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Are near-death experiences just psychedelic trips?

Our brains might be flooded with the hallucinogen DMT as we die, leading to vivid dreams.

By Ross Pomeroy

  • Near-death experiences have been reported for thousands of years.
  • One possible explanation is that our brains are flooded with a hallucinogenic, DMT, as we approach the moment of death.
  • Researchers observed a spike of DMT in the brains of rats that suffered a cardiac arrest.

For many people, the thought of dying fills them with dread and trepidation. What will it feel like? Will I be scared? Does everything just go black? Assuaging some of those fears, emerging science suggests that the elderly, dying brain often grants us a comfortable demise. And it does this through dreaming.

Accounts across history describe meaningful dreams and visions that arrive at the closing of one’s life. All too often, these experiences are brushed aside as byproducts of brain-addled delirium or side effects of medication. But in 2014, researchers at Daemen College and at Hospice Buffalo asked 63 patients admitted to hospice care over a period of 18 months for their perspectives on any dreams or visions that they might be having. Participants described most of them as a source of personal comfort. In their dreams, hospice patients reported being in the presence of deceased loved ones, preparing themselves for a long journey, or seeing dead spouses, siblings, or parents waiting for them.

“[These dreams] bring about a sense of peace, a change in perspective or an acceptance of death, suggesting that medical professionals should recognize dreams and visions as a positive part of the dying process,” Emma Badgery wrote for Scientific American.

Are near-death experiences just psychedelic trips?

Following these dreams at the twilight of life are more vivid ones that could arrive at the moment of death, itself. Science points to our final moments being quite a mentally sensorial finale. For starters, there are the accounts of people who have been to the brink of death and back. Many of them report having wild visions, which have been termed “near-death experiences” (NDEs). Philosopher and psychiatrist Raymond Moody coined the phrase almost a half-century ago and discovered a few common elements of NDEs: a bright light, a sense of detachment from the body, feelings of security and warmth, and encounters with mystical beings. To religious people, this experience might seem like being welcomed into an afterlife, while nonreligious people might just enjoy the trip.

Likening NDEs to “trips” is actually a reasonable comparison. A highly-cited 2018 study provided participants with low doses of the hallucinogenic drug N,N-dimethyltryptamine (DMT) in a controlled setting, then asked them to describe their experience. Their descriptions were uncannily similar to collected descriptions of NDEs. We are now learning that there is a good reason for that.

It turns out that DMT is widely present in the mammalian brain. In 2019, researchers at the University of Michigan not only found the compound in various locations in rat brains, but they also discovered neurons with the two enzymes required to make it. Moreover, the neurons seem to produce DMT at levels comparable to those of other key neurotransmitters like dopamine, which drives pleasure, and serotonin, which stabilizes mood.

DMT has also been found in small amounts in human brain tissue and larger amounts in cerebrospinal fluid, a clear fluid that surrounds the brain and spinal cord. Is it possible that DMT floods the human brain at death, causing vivid dreams and NDEs?

The University of Michigan researchers witnessed this happen in rats. They directly measured brain levels of DMT as rats suffered cardiac arrest and saw the substance spike up to ten times above baseline levels, enough to trigger psychedelic effects. If a similar increase also occurs in humans, it might just account for NDEs and vivid dreaming near death. But a larger dose might be necessary in alert, healthy subjects.

According to lead scientist Jimo Borjigin, a molecular and integrative physiologist:

“During near-death states, the brain activity that supports non-essential activities, such as walking, is severely reduced. So far scientists have studied experiences when people are fully awake, when they have many other types of brain activity going on. So in order to have a psychedelic experience, you need high levels of DMT that rise above the other noise that our brain is generating. At the near-death state, the level of DMT needed to contribute to a near-death experience may not be at the same level as for normal people having a normal psychedelic experience.”

So just a small hit of brain-produced DMT could make our final minutes on Earth a psychedelic adventure.

Complete Article ↪HERE↩!

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Loyal dog and veteran pass away within hours of each other

A dog’s loyalty to its owner is unshakeable. Even during the toughest times, they will remain by their human’s side.

By iHeartDogs.com

Gunner, an 11-year-old lab, was an extremely loyal pooch.

He has never left Daniel Hove’s side. Everywhere his human went, he was there. They turned out to be hunting buddies and best friends, too.

When Daniel received his pancreatic cancer diagnosis, Gunner was with him.

Even though he was a big dog, he’d go to Daniel and the two would cuddle up together. They’d spend an entire day like that.

“They were best buddies till the end. They were hunting buddies, they went everywhere together,” Daniel’s daughter, Heather Nicoletti, said in an interview Kare 11.

The Air Force veteran and his dog were literally inseparable.

Eventually, though, Gunner fell ill.

This was a bit expected, as the family noticed how incredibly in sync the two were.Daniel’s daughter, Heather, shared that she and her family more or less based their expectations of her dad’s daily health off of his dog.

