On psychedelics, dying, and wisdom that predates modern medicine.
When death becomes a true player and approaches our present day, in a very real way, it brings with it a spectacular kind of fear. The fear of pain or the fear of what happens to the body is not the one on focus right now. This fear is something more abstract and more difficult to place your finger directly on. This fear is of dissolving, no longer being of a body with your consciousness, your face, and your idea of your place on this planet. This fear takes a step beyond the edge of things familiar and places it into a space that can not be rehearsed or fully imagined. Some kind of trust is involved.
In the process of dying, this fear can move in waves as tumultuous as the ocean. Sometimes it crests as sharp and immediate; other times it hums annoyingly in the backdrop of your life. The fear shapes the emotional landscape of a human’s dying process. Even for those who have lived full lives, even for those who feel prepared and ready, there is this deep, instinctual resistance to the unknown.
What if there was a way to meet that fear in a different way? What if you did not have to erase or bypass its existence? What if you were able to shift the relation with this fear, soften its grip with your present reality and open up space around the fear?
Certainly, these are not new questions and observations. They are very old ones that many humans have forgotten, and the answers have been stripped from many of us, replaced by fear.
The Long Memory
Ages before modern medicine began to define what is acceptable at the end of life, human beings across cultures had been working with powerful tools, plant medicines, to navigate the transitional threshold between life and death.
In the mountains of Oaxaca, Mexico, Mazatec healers have worked with psilocybin mushrooms for generations. These were not casual substances. They were held as sacred medicines, used in ceremony to heal, to receive guidance, and to move between worlds. María Sabina, one of the most well known curanderas, described these mushrooms as a way of speaking with the divine. They were a means of entering a state where the boundary between the living and the unseen becomes more permeable. For those nearing death, or those accompanying the dying, these ceremonies offered a way to approach the passageways and crossings with reverence rather than fear.
In ancient Greece, there were initiates who traveled to participate in the Eleusinian Mysteries. These mysteries were a ritual tradition that endured for nearly two thousand years. Participants drank a ceremonial brew known as kykeon and underwent an experience often described as a symbolic death and rebirth. Philosophers like Plato and Cicero wrote of these rites not as myth or superstition, but as profound encounters that transformed their understanding of mortality. To be initiated was to lose the terror of death, not through belief, but through direct experience.
In the Amazon basin, Indigenous traditions have long used ayahuasca in ceremonial contexts to prepare individuals for death and to support communities in grieving. These practices are relational, guided by skilled healers, and embedded within a broader cosmology that understands death not have to be an abrupt ending a transition within a larger web of existence.
Across continents and centuries, the pattern is clear as day. Human beings have repeatedly turned to these medicines at the edge of life. The medicines, ceremonies, and people were intentional and not reckless. They were held in community and not fringe practices in isolation. They were cultural, central, and woven into the fabric of understanding. For a very long time, this knowledge was carried forward with care.
What Was Lost, and Why?
The continuity of dying wisdom was disrupted in the mid-20th century. In a relatively short span of time, substances that had been used ceremonially for generations were reclassified under emerging drug laws. Psychedelics became associated with danger, instability, and a lack of medical value. The research was halted, and these wise cultural practices were pushed to the margins. The healers, elders, ceremonial guides and communities, the people who held this knowledge, were dismissed or silenced or colonized for profit.
This shift did not occur because these medicines had been thoroughly studied and found ineffective. Of course not, the disregard was, in many ways, a broad and sweeping response shaped by political, social, and colonial forces of the time. The result was a rupture. A thread that had connected ancestral practices to the modern world was intentionally cut. In the process, something meaningful was lost, for those seeking healing in life and for humans in relation with death.
The modern medical system continued to evolve in remarkable ways, extending life and managing physical symptoms with increasing sophistication. Profits skyrocketed in exchange, insurance companies and greed consumed the treasured meanings and relations with stewards of the land. Now, when it comes to the inner experience of dying with the psychological, emotional, and existential dimensions, so few tools remain. The fears have not disappeared and the questions are still present. What was once there to meet people with woven, ancestral practices are no longer accessible.
What the Research Is Remembering
In recent decades, a conversation has begun to reopen. The profits and greed and insurance are still there. Studies carefully designed at institutions like Johns Hopkins University and New York University continue to explore the use of psilocybin-assisted therapy for individuals facing life limiting and threatening illnesses. The findings have been helpful for loosening the grip of stigma.
