I’d be remiss not to point out that Medscape, in this context, is merely reporting medical news. Their article centers around a new analysis, drawn from the Columbia Mass Murder Database (CMMD), which suggests that mental illness is incidental in mass shootings.

“People with serious mental illness constitute only a small portion of the perpetrators of gun violence in this country,” Paul Appelbaum, MD, professor of psychiatry, medicine, and law at Columbia University in New York City. told Medscape.

The analysis covered 82 incidents of mass murder in academic settings including schools, colleges, and universities. The average number of victims of these incidents was eight. All 82 incidents were initiated by men (mean age 28), and 67% were Caucasian. About two thirds (63%) involved guns.

More than three-quarters (77%) of all perpetrators of mass murders in academic settings had no recorded history of psychotic symptoms. (emphasis added by author)

Swiss Cheese

To extrapolate data and draw conclusions from an existing data set, the cohort needs to be at least mildly historically similar. All this analysis suggests is that 77% of the shooters were not yet diagnosed as suffering from a mental illness or had insufficient coping mechanisms to deal with the stresses they faced. The authors conclusions, that only 23% of the shooters suffered from mental illness is an overreach of monumental proportions.

Most modern research suffers from these biased slants, which either lose sight of their controls or interpret data in wildly irresponsible fashion. All the more sad, as the true value of the data is lost behind an overriding narrative the authors wish to justify. What is clear from this analysis data, is that our systems for managing and identifying mental illness and related conditions are flawed. As is the care we offer to those diagnosed.

A significant majority of these shootings may have been prevented had individuals with a myriad of life challenges or psychological struggles been flagged. This begs the argument, why did the 23% slip through the cracks if they had been diagnosed and were, one would assume, under treatment?

These incidents, targeting young children by individuals who are themselves still just teenagers or newly minted adults, are a new phenomenon. Discovering the “why” matters almost as much as restricting access to weapons.

What can the 82 teach us?

Numerical data in this instance, used as it was, for the analysis above, is of little import and can be manipulated to suit any agenda. What researchers should instead be pursuing are the 82 lives that led to these horrific events.

Who were these young people, social backgrounds, family, schooling, infractions with law and authority, medical histories, friendships, potential triggers, medication, anything and everything that can be found that relates to their lives. Examine this and patterns will emerge. Patterns that may very well point the finger of blame to society, broken families, flawed mental health policies and the social stigma of reaching out for help – even in-patient care.

Identifying these patterns and potential triggers matters. Our human capabilities no longer limit us and AI can be incorporated to search social media for matches, allowing for early intervention. Teenagers or young adults do not just pick up a weapon and commit mass murder. They progress, in increments, to this course of action.

There are always signs.

Often we simply fail to see the signs and sadly, when we do pick up on them, we tend to ignore them – we cannot image that they will lead to something so horrible.

But, there is another challenge – access to mental health help. Ask anyone who needs to find a therapist how daunting the task is. It can take months, sometimes more than a year, to secure an appointment with someone with experience to address serious mental health challenges.

Again, this is unsustainable in a society where stable parenting is becoming an archaic concept, whether by design or necessity. Stable homes are in rapid decline.

The real indictment of this analysis are the diagnosed 23%. They represent the ever-increasing cost of our inability to help children who are crying out for guidance, care and a sense of belonging and purpose. How many lives could have been spared? How many lives will still be forfeit? We can, and must, do better.

Reaching for the closest solution

Mental health issues may be the motivating factor to committing mass murder. The preferred tool of choice for these murders is the assault weapon or other firearm. While we can debate the motivation for each individual heinous act, this choice of tool is far simpler to comprehend. Ease of access.

In countries where access to firearms is limited or non-existent, school shootings DO NOT HAPPEN. In America, gun ownership, legal or otherwise has reached pandemic proportions. It is even questionable at this point if tightening ownership laws and policy changes will have any impact whatsoever on teens being able to find and use weapons designed to maim and kill, so prolific is their distribution in American society.

While we struggle to find ways to prevent these tragedies from a mental health perspective, an arduous and difficult task, surely removing the preferred tool from the equation makes far more sense. No access to guns equates to no school shootings. A globally proven fact.

The post Why It is Imperative We Redefine Mental Illness and How We Treat It appeared first on Medika Life.

This research paper is a very confusing read, even for someone who is quite familiar with this kind of research. Yet what is said in the paper is crucial to the case being made by Jean Twenge (and Jon Haidt) that government intervention is urgently needed to curb the harms of social media to the mental health of teens. I’ll use the abstract of the paper to discuss how to find flaws in a research study that is intended to influence public health policy.