“My dad was unresponsive, the dog was unresponsive. So once we saw how the dog was doing–he wasn’t moving much anymore, not doing well– we knew, it was coming.”

One day, Gunner grew listless.

His arms began to swell and he fell more ill. At that point, Heather knew that it was time to say goodbye to her dad’s dog.

She called the clinic she used to work at. When she got there, they put her dad’s long-beloved dog to sleep. He was right there beside him as he passed.

Within just an hour and a half, Daniel was gone too.

Knowing what happened to Gunner, the family couldn’t help but feel that the loving veteran would be gone soon as well. They did everything together, after all.

“Gunner could not be without my dad. I think he chose to go with him,” Heather continued.

However, they didn’t expect them to pass away within such a short time of each other. Losing both of them within the span of 90 minutes dealt a heavy blow to the ones that Gunner and Daniel left behind.

The family was devastated.

It’s always so sad to say goodbye to someone close to your heart. For Heather, she took comfort in the fact that her father never really had to say goodbye to his devoted, loving, and loyal dog.

In a sense, his passing couldn’t have gone any better. He wouldn’t be making the trip to the afterlife alone. His best friend was now with him even into eternity.

Now, Daniel and Gunner get to be together forever, pain-free.

In that sense, at least, the family was able to spare them from the pain of saying goodbye to each other.

“I had said I don’t know what’s going to be more traumatic for him. To try to take him away to end–to put him to sleep– to end his suffering, or if you let him live through dad dying. I think either way it’s going to kill him. We knew they were going to go together. We just didn’t know it was going to be hours apart,” -Heather shared.

Complete Article ↪HERE↩!

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When the Death Certificate Omits the True Cause of Death

Having accurate death records saves lives.

By Jane E. Brody

A combination of journalistic curiosity and advancing years prompts me to read obituaries regularly. I routinely check for ages and causes of death that can help inform what I write about and how I live.

Increasingly, I’ve noted in published reports that people are often said to die of “complications of” some disease, rather than the disease itself.

For example, in an obituary published on Jan. 9 in The New York Times for Dwayne Hickman, who starred in the television sitcom “The Many Loves of Dobie Gillis,” a spokesman attributed his death at 87 to “complications of Parkinson’s disease.” And another, published two days earlier for Lani Guinier, a legal scholar and champion of voting rights, stated that she succumbed at 71 to “complications of Alzheimer’s disease.”

What, I wondered, does that mean? How is it recorded on death certificates? And does it result in accurate mortality statistics needed for assigning priorities for medical research and allocating resources?

I looked up the complications of Parkinson’s and Alzheimer’s diseases. Someone with Parkinson’s disease may have poor balance and die from a fall, for example, but Parkinson’s is actually the underlying cause of the death. Similarly, people with Alzheimer’s disease often have difficulty swallowing and may accidentally inhale food and develop a fatal pneumonia; such secondary infections are listed as the cause of death for as many as two-thirds of these patients.

The result can be seriously misleading information, said Dr. James Gill, the chief medical examiner for the state of Connecticut. While pneumonia may be the proximate cause of death, Alzheimer’s disease, which is why the patient developed pneumonia in the first place, is the “specific underlying cause that started the chain of events and should be listed as the cause of death,” he said.

In fact, one study from 2014 suggested that the real death rate from Alzheimer’s in 2010 may have been more about six times higher than the number of deaths reported to the Centers for Disease Control and Prevention. Likewise, if someone with Covid-19 develops pneumonia and dies, their death certificate might say that pneumonia was the cause of death, but in reality it was a coronavirus infection.

I asked Dr. Gill, who heads the College of American Pathologists Forensic Pathology Committee, why this matters. “In order to prevent deaths, we want to know what’s causing them, which influences medical practice and the awarding of research grants,” he said. “If many dementia deaths are hidden, the disease is not getting enough funding.”

More dramatically, Dr. Gill added, “Having accurate death certificates saves lives. It enables us to identify new and trending diseases and take appropriate action.” If someone is living or working in a building with a poorly installed or maintained furnace, for instance, they may be exposed to toxic levels of carbon monoxide that could eventually cause fatal cardiac and respiratory failure. The cause of death might be recorded as cardiac arrest, but in fact was a result of carbon monoxide poisoning, and the presence of the faulty appliance would likely be missed and could result in further casualties.

In a research review published in the magazine Today’s Geriatric Medicine, Dr. Emily Carter, a geriatrician affiliated with the Maine Medical Center, and co-authors noted that the data submitted on death certificates can affect families with regard to life insurance, estate settlement, genetic risk factors and finding closure. They estimate that major errors, like incorrect cause or manner of death, occur in 33 to 40 percent of death certificates that are completed at academic institutions like their own in the United States.

