May-June 2022 | Health

Lucid dreaming and visions of God: How psilocybin therapy helped locals cope with depression

A Rockville cancer center led an FDA-approved study to treat patients with psychedelic mushrooms. Here's what happened.

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“A lot of what I saw had to do with water. At one point I was watching whales swim as I was under water with them.” Illustrations courtesy of Even Craig

Evan Craig created the artwork throughout this story after receiving treatment with a synthetic version of psilocybin at the Aquilino Cancer Center in Rockville. The artwork shows what he saw while hallucinating, and the quotes printed with the images are descriptions from Craig.

Lying on a sofa bed with his eyes closed behind thick black eyeshades, Evan Craig envisioned a large greenish creature with a woman’s torso, the bulging eyes and pincers of an insect, and a serpent’s tail.

As if a movie were unfolding in his mind, the 31-year-old storm-door sales representative watched as the winged “insect lady” grabbed him and ripped his body in half. Then the creature “kind of helped me up and said that I could live with everything from my lungs up. I didn’t need anything from my waist down,” Craig recalls.

The vision appeared to Craig, who has been diagnosed with advanced colon cancer, after he took a dose of a synthetic version of psilocybin while participating in a clinical study at the Shady Grove Adventist Aquilino Cancer Center in Rockville. Now closed, the study examined the safety and feasibility of using the active ingredient in psychedelic mushrooms in a group setting to help treat cancer patients suffering from depression.

Weeks of preparation—including undergoing sessions with a therapist and stopping the antidepressants Craig had taken for years—led to that day in late June of 2021. Diagnosed with stage 3 cancer in 2018, Craig had been riding a roller coaster of emotional turmoil ever since. He divorced, remarried and had his third child. In August 2020, the Carroll County resident learned that his cancer had advanced to stage 4 and required more treatment. Though he had been taking antidepressants for depression and anxiety since before his original diagnosis in 2018, he says they weren’t helping his mood and made him feel like “a zombie.”

On the day of the psilocybin dosing, Craig and three other participants arrived at the facility’s Bill Richards Center for Healing in the morning, met together with their therapists and then settled into separate treatment rooms where they were each given five pills totaling 25 milligrams. Donning eyeshades and headphones, Craig began listening to a curated playlist of music from different genres, including Eastern and classical, that was part of the treatment. Soon, the drug began to take effect.

What followed was several hours of “lucid dreaming,” during which he confronted his fears and anxiety with the help of his therapist, who was with him in the treatment room. “Nothing is avoidable when you’re dealing with the subconscious,” Craig says.

As he hallucinated, he saw himself as a mouse moving through Greek architecture while an eagle with “really sharp claws” chased him. “I remember screaming repeatedly for probably like 10 minutes, ‘Not today, Death!’ ” Craig says. He also climbed to the top of a Japanese-style building and looked down at a beautiful vista. At one point, he was a sound beam traveling between the gongs of two massive bells. At another, he was in the presence of a being that he thought represented God. “He told me I did not need to worry about my spirituality, but that I needed to focus on my friends and my family and those that supported me to be my guidance and my strength to be able to get through things,” Craig says. Other beings advised him on breathing exercises for handling stressful situations.

As the visions unfolded, Craig says, he watched himself die in a variety of ways. Experiencing terror, sadness and joy over the six-hour period, he found his way through to a sense of peace that has greatly eased his depression and anxiety.

“My entrails on giant metal spikes inside of a coliseum.” Illustrations courtesy of Even Craig

“I washed up on the beach as trash a handful of times. I washed up on the beach as a whale carcass. I was a big white moth being laid to rest on a pond at night. The only light illuminating this pond were fireflies, and there were other white moths observing the funeral. It was actually really peaceful. If that was the way I was gonna die, I’d be completely OK with it,” he says.

As research into the use of psychedelics has developed in recent years, medical institutions, including Shady Grove Adventist, have been studying whether psilocybin can help patients with mental health disorders. Studies released in 2016 by Johns Hopkins Medicine in Baltimore and New York University Langone Medical Center each found that a single dose of psilocybin administered in a controlled setting significantly relieved anxiety and depression in cancer patients for up to six months.

