow them to live longer. And the audience is encouraged to confront existential fears, to develop empathy, and even to reflect on how best to live – in the face of imminent death and especially absent it.

‘We don’t really address death very directly’

People grapple with death’s unknowns in a number of ways, made all the more difficult by Western cultures that sanitize death or hide it, said Pamela Rutledge, an expert on the psychological and social impact of media and technology. The invisibility of death exacerbates fear.

A century ago, Kessler said, death was visible. Grandchildren watched their grandparents die at home. When he was a boy, Kessler remembers being on his way to school and seeing hearses on the street.

“Now the dead move around our cities in white unmarked vans,” he said. “If you want to see death now, you’ve got to see it in a movie or online or on a TV show.”

Like Pierson, many TikTok accounts are offering a raw look at dying, the way its nearness clarifies the preciousness of life. Many encourage followers to take care of their health. Some accounts are intimate, others more humorous.

User @solelenaq& ;shared her perspective on appreciating each day: “If I don’t make it I just want to say, ‘live your life.'” User @kora_the_herbivora shared a video of how overwhelmed she became by something that before her cancer diagnosis may have gone unmarked – the sensation of warm sun on her skin. User @pheovsfabulous posted a video about how she spent her life’s savings when she was given a year to live, only to outlive the prognosis.

Pierson’s mother, TK Dunn, said she’s glad her daughter uncloaked her own experience with death, especially how ambigious it can be. Pierson never really knew how much time she had left.

“There was this roller coaster of, ‘Am I going to die now? What does that mean? Who do I turn to?'” Dunn said. “Our culture doesn’t normalize conversations about death. Death happens. We act like it doesn’t. If we can start demystifying it, maybe these events wouldn’t be so jarring or traumatic.”

‘One of the biggest ways people matter is through personal connection’

The Internet may be making death visible again, but it also offers something to the dying – the ability to connect. To matter widely.

“One of the biggest ways people matter is through personal connection,” Rutledge said.

Research shows people with strong social connections may live longer, healthier lives. Conversely, people who are isolated face a 50% greater risk of early death.

“The ability to connect with people – to have that level of feedback and that level of support can be very positive emotionally,” Rutledge said.

The desire for connection goes both ways. Pierson’s audience was likely captivated because they craved connection, too, Rutledge said. And Pierson gave them that – often telling followers how grateful she was for their support, how much they meant to her.

“If the person who’s going through this, the person who’s dying, is thanking you for your attention and your participation in their journey, then you’re establishing … a parasocial connection in the sense that these people don’t know each other but become emotionally invested, just like you would with any narrative.”

These narratives also offer people fearful of death an alternative to the most terrifying story they tell themselves about how they would cope. Everyone makes up stories, consciously or not, about what they might do when death is close.

“You wonder how you would deal with your erasure,” Rutledge said.

‘It psychologically feels like it prepares us’

Kessler said he believes every fear we have connects back to a fear of death. But that fear isn’t productive. Fear doesn’t stop death, he said. It stops life.

Accounts documenting terminal illness allow people to confront their fears. To go to the edge in a safe, observing way.

“It psychologically feels like it prepares us, or it lets us know when our worst fear happens, we might be OK, too,” he said.

In the final weeks of Pierson’s life, she had family time, wrote in journals to her son, did a ride-along with the police department and sat in a private jet. She reminded her followers not to “be stupid” and to get their skin checked. She cheered on thwho heeded her advice.

“I would like to take you guys as far as I can on this journey with me. I’d like you guys to all see it and experience it and learn,” she said in a video on August 11th. “You’re not alone. … We’re doing this together.”

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