Parents and school teachers and administrators cannot be expected to interpret original research studies on their own. But they might learn from discussions like this one to be more skeptical of experts who claim their advice is based on social science, but who make emotional appeals and rely on anecdotes to rouse their readership into action.

The ratio of emotional story-telling to actual scientific evidence is very high in stories in the popular press expressing alarm about the damaging effects of teen girls’ use of social media on their mental health.

There is an excess of hype and drama about this topic, even in op-eds in the New York Times. When in doubt, be skeptical of social scientists who try too hard to convince you that they are correct and that other experts have just not noticed something that is obvious to them.

In a widely discussed article, Jean Twenge says that she has been studying generational trends in mental health for over 25 years and that she never before found such a dramatic change in mental health as she saw around 2012.

Have Smartphones Destroyed a Generation? More comfortable online than out partying, post-Millennials are safer, physically, than adolescents have ever been.

Around 2012, I noticed abrupt shifts in teen behaviors and emotional states. The gentle slopes of the line graphs became steep mountains and sheer cliffs, and many of the distinctive characteristics of the Millennial generation began to disappear. In all my analyses of generational data — some reaching back to the 1930s — I had never seen anything like it.

Twenge has advice for parents and teachers:

If you were going to give advice for a happy adolescence based on this survey, it would be straightforward: Put down the phone, turn off the laptop, and do something — anything — that does not involve a screen.

Twenge commands special authority because her views are said to be derived from the best available evidence.

However, most of the key research that Twenge and her fellow advocate Jonathan Haidt cite was not conducted by either of them. I suspect that many of the authors of these studies they cite would disagree with Twenge and Haidt’s interpretation of their work, some vigorously so. That situation makes one centerpiece study led that was led by Twenge particularly important.

The key research article by Twenge and her colleagues is here.

Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S…In two nationally representative surveys of U.S. adolescents in grades 8 through 12 ( N = 506,820) and national..

The article is unfortunately paywalled, but here is its abstract. We can do a lot with it.

In two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year.

The editors at a top psychology journal, Clinical Psychological Science, and the reviewers the editors picked were obviously impressed enough to recommend the article and its abstract be published in the form that we now see.

I noticed lots of things that made me suspicious because I have higher standards for talking about risks to health than most psychologists do.

• I received excellent training in my Ph.D. studies as a research-oriented clinical psychologist. I received my doctorate in 1975 but then began working in situations where medical scientists and public health officials demanded stricter standards than what was required of psychologists trying to get published in a respectable psychology journal. Lives depended on what a different kind of expert decided about risks from the often limited and flawed data that was available to them.

The COVID pandemic and the quick decisions that had to be made about what advice could be given concerning vaccination, social distancing and lockdowns put this kind of expertise on display. The world-class experts giving briefings on the best of cable news were good at policing each other to avoid exaggerating what was known and to admit they did not know. “We don’t know yet” was often the best answer, as frustrating as it was.

For a start, I expect more information from an abstract than this one provided. The authors did not follow standard advice on what to include in an abstract. I’ll have a future story documenting how abstracts attached to paywalled articles like the one we are discussing here can actually kill people, aside from spreading misconceptions.

Rather than doing their own research to collect new data, these authors relied on existing survey data sets collected for other purposes. This leaves lots of questions about they did this that the authors do not address in a transparent way.

How did the authors integrate this data from different sources in one study? Relying on someone else’s data is attractive and may at first seem expedient, but effectively and validly doing requires a lot of difficult decision-making.

Inevitably, the original researchers did not ask the right survey questions for new research. What questions in the surveys best fit the new issues researchers wanted to address? How could the new researchers verify that their selection from already collected data was most valid and relevant to their issues?

Twenge and her co-authors imply in the abstract that they had been able somehow to integrate the survey questions with information from the national statistics on deaths by suicide. I knew that was bunk. Ethics committees overseeing the protection of human subjects insist the data be anonymized so that identification and matching of people across data sets becomes virtually impossible.

Then, there is the problem of the small number of suicides in this relatively low-risk group. Let’s stop here and apply some numbers I revealed last time.

Any potential risk factors the authors can find in these pre-existing survey questions must pass the test of predicting relatively infrequent events with some percision. The abstract suggests the authors may have succeeded (“which may account for the increases in depression and suicide), but that would be statistically improbable, given the basic rate of death by suicide and any conceivable fluctuation in the study period of this article.