A 2020 study conducted by Hopkins’ Center for Psychedelic and Consciousness Research found that of 24 adult participants suffering major depression, a majority showed an improvement in symptoms after two separate doses of psilocybin along with psychotherapy. Four weeks after taking the substance, more than 50% of participants no longer qualified as suffering from depression, according to the study. A follow-up study of those participants found that “the substantial antidepressant effects of psilocybin-assisted therapy, given with supportive psychotherapy, may last at least a year for some patients,” according to results released by Hopkins researchers in February.

The Aquilino Center’s psilocybin study was the first approved by the Food and Drug Administration to be administered in a cancer center—most studies involving psilocybin have occurred in mental health centers, according to oncologist Manish Agrawal, the medical director of the Aquilino Cancer Center and the study’s lead investigator.

The study was open to adults diagnosed with all stages of cancer and major depression as rated on a medical scale. Thirty people participated, ranging in age from early 30s to late 70s. Participants were followed for eight weeks to monitor changes in their depression symptoms, Agrawal says.

While most psilocybin studies have focused on terminally ill cancer patients, Agrawal chose to include those who had been diagnosed with early stages of the disease. “As an oncologist, I’ve seen so many people with cancer that are quote ‘cured,’ but they really continue to suffer from the effects of treatment or having a crisis of having a cancer diagnosis, whether it affects their sexuality, their physical appearance,” or causes them to question the meaning of life, he says. “So I felt that’s like another population of cancer patients that needs this kind of help.”

Though the study data hasn’t been published, Agrawal says results have been “profound,” with 82% of participants registering a more than 50% reduction in their depression scores. Half of all participants no longer suffered from clinical depression eight weeks after taking psilocybin and participating in group therapy. Some participants continue to see changes more than a year after taking psilocybin. “This really does impact the patient’s psychological health in a way that I don’t have tools for,” Agrawal says.

“A being that I met turned us from 2D to 3D with the bass in his voice every time he spoke. The diagram showing this is below.” Illustrations courtesy of Even Craig

That was the case for “Sally,” another study participant and a Montgomery County resident in her mid-60s who didn’t want to be identified because her family doesn’t know she underwent psilocybin treatment. A survivor of child abuse, she later experienced the death of her husband and then was successfully treated for breast cancer while raising their two children. After a bout of colon cancer, she’s been in remission since 2017. She says she took antidepressants before participating in the study but still felt “very anxious and depressed” much of the time. “Cancer really carves a big hole in your psyche and leaves a very dark place,” she says. “I was always worried about recurrence…because the treatments are pretty brutal. It’s just not a very happy way to live, going through cancer treatment and then always looking over your shoulder waiting for it to recur.”

Taking psilocybin helped her to “get beyond” her experiences, she says. “Psilocybin felt like it opened my brain and my mind up to fully living and being open to all of the possibilities that are out there instead of being so guarded,” she says.

Agrawal, 52, began looking into psychedelic therapy after growing dissatisfied with the traditional approach to cancer care that focused mainly on treating patients’ physical symptoms. “You close a door and you talk about the side effects, you talk about the treatment and the scans, but there’s so much that they’re going through that you haven’t really addressed,” he says.

Agrawal completed his residency at Georgetown University Medical Center and trained at the National Cancer Institute in Bethesda.

The doctor, who also holds a master’s degree in philosophy from Georgetown University, says he has long been interested in a holistic approach to treating his patients. When he gives medical talks, he shows a slide depicting an iceberg: Above the waterline are the traditional treatments of chemotherapy, radiation and surgery. Below the water are the emotional and psychospiritual issues that patients may be experiencing as they deal with a diagnosis that can fundamentally change their lives.

“My belief is that cancer care is taking care of the entire iceberg, not just what’s above the water. When I saw all of the research coming around psychedelics, I almost couldn’t believe it that they were purporting to address this directly,” says Agrawal, who spoke with psychologist and pioneering psychedelics researcher Bill Richards and researchers at the Center for Psychedelic and Consciousness Research in Baltimore. He also spent a year achieving certification in psychedelics from the California Institute of Integral Studies, traveling regularly to that state to learn from experts in the field.

“Psychedelics sort of merged both my medical practice and this larger interest around how to take care of the whole person,” he says.