An analysis of death certificates at their own institution found that cardiac or respiratory arrest were incorrectly entered as the immediate cause of death on 11 of the 50 documents they reviewed. As Dr. Gill said, “Everyone who dies, dies of cardiopulmonary arrest. The critical question is: Why did this happen? Let’s say someone dies of a stomach hemorrhage. What caused it? Stomach cancer, an ulcer or what?”

There are many reasons for the high rate of inaccurate or incomplete death certificates, starting with the meager attention paid to the subject in medical school and the hectic pace in many medical settings. Speed is sometimes dictated by the need to release a body to a funeral home for burial or cremation.

The C.D.C. has estimated that 20 to 30 percent of death certificates, though not necessarily inaccurate, “have issues with completeness.” The agency stated that heavy workloads, insufficient information about a death or inadequate training can result in death certificates that are incomplete or inaccurate.

Furthermore, many deaths are certified by coroners, who are elected or appointed to their positions and may have bachelor’s degrees in forensic science, but are usually not doctors. They can be subject to political or family influence and may fail, for example, to list opioid overdose as a cause of death. Even when death certificates are completed by medical examiners, who are usually doctors, they may not be trained in forensic pathology and could miss the real cause of death. A death following a fall, for example, might have been accidental, or it could have resulted from an underlying disease or even homicide.

According to a blog post from Womble Bond Dickinson, a trans-Atlantic law firm with headquarters in London, “the death certificate may be critical in a lawsuit” to help determine “the nature of the death,” factors that contributed to it, when it occurred and illnesses that may have played a role.

If the death was the result of a medical illness, the death certificate is usually completed by the physician in charge, Dr. Carter and her colleagues wrote in their review. However, they emphasized, a medical examiner should certify all other causes, including deaths related to hip fracture which could have resulted from an accident, and deaths related to a history of malicious injury that could be a homicide.

Unfortunately, despite what you may see in films and on TV, autopsies today are performed less and less often. Families often have to pay for them out of pocket. Between the high cost of autopsies and the increasingly limited resources to do them, they have become a dying breed.

Families can often benefit from knowing the real cause of a relative’s or housemate’s death. Might there be a payout from life insurance? Is there a home problem, like a slippery floor, lack of grab bars in the bathroom or a faulty furnace, that needs correction? Is there an inherited medical condition that can be mitigated to avert further casualties? Could malpractice have caused or contributed to the death?

If a death certificate contains errors that warrant correction, the sooner that’s done the better. In New York State, the funeral firm or medical certifier can usually help with a correction request that’s made within six months of the death. Beyond six months, you would have to fill out an application for a correction.

Complete Article ↪HERE↩!

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Dignity therapy

— Making a patient’s last words count

Guided conversations with terminally ill people are popular with patients, families and doctors who’ve experienced them. But are they truly beneficial? Researchers are looking beneath the anecdotal appeal.

by Lola Butcher

In the mid-1990s, psychiatrist Harvey Max Chochinov and his colleagues were researching depression and anxiety in patients approaching the end of their lives when they became curious about this question: Why do some dying people wish for death and contemplate suicide while others, burdened with similar symptoms, experience serenity and a will to live right up to their last days?

Over the next decade, Chochinov’s team at the University of Manitoba in Canada developed a therapy designed to reduce depression, desire for death and suicidal thoughts at the end of life. Dignity therapy, as it is called, involves a guided conversation with a trained therapist to allow dying people to speak about the things that matter most to them.

“It is a conversation that we invite people into, to allow them to say the things they would want said before they are no longer in a position to be able to say it themselves,” Chochinov says.

Dignity therapy is little known to the general public but it has captivated end-of-life researchers around the world. Studies have yet to pin down exactly what benefits it confers, but research keeps confirming one thing: Patients, families and clinicians love it.

These end-of-life conversations are important, says Deborah Carr, a sociologist at Boston University who studies well-being in the last stages of life and explored the topic in the 2019Annual Review of Sociology.

A key need of people who know they are dying is tending to relationships with people who are important to them. This includes “being able to communicate their wishes to family and ensuring that their loved ones are able to say goodbye without regret,” she says.

And the closer we get to death, the more we need to understand what our lives have amounted to, says Kenneth J. Doka, senior vice president for grief programs for Hospice Foundation of America.

“As people reach the end of life, they want to look back and say, ‘My life counted. My life mattered. My life had value, had some importance,’ in whatever way they define it,” Doka says. “I think dignity therapy speaks to that need to find meaning in life and does it in a very structured and very successful way.”

A dignified ending

Chochinov’s search to understand why some people feel despair at the end of life while others do not led him to countries like Belgium, the Netherlands and Luxembourg, where euthanasia and assisted suicide have long been legal. There he learned that the most common reason people gave for seeking assisted suicide was loss of dignity.

