Anxiety

Anxiety is presented not as an isolated symptom but as part of a knot of fear, depression, and repetitive thought that can tighten under the pressure of a terminal diagnosis. In the book’s account of psychedelic research, this state becomes both a human crisis and a clinical question: can a guided psilocybin experience alter a person’s relationship to fear, and might that change last beyond the session? The evidence described is promising but still under investigation; the proposed explanations range from spiritual meaning to changes in patterns of brain activity.

Anxiety in the face of death

At New York University, a trial examined whether a single high dose of psilocybin could ease the anxiety and depression that may follow a life-threatening cancer diagnosis. Patrick Mettes, a volunteer in the study, underwent a turbulent six-hour session guided by palliative care psychologist Tony Bossis. Bossis later recounted that Mettes had spent two hours in silence before beginning to cry softly and repeating that birth and death involved a great deal of work. The account gives anxiety a setting and a duration: it is not an abstract diagnostic label, but fear unfolding in a treatment room as a person confronts mortality.

Bossis’s work with dying patients made the question urgent for him. He argued that psychiatry has few tools for existential distress, the interwoven depression, anxiety, and fear that can accompany a terminal diagnosis, and that a conventional anti-anxiety medication is not necessarily an answer to this larger predicament. He saw the possibility that a more spiritual dimension of treatment might help change how a person faces death. His question was not simply whether a drug could suppress a symptom, but whether an experience could recalibrate the process of dying.

The clinicians’ early reports from the cancer trials suggested a change that exceeded their expectations. Stephen Ross said that he initially doubted whether some participants were reporting genuine experiences. Patients described encounters with cancer as a dark cloud, journeys into earlier parts of their lives, and new priorities; some who had been visibly afraid of death later lost that fear. Ross regarded the duration of an effect after one administration as unprecedented in psychiatry. These are clinicians’ observations, not proof that anxiety is reliably or permanently relieved, but they help explain why the researchers pursued the question.

Anxiety among related forms of distress

The book places anxiety alongside depression and addiction rather than treating each as a sealed category. Tom Insel, formerly head of the National Institute of Mental Health, argues that the diagnostic divisions do not fully represent how mental suffering works and that the conditions exist on a continuum. The account notes that depression and anxiety frequently accompany one another, as can depression and addiction. Their distinction can be understood through the direction of attention: depression dwells on past loss, while anxiety anticipates future loss. Both can involve rumination, with the mind caught in recurring patterns of thought.

David Kessler’s account of psychological suffering supplies another way to describe this recurrence. His term for a shared process across addiction, depression, anxiety, mania, and obsession is capture: learned patterns of thought and behavior seize attention and keep a person circling through self-reflection. On this view, anxiety is connected to more than an immediate fearful response. It can become part of a loop in which repeated reactions strengthen the pathways that make those reactions more likely to recur. The model does not erase differences among conditions; it directs attention to a possible common mechanism beneath them.

Rigidity, flexibility, and the brain

Robin Carhart-Harris’s entropic brain theory offers a neurological interpretation of why changing entrenched patterns might matter. In his account, depression, anxiety, obsession, and addictive cravings are associated with excessive order: mental pathways have become too fixed. Psychosis lies at the opposite end of the proposed spectrum, where entropy is excessive, a distinction that may help explain why psychedelic therapy is not expected to suit every condition. The theory therefore presents anxiety not as a lack of mental control, but as a possible consequence of patterns that have become too rigid.

Carhart-Harris proposes that psychedelics temporarily raise entropy in an inflexible brain, loosening its default patterns and making change more possible. He compares the process to annealing: energy enters a system and gives it enough flexibility to bend. Researchers at Johns Hopkins University use a related idea, describing a period of heightened plasticity in which guidance may help a person learn new patterns of thought and behavior. These accounts are explanatory models, not direct descriptions of the experience or settled proof of a mechanism.

Brain-imaging research gives the models an observable point of contact. Studies at Imperial College London, later replicated in other laboratories using psilocybin, LSD, and ayahuasca, found changes in the activity and connectivity of the default mode network during psychedelic states. The book presents those findings as a possible bridge between experienced mental suffering and measurable, potentially alterable brain activity—not as evidence that imaging has established a complete explanation of anxiety.

From trial results to a broader question

The clinical research initially focused on people with cancer in part because researchers thought it might be easier to obtain approval to study a controlled substance in patients who were already seriously ill or dying. In 2017, Roland Griffiths and Ross brought their trial results to the U.S. Food and Drug Administration seeking approval for a larger study of psilocybin for cancer patients. According to Ross’s account, FDA staff responded by urging the researchers to consider a broader trial for depression, interpreting the results as a signal that warranted further investigation. The agency declined to confirm or deny the reported meeting, and the exchange did not amount to an approval of treatment.

A similar expansion of the research question had occurred in Europe. In 2016, researchers approached the European Medicines Agency about psilocybin for anxiety and depression associated with life-changing diagnoses. Regulators noted that existential distress was not an official diagnostic category covered by national health services, but pointed toward a larger study of depression. Their response, as presented in the book, shows the tension between suffering as patients experience it and the diagnostic categories that determine what can be studied or reimbursed.

The account leaves anxiety at the intersection of these tensions: an immediate fear, a recurring pattern of thought, part of a wider continuum of distress, and a target of experimental treatment. Psilocybin research offers a possibility rather than a conclusion. Its significance lies in the questions it opens about whether a temporary change in consciousness can loosen rigid habits of attention and help people meet fear differently, especially when the fear is bound up with mortality.