Death anxiety

Death anxiety, as depicted in accounts of psilocybin treatment for people with cancer, is not simply fear of dying: it belongs to a broader distress involving depression, anxiety, and the struggle to find meaning under a terminal diagnosis. The trials at New York University and Johns Hopkins University explored whether one guided high-dose session could ease that burden. Their reported results suggest a striking possibility: an encounter with experiences that feel like surrender, death, or a reality beyond the self may make mortality less terrifying, even when the illness itself continues.

Existential distress and the treatment setting

For palliative care psychologist Tony Bossis, death anxiety belongs to a problem for which psychiatry has few tools. Medication alone, in his view, cannot answer the existential distress common among people facing a terminal diagnosis. The treatment question was therefore not only whether a drug could reduce symptoms, but whether a guided experience could help a person recalibrate how dying is understood.

The New York University trial brought that question into a hospital room designed to feel less clinical. A long couch, art books, mythology, native craft objects, a ceramic mushroom, a Buddha, and a crystal supplied the atmosphere of a private den. Yet the hospital remained visible in the fittings, ceiling tracks, and fluorescent-lit bathroom. This half-domestic, half-medical setting framed the sessions: patients were invited into an inward journey while remaining under the care of a clinical team.

The trial was directed by Bellevue psychiatrist Stephen Ross, with Bossis guiding sessions and Jeffrey Guss serving as a coinvestigator. Ross had entered psychiatry without personal experience of psychedelics and initially knew little of their history. Research into earlier treatment of alcohol dependence led him to a body of knowledge that had largely disappeared from psychiatric training by the time he began his residency in the 1990s. The cancer studies thus revived a line of inquiry interrupted when sanctioned psychedelic therapy ended in the 1970s.

The session as an encounter with mortality

Patrick Mettes’s experience gave the abstract question a specific human shape. A volunteer in the New York University cancer trial, he underwent a turbulent six-hour psilocybin journey on the couch in the treatment room. Bossis later recalled that after two hours of silence Mettes began to cry softly and spoke of birth and death as demanding labor. The moment did not remove the fact of his cancer; it marked a change in how he could encounter the terror surrounding it.

The clinicians described other patients returning from sessions with new priorities and a changed relation to death. Ross initially found the reports so difficult to believe that he suspected early volunteers were pretending. Patients described encountering cancer as a dark cloud, revisiting earlier periods of life, or recognizing love as a force of exceptional importance. Some who had been palpably afraid of death lost that fear. The sessions appeared to offer not a conventional argument against mortality, but an experience that could alter its emotional force.

Former Johns Hopkins psychologist Katherine MacLean framed a high-dose session as a rehearsal for death: the participant may feel that familiar reality is falling away, along with the ego and the body. For cancer patients, that temporary surrender could resemble the loss they fear, while also making room for an impression that something persists beyond ordinary bodily identity. A volunteer described a serene expanse of consciousness in which she felt alone yet able to reach anyone she had known, and concluded that the destination of her life after death seemed acceptable. Such reports are accounts of experience, not proof of an afterlife; their importance here lies in how directly they gave participants a way to imagine death.

Mettes after the journey

At a follow-up with Bossis several weeks later, Mettes interpreted the session as a possible opening onto an existence beyond the physical body and spoke of love as infinite. In later sessions, he described his body and cancer as a kind of illusion. The narrative records these as his interpretations, not as a clinical finding about what happens after death.

The changes reported in his daily life were more observable. Mettes meditated regularly, felt more able to live in the present, and said his love for his wife, Lisa Callaghan, had deepened. Two months after the journey, while he was slowly dying of cancer, Bossis noted that Mettes felt happier than he had before. The contrast is central to the account: the treatment did not reverse his illness, but the months that followed could nevertheless be experienced with less fear and greater connection.

Trial findings and their limits

When the New York University and Johns Hopkins University cancer studies were published together in December 2016, their results attracted broad attention from the mental health establishment. In both trials, about 80 percent of participants showed clinically significant reductions in standard measures of anxiety and depression, and those effects lasted at least six months after the session. The intensity of the mystical experience participants reported closely correlated with the degree to which their symptoms subsided. The association is notable, but it does not by itself establish why symptoms improved or prove that the experience caused the reduction.

The studies included only eighty subjects in total. Larger replications would be necessary before the government could consider rescheduling psilocybin and approving the treatment. Even with that limitation, the results encouraged calls for further research: medical schools sought to take part, funders offered support, and New York University shifted from having tolerated the work to promoting it. The treatment room was invited to move from the dental college into the main hospital, and the cancer center, previously reluctant to refer patients, sought a room for a future trial.

Meaning, belief, and the fear of extinction

The account does not reduce the reported benefit to a single explanation. Psychedelic suggestibility and the psychotherapists’ guidance may help shape the meanings patients find. Jeffrey Guss prepared volunteers to expect the possibility of learning about themselves and the meaning of life, while avoiding a fixed definition of what a mystical or transcendent experience had to be. The treatment therefore joined a pharmacological intervention to a setting in which patients were helped to interpret what they encountered.

For some, the result was spiritual; for others, including atheist participants, the experience could charge an apparently godless world with significance. A sense of connection to nature, universal love, or a wider context of existence could make the extinction of the individual self less difficult to contemplate. The underlying wager is that meaning need not depend on religious belief alone: widening one’s interests beyond the isolated self may soften the boundaries of ego and place a finite life within a larger whole.

Death anxiety remains tied to the reality of dying, and the trials do not show that a single session resolves it for every patient. They do show why researchers considered the possibility worth investigating: in small studies, many people facing cancer reported durable relief, and the intensity of mystical experience tracked closely with that relief. In this account, the journey’s significance lies not in defeating death, but in changing the terms on which a person can face it.