To learn more, Chochinov and his colleagues asked 213 terminal cancer patients to rate their sense of dignity on a seven-point scale. Nearly half reported a loss of dignity to some degree, and 7.5 percent identified loss of dignity as a significant concern. Patients in this latter group were much more likely to report pain, desire for death, anxiety and depression than those who reported little or no loss of dignity.

Dignity at the end of life means different things to different people, but in interviews with 50 terminally ill patients, Chochinov and his colleagues found that one of the most common answers related to a dying person’s perception of how they were seen by others.

“Dignity is about being deserving of honour, respect or esteem,” Chochinov says. “Patients who felt a lost sense of dignity oftentimes perceived that others didn’t see them as somebody who had a continued sense of worth.”

Dignity therapy is tailored to enhance this sense of worth. In a session, a therapist — typically a clinician or social worker — carefully leads the patient through a series of nine questions (see graphic) that help a person express how their life has been worthwhile.

“It’s not like a recipe, that you can just read out these nine questions and then call it dignity therapy,” Chochinov says. “We train therapists so that we can help them guide people through a very organic kind of conversation.”

The session typically lasts around an hour. About half is spent gathering biographical highlights, and the other half focuses on what Chochinov calls the “more wisdom-laden” thoughts that the patient wants to share.

A few days later, the patient receives an edited draft for review. “There’s an ethos of immediacy — your words matter, you matter,” he says. “They can edit it and they can sign off on it to say, ‘That is what I want as part of my legacy.’”

But does it work?

Miguel Julião, a physician in Lisbon, Portugal, specialises in helping patients who have difficult symptoms, which is why he was asked one day a few years ago to see a patient suffering with unbearable pain.

“The minute I got into his room, he told me ‘I would like you to help me die soon,’” Julião says. “I told him, ‘I don’t agree with euthanasia and I don’t do it, but I would like to know about you as a person and what you are most proud of in your life.’”

In the next few minutes, Julião learned about the man’s pride in raising “two good human beings” and stories of their life as a family. And he received an invitation to return for more conversations, which continued until the man died a month later.

The encounter prompted Julião, who was pursuing his doctorate at the time, to pivot his research and focus squarely on dignity therapy. He has had lots of company. Chochinov estimates that nearly 100 peer-reviewed research papers, and at least four in-depth analyses — “systematic reviews” of the accumulated science — have been published so far, and more studies are ongoing. The largest study yet, of 560 patients treated at six sites across the country, is now being conducted by Diana Wilkie, a nursing professor at the University of Florida, and colleagues.

Wilkie also helped conduct the first systematic review, published in 2015, which came up with a conundrum. When all studies were viewed together, the evidence that dignity therapy reduced desire for death was lacking. “The findings have been mixed,” she says. “In the smaller studies, you see benefit sometimes and sometimes not; in the larger studies, not.”

The most definitive study— Chochinov’s original clinical trial, completed by 326 adults in Canada, the United States and Australia who were expected to live six months or less — found that the therapy did not mitigate “outright distress such as depression, desire for death or suicidality,” although it provided other benefits, including an improved quality of life and a change in how the patients’ family regarded and appreciated them. A few years later, however, Julião conducted a much smaller trial in Portugal in which dignity therapy did reduce demoralisation, desire for death, depression and anxiety.

Julião thinks that the different outcomes reflect differences in the patient groups: His study focused on people experiencing high levels of distress, while Chochinov’s did not. But Julião also notes that his study was small, with only 80 participants.

“We still need more evidence,” he says. “But, on the other hand, you see a high interest among clinicians, because they see it work in daily practice.”

Positive and negative results also may depend upon how studies measure “success.” Scott Irwin, a psychiatrist at Cedars-Sinai Cancer in Los Angeles, worked at a San Diego hospice that introduced dignity therapy in 2009.

“It was absolutely worthwhile — no question,” Irwin says. “Not only did the patients love it, but the nurses loved it and got to know their patients better. It was sort of a transformative experience for patients and the care team.”

Indeed, Wilkie’s literature review reported “overwhelming acceptability, rare for any medical intervention.” Patients seem to get something out of it, even if that “something” isn’t captured by measures like reduced desire for death. In one study of 100 terminally ill patients who received dignity therapy, 91 percent reported feeling satisfied or highly satisfied; in another, 93 percent gave high ratings of satisfaction.

In Portugal, family members of dying individuals have prompted Julião to develop new uses for the therapy. He and Chochinov first adapted the interview to be appropriate for adolescents. More recently, two individuals told Julião they regretted that their loved ones had died without receiving dignity therapy, prompting the researchers to create a posthumous therapy for surviving friends and family members.

In a study of this interview protocol for survivors, “we have wonderful, wonderful comments from people saying, ‘It’s like I’m here with him or with her,’” Julião says. Doing dignity therapy posthumously could be useful in helping families deal with bereavement, he says — an idea he’d like to test.