For 2017, we have about 420 suicides to explain among 20.5 million girls. I wish the authors luck in using whatever fancy statistics they can muster to predict which girls will die by suicide with the risk factors they can pull from other people’s data. Chances are no one died by suicide or only a chance handful from participants in the survey data they acquired. Neither Twenge and her co-authors or readers can tell.

Not being able to identify which of the teens completing the survey died by suicide means the authors will be left making speculative statements beyond what their data allow.

The authors used the term “iGen adolescents” in the abstract to describe the teens they studied. That fits with Jean Twente’s best-selling books, but I was skeptical about such a sweeping term being able to capture much of the similarities and differences in an increasingly diverse and divided America in the association of use of social media and mental health.

Was any similarity of teens falling in this age range more important than the vast range of differences? Consider one white teen having alcoholics or Trump supporters for parents versus another teen having teetotaler Hindu parents who insisted that their teen study hard enough to go to medical school and become a physician? White teens with two Ivy League faculty as parents versus a Black teen raised by a single grandmother who dropped out of high school and does not have internet? Versus a Black teen raised by a single grandmother who dropped out of high school, but the great of the story is the teen’s mother was an innocent victim of random gun violence and the grandmother insists the teen fulfill the mother’s dream and go to college, no excuses accepted?

I could generate thousands of these kinds of contrasts, and some would be quite absurd.

The final conclusion where I seem to be headed is that a generational label like iGen or Generation Z cannot capture much of variations among teens — or across an individual teen’s transition into adulthood and afterward.

“iGen” [Don’t you like the cool choice of labels so that you automatically think of having “iPhones” as what 25 million American teen girls have in common?] might serve to highlight some things teens that might be missed that teens have in common. Surely it misses a lot of things teens don’t have in common, whether they are from radically different backgrounds or with nearly identical demographics but just different in the place of social media in their lives.

The authors end their abstract with straight-faced reassurance that they controlled for “cyclical economic factors such as unemployment and the Dow Jones Index,” matched by year. I can just imagine some badass experts at conferences I have attended who would lie in wait for a speaker to say such a silly thing.

Academics who think their research saves lives can be real a*holes when dealing with other academics whose research they think will never save any lives.

Imagine the response of experts accustomed to identifying health risks from correlations found in survey or surveillance data. Unprepared for what they would hear, some would have spilled coffee on their fancy suits and chocked on the stale Danish from the free conference breakfast as they scrambled to correct the speaker, not allowing anyone to discuss what else the presenter had to say.

I can imagine the string of cliched criticism that could be unleashed.

“Of course, you know that correlation does not equal causality.”

“You can’t do magic with statical controls of correlations when all you have is somebody else’s survey data they collected for some other purposes.”

“What a dumb choice! Are you a psychologist who does not understand regression analysis or do you have books to sell at the conference? Will your next slide tell us where to find your Tedtalk?

Maybe the badass expert would be in an uncharacteristically charitable mood and simply explain:

“I appreciate your effort to find support for a hypothesis that excites you.You should realize that you are relying on statistical controls to settle some issues of causality that are not readily solved. If you were to rely on such controls, you are first making the assumption that you have isolated all the variables that could possibly explain away your findings. I don’t think these crude economic indicators begin to do that. Secondly, you are assuming that these variables are measured without error. I don’t think an economist would say these two variables perfectly measure year to year differences in the economy affecting either teen’s use of social media or dying by suicide.”

One final cynical a*hole comment before we move on —

“If we had used your approach to statistical analysis, we would have concluded at the early days of mystery in the HIV/AIDS epidemic that someone using poppers to enhance orgasm during casual sex or simply having too many Judy Garland LPs in their vinyl collection was a modifiable risk factor.”

Frightened and humiliated, the psychologist trying to finish their talk would miss a very serious and useful message that was being disguised here.

Not knowing what you are doing with bad data and a computer program can lead to all kinds of compelling, but spurious correlations to get worked up about, some more plausible for a while than the modifiable risk factor you are listening for in very noisy data.

So, just what did Twenge and colleagues do with “two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015?”

That is a true mystery that is never clarified in this abstract. I was stumped at first. I gave the authors the benefit of a doubt and thought maybe they did some kind of prospective analysis, looking ahead and predicting later things that happened to individuals from their earlier responses on surveys.

I had to get a copy of the paywalled article. The overall design of the study was still difficult to decipher from the methods section, where it should have been laid out in detail and given a name, like case-control or cohort study.

