Embracing Life and Death Facing Terminal Cancer Diagnosis: Existential Themes in Psilocybin-Assisted Therapy

A groundbreaking study on psilocybin-assisted psychotherapy conducted with four cancer patients revealed profound existential insights experienced during their journeys. Participants reported powerful shifts in their perspectives on life and death, spiritual awakenings, and a renewed sense of purpose and connection. The study demonstrated how psilocybin can help patients confront mortality, release emotional burdens, and enhance their psychological well-being. However, these deep and often overwhelming experiences require thoughtful integration. For this reason, the guidance of an Existential Analysis (EA) psychotherapist—trained to address existential concerns such as meaning, death, freedom, and isolation—is helpful for patients to enhance the benefit from their psychedelic journey.

Themes of life and death as shared by four patients with cancer after psilocybin-assisted therapy.

The use of psychedelics in therapy is expanding as a promising approach for individuals confronting profound life challenges, including terminal illness. In a recent study exploring the experiences of four cancer patients undergoing psilocybin-assisted psychotherapy, several existential themes emerged. These themes—acceptance of death, spiritual transcendence, interconnectedness, and the search for meaning—underscore the transformative potential of such therapy.

However, the depth of these experiences often requires skilled integration. An Existential Analysis (EA) psychotherapist, trained to guide clients through existential concerns, can provide critical support in helping patients make sense of and sustain these transformative insights.

(Note: Aestra Retreats facilitators Zoe Ilic and Graham Nelson-Zutter are formally trained in Existential Analysis and Logotherapy, as taught by Alfried Längle, the successor of Viktor Frankl)

Confronting Mortality: Finding Peace while Facing Terminal Cancer Diagnosis

For many cancer patients, the fear of death looms large. Psilocybin-assisted therapy often dissolves this fear by providing direct encounters with existential realities. Tom, a participant with chronic myeloid leukemia, described a profound shift in his perspective:

"There is nothing to fear after you stop being in your body... it’s just nothing to be afraid of."

— Research participant Tom

Similarly, Brenda, a participant with colon cancer, experienced a moment of spiritual transcendence:

"I think this might be what people experience when they die."

— Research participant Brenda

These revelations align with existential themes of mortality and transcendence. EA psychotherapists are uniquely positioned to assist patients in integrating such insights. By exploring the meaning of life and death within a safe therapeutic space, patients can move from fear to acceptance, enriching their remaining life with purpose and presence.

Spiritual Connection and Transcendence Beyond Death

Psychedelic therapy often evokes a sense of connection to something greater than the self. Victor, a young man with lymphoma, expressed a deep spiritual awakening:

"I didn’t have a body... I was just like this soul, this entity."

— Research participant Victor

He continued, describing a new understanding of his identity and life journey:

"I saw this body for what it’s worth. I picked it, it’s mine... I think that acceptance has been liberating."

— Research participant Victor

This experience led Victor to a conviction in the existence of a spiritual realm, offering comfort and clarity. Similarly, Brenda described a profound sense of oneness:

"I was the cloud, I was everything... that was the theme throughout the whole [experience], that I was all this."

— Research participant Brenda

Existential Analysis emphasizes the importance of spiritual connectedness and authenticity. By exploring these themes in therapy, patients can ground their transcendent experiences in everyday life, fostering a deeper connection to themselves and others.

Interconnectedness and Human Connection

A recurring theme in the study was the heightened awareness of interconnectedness. Psilocybin journeys often dissolve the boundaries between self and others, enabling participants to feel deeply connected to humanity and the world around them. Chrissy, a participant with breast cancer, reflected:

"I felt like I could reach out to anybody and connect with them."

— Research participant Chrissy

Similarly, Tom described an overwhelming urge to share a message of unity and love:

"I felt the urge to let people know to stop silly things and that nothing matters but love."

— Research participant Tom

These experiences highlight the existential need for meaningful relationships. EA psychotherapists focus on helping clients cultivate authentic connections, emphasizing that love and relationships are essential components of a meaningful life.

Accepting the Nature of Life and Death

Several participants encountered powerful imagery that helped them accept the cyclical nature of life and death. Chrissy described visions that reflected the rise and fall of existence:

"I was seeing these kind of stone faces... that’s the nature of life. It rises and falls."

— Research participant Chrissy

This awareness of life’s impermanence helped Chrissy come to terms with her own mortality:

"This was where my life would be drained from me some day, and I would surrender willingly when my time came."

— Research participant Chrissy

Through Existential Analysis, patients can explore these themes of impermanence and surrender, allowing them to confront mortality with peace and acceptance. This process empowers patients to find greater meaning in their remaining time and to live more authentically.

Finding Contentment and Meaning

Ultimately, psilocybin-assisted therapy provided patients with a renewed sense of purpose and contentment. Brenda articulated this shift clearly:

"I feel more contented and happy about my place in the world... I feel like I’ve really connected with a spiritual side in myself."

— Research participant Brenda

These experiences exemplify the existential concept of "meaning-making." EA therapists support clients in translating profound moments of insight into actionable changes in their lives. By integrating their newfound sense of purpose, patients can enhance their quality of life, even in the face of terminal illness.

Connection with Joy

Even though the four participants were facing the likely prospect of death, they were also able to access the experience the vitality of joy. Psilocybin assisted therapy invites journeyers to encounter their existence from new perspectives. While facing death, the vibrance of life is also felt.

“I started not just hearing, but playing the music. My entire body was the musical instrument for every sound which was coming through my head.”

— Research participant Tom

The Need for Existential Integration

While the psilocybin journey itself offers immense potential for transformation, the integration phase is critical to ensure long-term benefits. Without proper guidance, patients may struggle to retain the insights gained during their experience. This is where Existential Analysis proves invaluable.

EA therapists are trained to help clients confront core existential concerns—death, freedom, isolation, and meaning. By providing a structured space for reflection, they assist patients in processing their experiences and grounding them in daily life. Through this integration, patients can cultivate a lasting sense of peace, connection, and purpose.

Conclusion

Psilocybin-assisted therapy opens a powerful door to healing for those facing existential crises, particularly individuals grappling with life-threatening illnesses. As illustrated by the experiences of the four cancer patients in this study, the therapy can foster acceptance of mortality, spiritual growth, and a deeper connection to life. However, these profound experiences require thoughtful integration to maximize their transformative potential.

Existential Analysis offers a compassionate and effective framework for this integration, helping patients make sense of their journeys and live more fully in the time they have left. Together, psilocybin therapy and EA can provide a path to healing that honours both the depths of suffering and the heights of human resilience.

(Note: Aestra Retreats facilitators Zoe Ilic and Graham Nelson-Zutter are formally trained in Existential Analysis and Logotherapy, as taught by Alfried Längle, the successor of Viktor Frankl)

Sources:

1. Belser, A. B., Agin-Liebes, G., Swift, T. C., Terrana, S., Devenot, N., Friedman, H. L., ... & Ross, S. (2017). Individual experiences in four cancer patients following psilocybin-assisted psychotherapy: A case series. Journal of Psychopharmacology, 31(12), 1476-1484 https://pmc.ncbi.nlm.nih.gov/articles/PMC5891594/.

2. Van Deurzen, E. (2012). Existential Counselling & Psychotherapy in Practice. London, UK: Sage Publications.

3. Multidisciplinary Association for Psychedelic Studies (MAPS). (2022). MDMA-assisted psychotherapy treatment manual. Retrieved from https://maps.org/research/mdma/