This episode is about psychedelics and grief, and it starts from an unusual place: not death, but everything else grief actually is. Loss of a future you thought you had. Loss of an identity, a marriage, a body that no longer works the way it used to. That's the frame Dr. Sunil Aggarwal and I set for this final Psychedelic Salon of last season, recorded live at Town Hall Seattle.
Sunil isn't a hospice tourist to this topic. He's a physician at Seattle's AIMS Institute who has spent years fighting, in federal court, for his own terminally ill patients' right to try psilocybin. He was the first doctor to petition the DEA for Right to Try access on their behalf. We talk about the neurobiology of why a guided psychedelic experience can shift a story you've carried about a loss for years, a bereaved-parent retreat in Jamaica that's now the subject of a real qualitative study, and the distinction Sunil keeps returning to, containment versus integration.
Containment is what most of us default to. Put the loss in a box, keep functioning, call it managed. Integration is slower, and it's the only version of the two that actually changes your relationship to what you lost. Not less pain. A different relationship to the pain.
We also get into what the research does and doesn't support, from the fast-tracked synthetic psilocybin analogs now moving through the FDA to the early, mostly preclinical evidence on psilocybin and brain injury. And we close on the one resource almost nobody uses: every hospice in the country is legally required to offer 12 months of bereavement support, to anyone in the family, whether or not you were ever a patient there.
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0:00 Welcome, disclaimer, and the topic of this Salon: grief 0:45 Meet Dr. Sunil Aggarwal: hospice, palliative medicine, and medical geography 2:20 The Right to Try fight to get psilocybin to dying patients 5:00 Who controls psilocybin's Schedule I status, and why the FDA's fast-tracked analogs won't change access for most people 6:30 April's own experience with grief, and the parents who come to her after losing a child 8:30 How Sunil recognizes grief in a clinical setting, and what anticipatory grief looks like 11:30 Containment versus integration 12:20 Inside the Jamaica grief retreats for bereaved parents 17:20 The neurobiology of psilocybin, the default mode network, and reframing a loss 19:10 How to integrate a psychedelic experience afterward 22:20 The bereavement benefit almost no one uses 23:40 Key takeaways and what's ahead this season
Dr. Sunil Aggarwal is a physician at Seattle's AIMS Institute, where he leads an integrative oncology and palliative care practice and directs the clinic's psychedelic-assisted work with ketamine and psilocybin. He holds an MD and PhD from the University of Washington School of Medicine, where his doctoral work was in medical geography. Aggarwal was the first physician to petition the DEA for Right to Try access to psilocybin for terminally ill patients, litigation that produced a Ninth Circuit ruling finding the DEA had erred in denying that petition, a first for the agency. His clinical and legal work sits at the center of the current fight over who gets access to psychedelic medicine, and under what conditions, before federal rescheduling catches up.
@sunil1007 @aimsinstituteseattle
🔵 Additional Resources
Jamaica Grief Retreats, led by Dr. Dingle Spence, the group retreat program for bereaved parents discussed in this episode. Findings published as "Relief for Grief: Report from a Psychedelic Retreat for Bereaved Parents in Jamaica," Journal of Pain and Symptom Management, 2022.
The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief, Francis Weller.
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