I eventually figured out that the authors did not have two “nationally representative surveys of U.S. adolescents.” They had over two dozen cross-sectional retrospective studies (a one-time survey asking about the past year) with nonoverlapping samples and important differences in the questions that were asked. No questions at all about social media in the survey for some years (!).

This dog’s breakfast of a design for this study will be the topic of my next article about this study, as we dig deeper into what can reasonably be claimed from this study and what cannot — if we stick to principles of best science, not just good story-telling.

The post A Stunningly Bad Study Claims Social Media Devastates Teen Girls’ Mental Health appeared first on Medika Life.

A key study of psychedelic-assisted psychotherapy for depressed cancer patients actually included no patients with major depression. Other details of the study have been grossly misrepresented in ways that should influence our assessment of the study’s importance.

Most guests had left what we knew would be John Weakland’s last birthday celebration. John was dying from ALS (Amyotrophic lateral sclerosis, Lou Gehrig’s disease).

His lifework as an originator of family and grief problem-focused therapy had already been honored at a special conference in New Orleans. Weeks before his death, John would complete an article about the future directions of family therapy.

At least on that night, complications from that horrible disease did not seem to dull his spirit or his intellect, although his speech was noticeably slurred.

For what would be our last night together, John shared his cache of Cuban cigars and Bas Armagnac with me. We did not say much, mostly just enjoying the clear cloudless night until we fell asleep on the swath of grassy land that he and his wife, artist Anna Wu, owned in Los Altos. She discretely monitored us from inside their house.

John did not ask permission to smoke the cigars from the physicians who had been at the party.

Possession of the cigars was illegal. I recall the cigars having been smuggled into the US and presented to John as a gift in New Orleans. Fortunately, John knew more about how to savor an expensive cigar than I did, else he might have died instantly with a first deep draw.

Although both of us had experience with psychedelics, we did not think to ingest psilocybin that night. If we had wanted to trip, we would not have asked one of the psychiatrists to bestow a diagnosis of adjustment disorder on us to make it legal.

Why can’t two consenting adults legally ingest a substance that evidence suggests is safer than cigar smoke or Armagnac, particularly when it is the last visit together? Or at any time?

If the campaign for psilocybin-assisted psychotherapy succeeds, it will allow psychiatrists to market an expensive package deal of a psychiatric diagnosis, a couple of capsules of psilocybin delivered in an elaborate ritual, with six months of spiritually-oriented support and therapy thrown in.

Research concerning the role of psychedelics in mental health treatment and its superb publicity campaign depends on millions of dollars raised by venture capitalists. In a podcast series hosted by American entrepreneur, investor, author, and podcaster Tim Ferriss, a stream of investor guests expresses a vision of the treatment being provided private spa treatment, as well as psychedelics being used with underperforming athletes and a route to better sex.

At New York University, the ritual involves administering the psychedelic out of a chalice while new age music is played in a candlelit room, intended to create an aura of mysticism.

Before dismissing my skeptical perspective, let’s take a look at one of the key earlier studies cited as the rationale of the recent clinical trial of psilocybin as an antidepressant. The study from NYU is presented as a trial with dramatic results that were obtained when treating depression in terminal cancer patients. None of the patients in that study met the criteria for major depression.

Orchestrating an unprecedented publicity campaign

The article one of two clinical trials of psilocybin with cancer patients that were published with ten commentaries. The other study was from the group at Johns Hopkins that produced the recent randomized trial of psilocybin for major depression in JAMA Psychiatry discussed in my last article. Powerful Placebo in a Psilocybin for Depression Study

Leading the series of commentaries on the study of psilocybin with cancer patients, David Nutt, Editor of Journal of Psychopharmacology remarked:

The honours list of the commentators reads like a ‘who’s who’ of American and European psychiatry and should reassure any waverers that this use of psilocybin is well within the accepted scope of modern psychiatry.

The Heffter Research Institute funded both studies and managed publicity for the special issue. The institute’s website boasted of altmetrics (big data) revealing that the media mentions of the special issue had received over a billion views. The theme of the publicity was a mishmash of claims about mystical experiences, wild speculation about specific areas of the brain that psilocybin affected, and the distinctive religion-without-religion spirituality musings of popular writer Sam Harris.