Barriers to use

But for all its appeal, few patients actually receive dignity therapy. Though the tool is well-known among clinicians and social workers who specialise in caring for seriously ill patients, it is not routinely available in the US, Doka says.

A primary barrier is time. The therapy session is designed to last just one hour, but in Irwin’s experience at the hospice, patients were often too tired or pain-ridden to get through the entire interview in one session. On average, a therapist met with a patient four times. And the interview then had to be edited by someone trained to create a concise narrative that is true to the patient’s perspective and sensitive in dealing with any comments that might be painful for loved ones to read.

Julião says he transcribes each patient’s interview himself and also edits it into the legacy document. The entire process typically takes about eight days; he suspects this is why he is one of only two people who provide dignity therapy in Portugal. He says he has enthusiastic responses from clinicians and social workers attending the lectures and workshops he has conducted since 2011. “But they don’t do it clinically because it’s hard for clinicians to dedicate so much time to this.”

Dignity therapy is most widely available in Winnipeg, its birthplace, where all clinicians at Cancer Care Manitoba, the organisation that provides cancer services in the province, have been trained in the protocol. If a patient expresses interest, or a clinician thinks a patient might be interested, a referral is made to one of the therapists, among them Chochinov.

“And then I see them, either in their hospital bed or more typically at their home,” he says.

A few months ago, he spent about an hour with a dying woman. She told him about her proudest accomplishments and shared some guidance for her loved ones.

A few days after he delivered a transcript of the conversation, the woman thanked him by email for their discussion and for the document that “will give my family something to treasure.”

“Dignity therapy is part of the bridge from here to there, from living my life fully to what remains at the end,” she wrote. “Thank you for helping me to tell this story.”

Complete Article ↪HERE↩!

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Should You Get a POLST?

These portable medical orders give the seriously ill more control over their care

by Larry Beresford

Blake Anderson, 64, lives with numerous medical conditions, including chronic back pain, the rheumatic disease ankylosing spondylitis, other autoimmune conditions affecting his tendons and nerves, and non-Hodgkin lymphoma, a lymphatic cancer. But although he is disabled and in pain, he says he deeply values life and has no wish to end his.

Residing in a board-and-care facility in Carlsbad, California, he has good friends and enjoys reading, conversation, learning new things and traveling the world via the Internet. But he also has a POLST form, signed by his doctor, spelling out the treatments he would not want to receive in the event of a medical crisis in which he could no longer speak for himself. Were his heart to stop beating, he would not want medical personnel to try to resuscitate him.

POLST is a medical form completed by a doctor, nurse practitioner or physician assistant in consultation with the patient. It allows people with serious or chronic illnesses or the frailties of age to spell out what kinds of medical care they would want to be given in potential future medical emergencies.

Unlike legal documents such as the more familiar living will or other advance directives, which can be completed by those in good health, POLST is for when a serious diagnosis is known to the patient. It is more likely to be recognized, read and honored by emergency responders who show up for that potential emergency, such as a heart attack, when someone calls 911.

And, POLST advocates say, it’s not just about saying no to interventions such as cardiopulmonary resuscitation (CPR). Some POLST documents may detail that the person does not want to go back to the hospital or be put on a ventilator. Other orders might note a trial period to see whether aggressive treatments would be successful. But patients can express their treatment preferences, including for doctors to “do everything” medically feasible to keep them alive, if that is what they wish. Ideally, the POLST form signed by the doctor is copied to the patient’s electronic health record and given to close family members and the patient’s named surrogate decision maker for health care decisions.

Bright pink (or green) forms

Anderson’s doctor, Karl Steinberg, M.D., a geriatrician and hospice/palliative medicine physician in Oceanside, California, who makes home visits for Scripps Health, visited him at home to talk about POLST. “When he found out that I would not want to be resuscitated, Dr. Steinberg told me about the bright pink form I could fill out and put up on my wall where it could clearly be seen,” Anderson says. “I didn’t know there was such a form until Dr. Steinberg told me. It took some worry out of [the medical situation] for me.”

Anderson says he feels he is doing well, all things considered. “I know there’s no cure for any of my diagnoses.” Were he to die of a sudden heart attack, he says, he would want to be left in peace. “In fact, I’d call POLST the ‘rest in peace’ form.”

Steinberg told Anderson that discussing goals for medical care is a routine part of his visits with older patients. “I’m a big proponent of POLST in my practice,” he says. But patients shouldn’t be shy about bringing it up to their doctors or talking about it with their families. CPR is not what it looks like on TV, Steinberg adds. “Most people with serious illness don’t survive even the initial procedure, much less get back to a condition of full, active life.” One analysis of over 433,000 Medicare beneficiaries 65 or older who underwent CPR in U.S. hospitals found the chances of surviving and being discharged were about 18 percent.