In 2021, Agrawal co-founded Sunstone Therapies, a company dedicated to incorporating psychedelic therapy into cancer centers. The Bill Richards Center for Healing, on the third floor of the Aquilino Cancer Center, is Sunstone Therapies’ flagship site. Named after Richards, the psilocybin study’s lead therapist, the healing center also provides services to help patients and their families deal with the psychological effects of cancer. A new clinical trial that Agrawal was expecting to start at the center this spring would involve administering one or two separate doses of psilocybin to as many as 60 participants. Based on continuing positive results from his studies and others, Agrawal anticipates that the Food and Drug Administration could approve psilocybin for medical use within four years. It’s currently illegal and classified as a drug that has “a high potential for abuse” and “no currently accepted medical use” in the U.S., according to the Drug Enforcement Administration.

Photo by Skip Brown

Those who visit the healing center, which opened in June 2020, won’t find a typical sterile medical office. Instead, there are curved walls with pale blond paneling, furnishings in muted blue and gray, and large windows that open to the vista of a “healing” garden—all designed to create a sense of comfort and home, according to Kim Roddy, chief operations officer of Sunstone Therapies. A large room provides space for group therapy, meditation and yoga classes. Each of the four treatment rooms is furnished with blackout shades and a gray couch that unfolds into a bed, which is made up for participants with comfortable pillows and sheets that have higher thread counts than typical hospital bedding, Roddy says.

Agrawal says the healing center was purposefully located within the cancer center to ease access for patients. In the cancer center, “we have a place where you can get chemotherapy, we have a place where you can get radiation, but we also wanted a place where you can go to get emotional and psychological healing. You shouldn’t have to leave and go to some other facility,” he says.

Once Craig was accepted into the psilocybin study, he says he was determined to keep an open mind. “I didn’t want to go in with an expectation that I was going to meet God or something,” he says. “I really tried to go into it with the expectation that whatever happens, if it’s a good trip or a bad trip, it’s a necessary trip and whatever was going on in my head [during the treatment] was necessary.”

As part of the study protocol, each participant met individually with a therapist assigned to guide them through the experience. Therapist Betsy Jenkins, a licensed clinical counselor, has worked for the past eight years with cancer patients and their families. Jenkins, 66, now provides individual counseling and develops support groups and wellness programs at the cancer center. She got involved with the study after learning about the potential benefits of psilocybin treatment from Dr. Brian Richards, the son of Bill Richards and a member of the healing center staff.

“My passion is the change it makes in people’s [lives] and the life of their family as they go through the cancer experience,” she says. “It’s really miraculous to see the power of that one experience. Even a year later it continues to bear fruit—insight and empathy and connection—and that perspective trickles down through the whole family.”

Jenkins says she and her fellow therapists try to develop a bond with participants while talking about what to expect during the treatment, advising them to “trust, let go and be open” to anything that comes up. With the guidance of a therapist, the experience provides an opportunity to “shine a flashlight into the basement of your mind to really be able to look in those corners and not shy away from it,” Jenkins says. “You can’t be in a more supportive environment to do that.”

On the dosing day, Craig and the other three participants in his group and their therapists gathered to talk before each pair headed to a treatment room. Sally, who took psilocybin the same day as Craig, says she felt well prepared for the moment after meeting with her therapist and the other participants who were also dealing with cancer. “I felt really lifted up and supported from the very beginning,” she says.

“Beth,” a 57-year-old teacher from Bethesda who didn’t want to be identified by her real name because people she knows don’t know that she underwent psilocybin treatment, was also part of the group. Her longstanding depression and anxiety were compounded by her breast cancer diagnosis in June 2020. Aware of the research about the therapeutic benefits of psilocybin before she was diagnosed, she applied to be part of the study, hoping that taking the drug would ease her low-level chronic depression.

After taking the psilocybin, the study participants each embarked on a journey through their subconscious mind. In addition to all of the visions Craig experienced, he recalls that he laughed sometimes and also cried “hysterically.” He felt hot and then cold. At some points he was tucked into the bed. Other times he threw the sheets across the room. As he hallucinated, Craig says, he explained to Jenkins what he was seeing and she asked him what he thought each vision meant. She had given Craig, who has a background in graphic design, a sketch pad and colored pencils, and later he drew several pictures of what he had seen.

Sally’s journey started pleasantly with visions of swirling, brightly colored gems, she says. Soon she found herself in a tunnel with an archway full of mouths with “sharp, sharp teeth” and she started seeing visions of traumatic experiences from her childhood. Though she’d spent years in intensive therapy, she says it didn’t affect her the way her experience with psilocybin did. “I was a viewer watching the abuse happen and understanding that [it] was no longer part of me,” she says. “I feel like at that moment I was healed, that I didn’t really need to continue to relive it and have it affect my life, so I felt comforted.”