As part of the publicity campaign, the senior authors of the NYU and Hopkins studies lavishly praised their own work in a long article in Medscape:Psilocybin May Be a Psychiatry Game Changer

The new findings have “the potential to transform the care of cancer patients with psychological and existential distress, but beyond that, it potentially provides a completely new model in psychiatry of a medication that works rapidly as both an antidepressant and anxiolytic and has sustained benefit for months,” Stephen Ross, MD, director of Substance Abuse Services, Department of Psychiatry, New York University (NYU), Langone Medical Center, told Medscape Medical News.

And

Professor Roland Griffiths, of the departments of psychiatry and neuroscience who led the study at Johns Hopkins University school of medicine, said he did not expect the findings, which he described as remarkable. “I am bred as a skeptic. I was skeptical at the outset that this drug could produce long-lasting changes,” he said. These were people “facing the deepest existential questions that humans can encounter — what is the nature of life and death, the meaning of life.”

Delving into the details of the NYU study

The title of the article makes three claims:

(1) that anxiety and depression were being treated (2) that rapid and sustained symptom relief was achieved; and (3) that the cancer was life-threatening.

[How many titles of peer-reviewed articles in clinical oncology or psycho-oncology journals highlight that cancer is life-threatening?]

The 29 patients in the study consisted of 26 patients with adjustment disorder and three with a generalized anxiety disorder.

This study included a clinically mixed sample of ten patients with stage I or II cancer and 18 with stage III or IV cancer with a small representation of a broad range of cancer sites. Staging is not a good predictor of individual life expectancy, particularly in a mixed sample. Most patients still maintained some full or part-time employment or student status. Two died in the course of the study and follow-up period.

Most cancers could be characterized as “life-threatening” except for some skin cancers. The term is not particularly informative or precise in the context of a scientific paper, but the term does serve to dramatize the findings.

The trial is described as a double-blind, placebo-controlled, crossover trial with single-dose psilocybin or niacin (Vitamin B3), with both pills administered in the context of psychotherapy. Patients were randomized to get first either the psychedelic or the placebo pill. Patients then received the other pill in a crossover at seven weeks.

Before receiving the psychedelic or placebo pill in the first round, they were coached to expect a mystical experience.

Patients received 3 sessions of 6 hours total duration in which rapport was established, along with expectations for the drug experience ahead.

The therapist/facilitator/monitor was also present in the five-hour or so session in which the drug or placebo was given and then for 3 sessions of post-integration work. The sequence was repeated for the second administration of a capsule of whatever had not been given the first time. Next were 20 weeks of support and integration of the experience with the therapist who has accompanied the patient through the trial.

The authors claimed the psilocybin achieved ‘rapid and sustained relief of symptoms, but this must be understood in the context of 8 months of supportive psychotherapeutic treatment.

Critical commentary on the study

As a clinical trial. The study is described as “double-blinded,” indicating an intent to keep both the patients and the research team in the dark as to whether the patients had received psilocybin versus vitamin B3. Any mystery would only last until a half hour or so after the patient got the pill. At that point, a marked shift in the patient’s mood and perception alerted the patients and their facilitators to the patient had been given the psychedelic.

The study was no longer blinded a half-hour after the pill was administered and patients had no doubt to what condition they had been assigned.

The study is described as a randomized controlled trial (RCT). That should give confidence that results observed in the follow-up period were not simply due to the passage of time. But here is the catch. In a crossover design, patients get both drug and placebo, just at different times. Those patients who did not get the psilocybin the first time got it at seven weeks. From that point until the last follow-up 26 weeks later, all patients had ingested both psilocybin and the placebo. So, everybody had exposure to the drug and there was, therefore, no control for the passage of time. In that sense, the study was no longer an RCT in the crucial follow-up period in which the ‘sustained relief of symptoms’ is observed.

The study was no longer a randomized trial at long term follow up and the sustained relief of symptoms did not control for passage of time.

As a study of the treatment of patients with psychiatric diagnoses. Ninety percent of patients had a diagnosis of adjustment disorder, which meant that a psychiatric diagnosis had been ruled out for which an evidence-based treatment would have been indicated. Any depressive or anxious symptoms were subthreshold.

Clinicians, particularly non-psychiatrist physicians in cancer care, often prescribe an antidepressant to patients with subthreshold symptoms, but there is no evidence that an antidepressant would improve patient outcomes beyond placebo effects.

Adjustment disorders are administrative diagnoses usually made for documentation and billing purposes. Patients receive this diagnosis to justify clinicians taking some action administratively, but patients with such a diagnosis are a mixed group in terms of the source of any symptoms and the presumed mechanism by which the symptoms were produced.