Honoring patients’ preferences

Devised in Oregon in the early 1990s by medical ethicists and clinicians who had discovered that patients’ preferences for care at the end of life were not being consistently honored, the typically brightly colored, letter-sized POLST form has since spread to most states (and to locations in more than 20 countries) in a variety of versions and names and stages of development.

It has become mainstream, at least among health professionals. The original name, “physician orders for life-sustaining treatment,” is sometimes replaced by “portable medical orders” or simply “POLST.” The National POLST office, which is leading efforts to standardize its dissemination and promote recommended national language for the states to follow, calls POLST a process and a conversation as well as a form.

POLST has a specific place in medical planning, adds Judy Thomas, CEO of the Coalition for Compassionate Care of California (CCCC), the home for implementing POLST in California. In recent years CCCC has worked to standardize POLST statewide, she says. “We also got it established in statute, which has helped to make health care providers more comfortable with it, knowing they were complying with the law.”

CCCC has also developed training for health care providers on how to have conversations about POLST with consumers and taught hundreds of people to go out and train others. POLST is becoming better known, and more people have seen it used for a loved one, Thomas says. California’s 2021–2022 budget included funds to develop a statewide electronic registry of POLST forms.

In Oregon, with its three decades of experience with POLST, nearly half the people who die of natural causes have a POLST form in that state’s electronic registry, password-protected and accessible to EMS personnel and emergency care physicians, says Susan W. Tolle, M.D., a professor of medicine and director of the Center for Ethics at Oregon Health & Science University in Portland.

“If we could encourage people to take a deep breath and step forward and say, ‘I really want to talk about this,’ it could trigger conversations in their families. COVID is one more reason why we need to talk about it now,” she says.

“It is a true gift if you can engage in advance care planning, which would help your loved ones feel they know what you would want in a crisis and that they are doing what you would have wanted,” Tolle explains. “They won’t have to wake up at 2 a.m. and wonder if they did the right thing.”

Complete Article ↪HERE↩!

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How The Brain Rewires Itself After Losing A Loved One

Neuroscientist Mary-Frances O’Connor explores what happens in the brain when you experience grief and why it’s a struggle to accept loss.

by Mary-Frances O’Connor

The following is an excerpt from The Grieving Brain: The Surprising Science of How We Learn from Love and Loss by Mary-Frances O’Connor.

Neuroscience is not necessarily the discipline that springs to mind when thinking of grief, and certainly, when my quest began, that was even less the case. Through my years of study and research, I eventually realized the brain has a problem to solve when a loved one has died. This is not a trivial problem. Losing our one-and-only overwhelms us, because we need our loved ones as much as we need food and water.

Fortunately, the brain is good at solving problems. In fact, the brain exists for precisely this function. After decades of research, I realized that the brain devotes lots of effort to mapping where our loved ones are while they are alive, so that we can find them when we need them. And the brain often prefers habits and predictions over new information. But it struggles to learn new information that cannot be ignored, like the absence of our loved one. Grieving requires the difficult task of throwing out the map we have used to navigate our lives together with our loved one and transforming our relationship with this person who has died. Grieving, or learning to live a meaningful life without our loved one, is ultimately a type of learning. Because learning is something we do our whole lives, seeing grieving as a type of learning may make it feel more familiar and understandable and give us the patience to allow this remarkable process to unfold.

When I talk to students or clinicians or even people sitting next to me on a plane, I find they have burning questions about grief. They ask: Is grief the same as depression? When people do not show their grief, is it because they are in denial? Is losing a child worse than losing a spouse? Then, very often, they ask me this type of question: I know someone whose mom/brother/best friend/husband died, and after six weeks/four months/eighteen months/ten years, they still feel grief. Is this normal?

After many years, it dawned on me that the assumptions behind people’s questions demonstrate that grief researchers have not been very successful at broadcasting what they have learned. That is what motivated me to write this book. I am steeped in what psychologist and grief researcher George Bonanno termed the new science of bereavement. The type of grief that I focus on in this book applies to those who have lost a spouse, a child, a best friend, or anyone with whom they are close. I also explore other losses, such as the loss of a job, or the pain we feel when a celebrity whom we admire greatly and have never met dies. I offer thoughts for those of us who are adjacent to someone who is grieving, to help us understand what is happening for them. This is not a book of practical advice, and yet many who have read it tell me they learned things they can apply to their own unique experience of loss.

The brain has always fascinated humanity, but new methods allow us to look inside that black box, and what we can see tantalizes us with possible answers to ancient questions. Having said that, I do not believe that a neuroscientific perspective on grief is any better than a sociological, a religious, or an anthropological one. I say that genuinely, despite devoting an entire career to the neurobiological lens. I believe our understanding of grief through a neurobiological lens can enhance our understanding, create a more holistic view of grief, and help us engage in new ways with the anguish and terror of what grief is like. Neuroscience is part of the conversation of our times. By understanding the myriad aspects of grief, by focusing in greater detail on how brain circuits, neurotransmitters, behaviors, and emotions are engaged during bereavement, we have an opportunity to empathize in a new way with those who are currently suffering. We can allow ourselves to feel grief, allow others to feel grief, and understand the experience of grieving—all with greater compassion and hope.