The participants in these studies have shown substantial and sustained reductions in death anxiety. Many report an increased sense of meaning, a greater acceptance of mortality, and an improved quality of life in their remaining months. For some, a single guided experience led to a shift that endured well beyond the session itself. The fear is not eliminated or wiped off the map of our mind and body. We are capable of recognizing and obtaining the ability to change its shape. The way we perceive the fear by reducing its intensity, loosening its hold, and expanding its space for other emotional states to emerge.
Parallel research through organizations like MAPS have examined MDMA-assisted therapy for individuals with severe and treatment resistant PTSD. While this work is not specific to end of life care, it has shown to be deeply relevant. When there is unresolved trauma, this interrupted flow often intensifies distress at the end of life. It makes it more difficult for individuals to find peace, comfort, and ease. Sometimes, addressing trauma can significantly alter the emotional landscape of dying.
What these studies are seen to collectively suggest is that psilocybin and MDMA can facilitate experiences that are both psychologically meaningful and therapeutically beneficial. The studies are rooted in structured, supportive settings. For clinicians, this points to a growing body of credible research. For individuals, communities, and families, it may offer options beyond simply enduring the fear.
What Does This Look Like?
Psychedelic-assisted end of life care, at its core, is relational work. Many frameworks of best practices are being filtered into modern, western culture. These ethical codes are unfinished unless they include the necessary and relevant highlights on cultural humility, diversity, community care, plus a multitude of other reverent groundworks. Here, we take a look at three logistical steps for use with experiences into expanded or nonordinary states of consciousness.
Preparation begins with conversations about intention, fears and hopes, plus questions for what may come to pass. These sessions are for identifying and building trust between the client and the companions, guides, guardians, or facilitators. All participants use informed consent, boundaries, and ethical considerations while building a container where the experience can unfold safely with tenderness.
The day or night of the experience takes place in a balanced and supported environment. The participants remain present; companions offer grounding, reassurance, and attunement as needs arrive in the present. There can be music, art, movement, silence, and walking in frame. The preparation sessions set up the environment to be of support for a relaxed and expanded process. For many people, the experience envelopes a shift in perception, no matter how profound.
There may be an underlying sense of otherworldly interconnectedness. This may figuratively or relatively dissolve the rigid boundary between self and world. There may be subtle moments of insight, emotional release, or deep serenity. These individuals describe encountering death not as an abrupt void, but as part of a larger continuity. Others may find that the fear is no longer as overwhelming as it once was. The priority and narrative of what was considered deep grooves of behavior, becomes more pliable for reflective softening.
An expected, specific outcome does not do well with psychedelic-assisted experiences. The inner experience of dying is being tended to and the management of it is deeply personal.
Integration sessions begin just after a bit of rest and reset. There is time to reflect, to make meaning, to carry whatever emerged into the remaining days or weeks of life too. This step is as important as the experience itself. Integration offers help by bringing any insights into a lived reality. Death is not ever removed, it simply has a greater opportunity to be seen in a more integrative light.
Continuation of Thoughts
There is a growing recognition that end of life care has reached its own threshold and must extend beyond the physical. There are essential, extra ordinary care providers working with pain management, symptom control, and medical intervention. We are all growing in the same direction and a big part of the deathcare ecosystem. The psychological and existential dimensions of dying are threads within humanity and all living things. Ever more widely, humans are identifying the questions of meaning, connection, and fear.
There are plants, cultures, and communities that have been on our planet for a very long time. There may be a possibility of remembering these medicines and actively listening within conversations with them. Conversations around practice, research, land knowledge, ethical acceptance, plus consensual boundaries. We do not need a replacement for modern medicine. Death is a gigantic complement as an integral area of inclusion within the medical care system. This addition expands the options for care at the crossways, passageways, and transitions of deathcare.
Humans across time have welcomed a way of being with the unknown and it remains unforgotten.
Important Disclaimer
This resource is intended for educational and professional development purposes only. It does not provide medical or legal advice. Practitioners are to always follow local laws, professional guidelines, and medical consultation when appropriate.
Created by Jennifer M Brown of Under the Root
Presence-based death doula goods and support services for individuals and loved ones navigating death, dying, grief, and transitional thresholds.