“Myself as a white moth being laid to rest on a tranquil pond at night.” Illustrations courtesy of Even Craig

Then she started to feel like she was dying. “There was a bright light above that was sucking the life out of me, and I was terrified. I don’t know that I’ve been that scared since I was a kid. My body was just fading away like particles, grains of sand drifting away. My soul was being sucked out of my body up into this white light,” she says.

“And then in a moment I died and went up into this light and there was just pure joy. It went from a terrifying and a horrible experience into this just pure bliss and feeling like this is the essence of life. I felt really, really happy. I felt like I was surrounded by angels.”

At one point, Sally saw her deceased husband, which also made her “really happy.” At another point, she “felt a big cloud of depression and anxiety just fade away.” The rest of her journey has gone fuzzy over time, but she says she came out of the “very, very difficult” experience with a profound sense of well-being.

Before taking the psilocybin, Beth, who sees herself as a caretaker, says she was worried about the other participants in her group. But once the drug kicked in, she entered her own world. At first, frogs with umbrellas rained down around her. Then Ganesh, the Hindu god who is known as the remover of obstacles and is usually portrayed with the head of an elephant, came to her and stayed with her through her journey. “I knew about Ganesh, but I couldn’t remember what Ganesh meant. It was outstanding that Ganesh would come to me at such a time,” Beth says.

She soon found that she was unable to lie down and had to remove her headphones and listen to the music through the speakers in the room. “It was too much stimulation for me,” she recalls.

Throughout the experience, “nothing happened that I couldn’t handle,” Beth says. Though she hated the curated acoustical music at the time, she understands how the choice of music, whether it was peaceful or soaring, allowed her subconscious to create visions that helped her explore family trauma that she believes caused her to develop cancer. “I remember I kept saying, ‘When is this going to be over?’ ” she says. “I felt like it was a stomach virus that wouldn’t end. I was just so exhausted from the whole experience.”

“Myself as sound bouncing around giant metal gongs.” Illustrations courtesy of Even Craig

The day after the dosing, the participants gathered again with their therapists at the healing center to talk about what they had seen and felt. “We do a lot of work with integrating that experience,” says Jenkins, who runs monthly Zoom group sessions for participants. Sharing their journeys immediately with each other and then continuing to meet after the study concluded is what makes the experience “so powerful,” she says. “Otherwise, it’s just like partying, right? That doesn’t help.”

Sally attends the Zoom meetings with other study participants and has met in person with Beth. Getting together with Beth took Sally
“straight back to that wonderful blissful” feeling that she had after taking psilocybin. “The connection with another participant was just awesome. I could feel the love emanating from her and from me from the shared experience,” she says. “It’s a different kind of connection than I have with anybody else in the whole world. It’s very healing in so many ways.”

Agrawal says he chose to study the administration of psilocybin in a group setting because previous research had shown that it could be more helpful to patients than providing individual therapy. If the method ultimately proves to be beneficial, it could be a way to efficiently provide the treatment to more people while also reducing the cost, he says.

“What’s been remarkable is that even though the study is finished, many of the participants continue to meet once a month. They want to be together,” he says. Having the opportunity to share difficult emotions with others also dealing with cancer is “very healing for an individual person,” he says.

More than seven months after taking the psilocybin, Craig was facing more surgery to treat his cancer, but says he no longer feels sad about his diagnosis and has stayed off antidepressants. While the clarity of thought that he experienced after taking psilocybin has dissipated, he continues to process what he went through by attending the Zoom sessions with other participants and listening to the music from the psilocybin treatment. “I feel like taking psilocybin was kind of the start of things and it’s kind of opened a door for bettering myself mentally,” he says.

Sally says she feels like “something had physically changed” in her brain after she took the psilocybin. She also has stayed off medication and says her anxiety is “completely gone.” She’s more focused on taking care of herself and eating better. The emotional journey she took that June day helped her understand that she needed to establish boundaries with others so she doesn’t take on their problems like she used to, she says.

“I was hoping and expecting to feel calmer, but I never expected to feel…as happy as I’ve been,” she says. “I feel so much richer, my life has been enriched by this. I’m better able to enjoy the things I really, really love, like my family.”

Contributing editor Julie Rasicot lives in Silver Spring.