You may have noticed that I use the terms grief and grieving. Although you hear them used interchangeably, I make an important distinction between them. On the one hand, there is grief—the intense emotion that crashes over you like a wave, completely overwhelming, unable to be ignored. Grief is a moment that recurs over and over. However, these moments are distinct from what I call grieving, the word I use to refer to the process, not the moment, of grief. Grieving has a trajectory. Obviously, grief and grieving are related, which is why the two terms have been used interchangeably when describing our experience of loss. But there are key differences. You see, grief never ends, and it is a natural response to loss. You will experience pangs of grief over this specific person forever. You will have discrete moments that overwhelm you, even years after the death when you have restored your life to a meaningful, fulfilling experience. But, whereas you will feel the universally human emotion of grief forever, your grieving, your adaptation, changes the experience over time. The first one hundred times you have a wave of grief, you may think, I will never get through this, I cannot bear this. The one hundred and first time, you may think, I hate this, I don’t want this—but it is familiar, and I know I will get through this moment. Even if the feeling of grief is the same, your relationship to the feeling changes. Feeling grief years after your loss may make you doubt whether you have really adapted. If you think of the emotion and the process of adaptation as two different things, however, then it isn’t a problem that you experience grief even when you have been grieving for a long time.

You can think about our journey together through this book as a series of mysteries that we are solving, with part I organized around grief and part II organized around grieving. Each chapter tackles a particular question. Chapter 1 asks, Why is it so hard to understand that the person has died and is gone forever? Cognitive neuroscience helps me to address this question. Chapter 2 asks, Why does grief cause so many emotions—why do we feel such strong sadness, anger, blame, guilt, and yearning? Here I bring in the theory of attachment, including our neural attachment system. Chapter 3 builds on the answers in the first two chapters with a follow-up question: Why does it take so long to understand that our loved one is gone forever? I explain the multiple forms of knowledge that our brain holds simultaneously to think through this puzzle. By chapter 4, we have enough background to dig into a primary question: What happens in the brain during grief? However, to understand the answer to this question we also consider: How has our understanding of grief changed over the history of bereavement science? Chapter 5 looks with more nuance at why some people adapt better than others when they lose a loved one, and asks, What are the complications in complicated grief? Chapter 6 reflects on why it hurts so much when we lose this specific beloved person. This is a chapter about how love works, and how our brain enables the bonding that happens in relationships. Chapter 7 addresses what we can do when we are overwhelmed with grief. I rely on clinical psychology to delve into answers to this question.

In part II we turn to the topic of grieving, and how we might go about restoring a meaningful life. Chapter 8 asks, Why do we ruminate so much after we lose a loved one? Changing what we spend our time thinking about can change our neural connections and increase our chances of learning to live a meaningful life. Turning from focusing on the past, however, leads us to the question in chapter 9, Why would we engage in our life in the present moment, if it is full of grief? The response includes the idea that only in the present moment can we also experience joy and common humanity, and express love to our living loved ones. From the past and present, in chapter 10 we turn to the future and ask, How can our grief ever change, if the person will never return? Our brain is remarkable, enabling us to imagine an infinite number of future possibilities, if we harness this ability. Chapter 11 closes with what cognitive psychology can contribute to our understanding of grieving as a form of learning. Adopting the mindset that grieving is a form of learning, and that we are all always learning, may make the winding path of grieving more familiar and hopeful.

Think of this book as having three characters. The most important character is your brain, marvelous in its ability and enigmatic in its process. It’s the part of you that hears and sees what happens when your loved one dies and that wonders what to do next. Your brain is central to the story, built from centuries of evolution and hundreds of thousands of hours of your own personal experience with love and loss. The second character is bereavement science, a young field full of charismatic scientists and clinicians, as well as the false starts and exciting discoveries of any scientific endeavor. The third and final character is me, a griever and a scientist, because I want you to trust me as your guide. My own experiences of loss are not so unusual, but through my life’s work, I hope you may see through a new lens how your brain enables you to carry your loved one with you through the rest of your life.

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“Microdosing helped me come to terms with my own death”

Doctors don’t understand why I’m still here. I think the peace of mind psilocybin has given me is a huge part of it

By

Who: Andrea Bird, a 60-year-old artist and former art educator based in Caledon

Treatment: Psilocybin microdoses, one to three times a year

My husband, Daniel, and I ran an art school for years at the Alton Mill Arts Centre in Caledon. In 2012, I went for my first mammogram, and they found a large tumour in my right breast. I was diagnosed with Stage 2 cancer. I felt shocked and confused. I had surgery, followed by chemo, followed by radiation. That took about a year, and then I was told, “You’re cancer free. Go live your life.” And so I did.

