[Paleopsych] NYT: Rave On, and Out: Going High Into That Good Night

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Rave On, and Out: Going High Into That Good Night
NYT January 16, 2005
By BENEDICT CAREY

IF there's a drug for social phobia, maybe there could be
one to help us relax in the company of death.

Last month, the Food and Drug Administration gave the
go-ahead to a Harvard University plan to study the
recreational drug "ecstasy" as a treatment for anxiety in
terminal cancer patients. Elsewhere, researchers in
California are studying the effect of psilocybin - the
active ingredient in hallucinogenic mushrooms - in similar
patients. Both teams hope to learn whether the drugs, which
can induce effusiveness and heightened awareness, will help
people express and manage their fears in a therapeutic
setting.

Although these illegal drugs are controversial, their use
is a natural outgrowth of the medicalization of all
emotional difficulty, from childhood shyness to adult
phobias and depression. Doctors already prescribe
antidepressants widely to dying patients, as well as
anti-anxiety medications, like Valium, which can be
emotionally numbing.

The possibility of using potent consciousness-altering
agents raises a question: At what point do the theological,
cultural and personal significance of mortality become
altered, or lost? Does going high into that good night risk
mocking end-of-life customs - prompting rave flashbacks
rather than life review, rude jokes rather than amends?

"I see death not only as an opportunity to reflect on the
meaning of your own existence, but to offer your life as a
gift to others," said the Rev. Donald Moore, a professor of
theology at Fordham University. The end presents us with a
time to ponder - and discuss, if possible - what life has
meant and might continue to mean for others. Any drug that
interferes with that experience comes at a steep cost, he
said.

"If I never ponder these things," Father Moore said, "if I
never face up to these questions intellectually, if I'm so
spaced out it doesn't make any difference, then I think the
experience is pretty empty and meaningless. In death we can
become more a part of others' lives, and if I have decided
simply to escape, I may have missed that opportunity."

>From the sixth-century politician Boethius, who turned to
philosophy for consolation at the end, to Mozart, who
plunged into his requiem Mass, history is filled with
examples of those who faced the unknown unaided, and
apparently shared in some universal reckoning with their
purpose.

But there is no philosophical or psychological reason why
existential questions should wait to the end of life. Death
itself hardly respects concerns about meaning or timing. It
strikes friends and loved ones often without warning.
Moreover, it casts a deepening psychological shadow
starting in middle age, which gives most people ample
opportunity to contemplate the purpose and content of their
lives simply by virtue of living to adulthood,
psychologists say.

If a drug taken at the end can help them simply reflect on
the pleasure of having lived, that in itself might provide
comfort and meaning to those left behind, said Dr. Simon
Blackburn, professor of philosophy at the University of
Cambridge.

"If you look at what people envy as opposed to what they
say they like, I think we envy people who go out on a
high," he said. "An old don in my college, he had a stroke
at the end of college dinner, and died on the spot, sitting
in his suspenders, in candlelight, holding a wine glass. It
was the perfect end for him, just incredible, and I think
it struck people as very admirable."

The insistence on making amends, on finding or declaring
meaning, stems as much from cultural expectations of a good
death as it does from the needs or the psychological state
of a dying person, psychiatrists say. Some people have an
anguished need to talk with loved ones, but cannot bring
themselves to do so; others simply want to say goodbye and
laugh their way out. And the effect of even a strong drug
may not alter those desires much.

Researchers tested LSD in terminal patients in the 1960's,
and heroin in the 1980, and neither drug made much
difference in the emotional or family experience at the end
of life, said Dr. David F. Musto, a professor of psychiatry
and medical history at Yale University School of Medicine.

"The larger danger is that we try to manage a death along
the lines of what we consider the right way of doing it,"
Dr. Musto said. "Some want to leave peacefully, and others
are anxious to find some meaning and get things taken care
of," and new drug treatments may help both.

Not to mention those who want simply to laugh, and trust
their maker to understand their choice. "There was some one
thing that was too great for God to show us when He walked
upon our earth," wrote the Catholic philosopher and
commentator G. K. Chesterton, in his classic "Orthodoxy,"
"and I have sometimes fancied it was His mirth."

http://www.nytimes.com/2005/01/16/weekinreview/16care.html