Psychopharmacologists would not expect the patients with adjustment disorder to have any particular biological abnormality in common. So, the presumed action of a drug effective in treating major depression might not be observable in this population because of the lack of the biological abnormality that an antidepressant is theorized to address.

Conventional antidepressants are not happy pills. They do not make persons below a minimal threshold of depression happier than a placebo.

As a study of cancer patients. Responses to the diagnosis and treatment of cancer are quite varied, but cancer does not typically pose the mental health issues that the authors claimed in the peer-reviewed article and their statements to the media.

My team studied a waiting room sample of over 400 consecutive breast cancer patients at a comprehensive cancer center. We found a third scored in the distressed range on a screening instrument, virtually the same as in a primary care waiting room sample that we had also studied. There were few cases of PTSD, all patients with a history of being treated for major depression.

Most distress among cancer patients resolves in three to six months, typically without the patients obtaining formal mental health treatment. As in other studies, we found that approximately 10–14 percent of patients remained distressed at 6 months, despite receiving a variety of formal interventions. The same proportion of unresolved distress probably holds in other medical populations.

Persistent distress can have diverse causes, including current circumstances beyond cancer, conditions created by the treatment of cancer including being devasted financially, and pre-existing psychopathology.

There are crude, psychometrically unsound checklists for assessing the unmet needs associated with distress in cancer care. The items which are endorsed most vary across populations, but typically the most common are practical matters. A need for formal mental health treatment does not get a strong endorsement.

As a study of end-of-life-treatment. The peer-reviewed paper is vague about the nature of therapy and support provided except for noting it draws on a “number of manualized existentially oriented psychotherapies [that] have been developed to address…existential/spiritual issues.”

Dignity therapy is a particular brand of manualized existential therapy for the end of life. Unanticipated and fascinating results were found in a large RCT.

The multisite trial involved over 400 patients. The study compared this manualized psychotherapy delivered by psychiatrists and psychologists to a simple supportive discussion with someone who was not formally trained as a psychotherapist, such as a pastoral counselor, and to remaining in routine cancer care without additional intervention.

No differences were found among the three groups across two dozen outcome measures, including various measures of depressed mood, hopelessness, and despair, as well as psychological, existential, and spiritual distress.

One reason is a floor effect dictated by the low level of mental health symptoms with which patients entered the study. Their symptoms could not fall any lower. That finding alone should shake up some myths about mental health care at the end of life.

The condition treated by psychiatrists in terminally ill medical patients. All but two had an administrative diagnosis with subclinical symptoms. Outside a small group of psychiatrists and psychologists, I do not think there would be much agreement about the validity of a “cancer-related demoralization syndrome.” Or that is necessarily a clinical problem when patients give up at the end of life and desire a hastened death without seeking further hope, meaning, or purpose in prolonged life. At least not a problem that mental health professionals would be the most equipped to address.

A lot of prescriptive moral judgments are being made in this study about how people should live and die. These psychiatrists have a wealth of ideas about the good death which they apparently promote with great passion in the 8 months of support and drug-assisted psychotherapy. As Stanford David Spiegel indicates in the title to his commentary, the NYU research group believes that they are guiding cancer patients on the last trip.

Outside the trial. a lot of cancer patients face death with their own form of spirituality that has served them well over a lifetime. It is perhaps for good reason that so few Christians enrolled in the study.

Many Christians would rather slowly walk with Jesus on their last trip, not fly with these NYU psychiatrists.

That only a couple of Christians enrolled in the study probably avoided some clashes in theology and basic values.

On the other hand, there are people who very much want an experience with psilocybin that this research group advertises. They may have seen NYU’s normal volunteer study with psilocybin. In what sounds like a Trip Advisor review, the paper reports:

Thirty-three percent of the volunteers rated the psilocybin experience as being the single most spiritually significant experience of his or her life, with an additional 38% rating it to be among the top five most spiritually significant experiences.

Some may even think “Too bad I don’t have cancer.”

They would not have to meet the criteria for major depression. They would only need to impress a psychiatrist with subsyndromal symptoms. That could be easily done by a motivated person.

The nondepressed research participant would get to trip. The NYU researchers would get data points for claims about psilocybin as an antidepressant.

But how perverse is it, that psilocybin needs to be accessed through an RCT of a mental health treatment because it is needlessly kept as criminalized heroin?

For more details of the psychotherapy provided in this trial including patient testimonials see the NYU Alumni News.

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