About four years later, my cancer had metastasized to my bones and lungs, and last summer, it spread to my brain as well. I was diagnosed with Stage 4, which is terminal. My doctors and I were now talking about end-of-life plans. The estimated timeline is about two years, according to my husband’s research. I was not so keen to have a date floating around, so I left that part of the process to him. It was really challenging for me to wrap my brain around mortality, and I tried antidepressants but they didn’t help much. I had all this internal turmoil, thinking, How do I want to spend this time? I wanted my days with the people I love, in ways that were nourishing for all of us.

At the time, Daniel was reading Michael Pollan’s book, How to Change Your Mind, which is about how psychedelics can be used in therapeutic treatments for PTSD, addiction, trauma and end of life. I read the chapter on psilocybin and told my husband I wanted to try it. I had never done anything like this before and was always very cautious about those kinds of things, but I thought it might be helpful. Dying had pushed me to the edge of my capacity to cope.

I mentioned psilocybin to a friend, and they told me they knew someone who could help—a guide of sorts. It felt like the universe was aligning because I had no idea how to do it or how to access the drug. Everything fell into place extremely easily and I thought, Andrea, life is giving you the opportunity to try this. Do you have the courage to do it?

I had a lot of conversations about what to expect with my guide. They’re not a doctor, but they’ve researched psychedelic medicine and are extremely knowledgeable. I quickly realized that I was in good hands. They asked me, “What do you want to get out of this? What are your fears?” I hoped to come to terms with death and dying. I also wanted to know what I could let go of. Like preparing to climb a mountain, I wanted to lighten my load and only take what was essential.

I had my first trip in December of 2018. My guide boiled three and a half grams of mushrooms in hot water with lemon and ginger. I was sitting at home, and Daniel went out with our pets. The guide had Daniel’s phone number if they needed him. I sat in a reclining chair with eye shades and headphones, playing a psilocybin playlist on Spotify made by the team at Johns Hopkins University, a leader in psychedelic therapy research.

I started to feel the effects in half an hour, a full spectrum of emotions: gratitude toward Daniel, then sadness that I was dying, and then a deep realization of how fortunate I had been. It helped me to come to terms with my reality. I recognized that being sad and grieving for my life was not a problem. Because if I didn’t love life so much, then there wouldn’t be that sadness.

It also helped me to understand that life is a gift that we get to have for a little while, and then we have to give it back. On my first trip, my death showed up as a physical form in my mind’s eye. You know when you’re running a relay race and you’re carrying the baton, and your friend up ahead is waiting for you to pass the baton into their hand? Their hand is in the ready position, they’re crouched over with their arm outstretched behind them. That’s what death looked like. Death was the hand waiting for me to pass the baton to it, and the baton was my life. And death wasn’t in any hurry. But it was there. And it’s there for everybody. At some point, everybody has to part with their life. I don’t want to die. I don’t want to give up this beautiful life. I don’t want the people I love to have to grieve for me and all of that. But that’s just the nature of life. It’s not personal. This is how it is.

I did another trip a year later to see if there was anything else I needed to understand and I got this resounding message: You’ve got this. You’re as okay as you can be in this situation. The second trip confirmed the realization I was edging towards: death is not separate from life, deep despair and grief are not separate from wholehearted love and joy.

Since then I have microdosed off and on, under my guide’s advice. I would take tiny amounts, like one tenth of a gram, grind up the mushrooms, and put it on toast. There was no psychedelic effect at all. Rather, microdosing upped my capacity to deal with the emotional waves that were hitting me at that time.

Last summer, through TheraPsil, a Victoria-based advocacy group, I got an exemption from the federal government to take psilocybin legally. When I got the exemption, I felt such a relief. I know psychedelic therapy is all relatively new, but it feels like it’s overdue because it’s so effective. I haven’t microdosed for months now but it’s good to know it’s an option.

I want to help de-stigmatize and demystify some of the concern that comes with this drug and advocate for legalization. It’s possible to get an exemption, but why should dying people have to deal with yet another obstacle during this time when they’re doing everything they can to wrap their brain around dying? People should be made aware that psilocybin is an option, whether they choose to take it or not. And if they choose to, the process should be effortless for them.

Taking psilocybin was the most helpful thing I did in the last four years in coming to terms with my own death. I’m currently on a cancer regimen that involves a monthly injection, morphine for pain and all kinds of other drugs to treat the side effects of opiates. But I mostly feel like myself. I’m still in pain and get tired easily, but with the energy I have, I am painting, reading poetry, listening to music, dancing and visiting with dear friends. The doctors don’t understand why, four and a half years later, I’m still here, feeling as well as I do. Clearly the treatment plan I’m on is working. That’s part of it, but I think the peace of mind psilocybin has given me has been huge.

Complete Article ↪HERE↩!