What We Know About Treating Extreme Grief With Psychedelics

The New York Times

By Dana G. Smith

Jan. 10, 2023

In his new memoir, Prince Harry talks about taking psychedelics to deal with the ongoing pain over the death of his mother. Here’s what we know and don’t know about their effectiveness.

Prince Harry and Meghan Markle have been remarkably transparent about their psychological struggles. In a documentary about mental health that he filmed with Oprah Winfrey in 2021, Harry included a video of himself undergoing E.M.D.R., or eye movement desensitization and reprocessing therapy, which helps people with post-traumatic stress disorder cope with triggering memories. Ms. Markle has spoken candidly about experiencing depression and suicidal thoughts.

Harry’s new memoir, “Spare,” is no different, including raw and sometimes shocking details about his battles with mental illness. At the center of many of these experiences is his grief and trauma over the death in 1997 of his mother, Princess Diana, when he was 12 years old.

In the book, he described trying both traditional and unconventional ways to cope with his pain and that using psychedelics was particularly helpful. After one therapist suggested that he suffered from PTSD, Harry started to use mushrooms and ayahuasca “therapeutically, medicinally.” (He had previously experimented with psychedelics recreationally.) “They didn’t simply allow me to escape reality for a while, they let me redefine reality,” he wrote.

Psychedelic therapy has experienced a groundswell of enthusiasm over the past decade as research mounts showing the mind-altering drugs can be useful for treating depression and other mental health disorders. (The therapy is still illegal in most places and is primarily done in underground sessions, abroad or through clinical trials.) However, there is scant evidence about whether psilocybin — the psychoactive ingredient in hallucinogenic mushrooms — and ayahuasca might be helpful for processing grief and trauma specifically.

Dr. Joshua Woolley, director of the Translational Psychedelic Research Program at the University of California, San Francisco, is optimistic about the drugs’ potential. “Can psychedelics help with the experience of grief? I would say probably yes,” he said.

But other experts are less bullish on the idea of using them for trauma. “The actual evidence is really lacking,” said Dr. Shaili Jain, a PTSD specialist at Stanford University and author of “The Unspeakable Mind.” “It’s very early, and we still don’t know the long-term side effects. We are not there yet.”

Grief Versus Prolonged Grief

Grief is not a mental illness; it is a normal human experience that comes after the loss of a loved one. Sadness, anger and disbelief that the person is dead — something that Harry described in his book — are all typical responses to the profound pain of death and can last for months or years. However, if the grief has not improved at all after a year and is affecting a person’s ability to function, a diagnosis of prolonged grief, sometimes called complicated grief, might be warranted.

“What we see with prolonged grief is that the grief becomes very entrenched, that things look the same for this person today as they did the day after” the death, said Mary-Frances O’Connor, an associate professor of psychology at the University of Arizona and author of “The Grieving Brain.” “For a person who’s adapting more typically, a year after a loss, they’re still going to have sadness. They’re still going to miss the person who’s gone. But you can see this trajectory of change where they have started to restore a life that feels meaningful to them.”

People with prolonged grief may feel that life has lost its meaning or that a part of themselves has also died; they might have intense emotional pain or feel complete psychological numbness. Harry does not say in his book whether he was ever diagnosed with prolonged grief, but he does describe some of these emotions, and symptoms of PTSD and prolonged grief often overlap. About 10 percent of people mourning a loved one will develop prolonged grief, and the risk is higher if the death happened suddenly or traumatically.

Treatment for prolonged grief often involves cognitive behavioral therapy to help people start to move on and engage in meaningful activities again while they continue to cope with the grief. “It’s not about taking grief away,” Dr. O’Connor said. “It’s about learning how to live with the fact that you are a person who has waves of grief now.”

Using Psychedelics for Grief

Scientists think that psychedelics work in two ways: through their chemical effects on the brain and the subjective experiences a person has while on the drugs. For many people, psychedelics act like “a very intense, fast psychotherapy,” Dr. Woolley said.

Psychedelics “have this potential to induce these transpersonal states of consciousness where people might feel like they are connected” to the deceased relative or friend, added Greg Fonzo, co-director of the Center for Psychedelic Research and Therapy at Dell Medical School, University of Texas at Austin. “That might allow people to move past some of the stuckness that occurs when they’re in this phase of grief.”

In the brain, scientists think that psychedelics induce a “plastic state,” helping to rapidly form new connections between cells. Those new connections may be behind the insights and reprocessing that people can experience when they use the drugs in a therapeutic setting.

There are very few published studies focusing on psychedelics’ effect on people experiencing prolonged grief. In one of the few relevant trials, Dr. Woolley looked at whether psilocybin, combined with group therapy, could help older, long-term AIDS survivors process their depression and survivor’s guilt surrounding their diagnosis, as well as the loss of friends and family to AIDS. The 2020 study, which included just 18 men, assessed the participants’ levels of demoralization — a therapeutic term for an existential sense of hopelessness and loss of meaning in life. Most of the participants had experienced profound grief and trauma because of the AIDS epidemic; on average, the participants had lost 17 loved ones to the disease.

After one psychedelic therapy session, nearly 90 percent of the men experienced a reduction in demoralization, and many saw a decrease in symptoms of PTSD and complicated grief. In a follow-up paper describing the men’s subjective experiences, the researchers wrote that psilocybin was “a catalyst for reconstructing their identities from rigidly centered on their past traumas to more flexible and growth-oriented life narratives.”

“The people in our study often talked about feeling stuck and detached from people around them and not able to move forward,” Dr. Woolley said. The psilocybin “did seem to help them move forward, to become unstuck and start being more engaged in life.”

Another study published in 2020 by researchers in Spain found that 39 bereaved adults who took part in ayahuasca ceremonies at a retreat center in Peru reported a decrease in the severity of their grief, and those benefits lasted for at least a year. The researchers wrote that people using ayahuasca to process their grief “described emotional confrontations with the reality of the death, the reviewing of biographical memories, and a re-encounter with the deceased.”

While these results are promising, both studies were small and neither included a control arm to compare the effects of the psychedelics against a placebo or another medication. The majority of participants in the ayahuasca study also reported that they expected to benefit from the experience, which may have had an impact on the results.

There is stronger evidence that psilocybin can be useful in treating depression, including in trials comparing the drugs’ efficacy to standard antidepressant medications. Similarly, M.D.M.A, which is sometimes classified as a psychedelic, has been shown to be effective at treating PTSD. Some researchers think that because prolonged grief has many similarities with depression and PTSD, psychedelics could be useful for treating it too.

Dr. O’Connor said that given how scientists think psychedelics work in the brain to treat depression, it’s conceivable that the drugs could also be helpful for people with prolonged grief. However, she cautioned against using the drugs to cope with grief that had not been diagnosed as prolonged or complicated.

“I would not say that it is appropriate to intervene with something as mind-altering, as dramatic, as psychedelic therapy if a person is, in fact, healing in the way that we would expect them to,” Dr. O’Connor said. “Meaning, I would worry that you could do more harm than good and that it just may not be necessary.”

The experts also emphasized that experimenting with the drugs recreationally is not the same as using them in a controlled therapeutic environment. After trying psychedelics in both settings, Prince Harry echoed this sentiment. In an interview with 60 Minutes, he said that he “would never recommend people to do this recreationally,” but that in the right setting the drugs worked “as a medicine” to help him process his grief and trauma.