Why—Still—the Sound of Silence?

In our work in drug development, we seek psilocybin-based medical solutions for those who suffer from intractable anxiety or depression after receiving a difficult or life-limiting diagnosis. We’re guided by remarkable breakthroughs in psychedelic research that include data from trials at NYU, UCLA, and Johns Hopkins, which demonstrate immediate and lasting symptom relief.

We are also guided by patient experiences and patient voices. In Canada, for example, stage IV cancer patients are now active advocates for psychedelic access at end of life. One patient, Thomas Hartl, has joined a legal challenge expected to go before that nation’s highest court. In America, Erinn Baldeschwiler, a mother of two who suffers from end-stage metastatic breast cancer, joined the long tradition of peaceful civil disobedience in Washington, DC, by demonstrating at the headquarters of the Drug Enforcement Administration. On the Monday after Mother’s Day, she was arrested for asserting her legal right to medicinal psilocybin under the federal “Right to Try” law.

These brave patients are advocating for access to safe and legal medicinal psychedelics to secure their own wellbeing and to help others facing the despair of similar mental health challenges. In working to improve access for themselves and others, they are educating both the public and policy makers. As recently as March 2023, a bipartisan group in the U.S. Senate reintroduced legislation to ensure that investigational psychedelic medicine is available for palliative care.

Yet one group of voices is missing—and that’s our own. We are now asking ourselves why we so rarely hear the insights of the doctors, healers, and biopharma executives? Is it because our work is expected to speak for itself? Or is it because we have been trained as professionals to be quiet, and because our ecosystem discourages the sharing of our emotions?

What we have come to realize is that a code of professional silence is established early; even when—or perhaps especially when—our healing treatments fail. Indeed, the very definition of “professionalism” is defined in large part by what the Godfather would have called omertà: the code of silence. To break silence is to betray the field.

For one of us, Dr. Amza Ali, silence arrived early in his medical practice. As a newly minted MD, he felt personally invincible and certain that his degree and white coat would allow him to protect his patients. But a white coat is not a superhero cape, a hard lesson he learned at the bedside of his youngest patient, “LH,” who was two years old.

LH was admitted to the pediatric surgical ward with an advanced aggressive tumor with brain metastases. Whenever Amza stopped by LH’s crib, which he did often, LH would smile and even laugh through the terrible pain that was largely caused by the treatments.

One day Amza stopped by to find that LH wouldn’t wake up; that night, he remained the same. The next night the crib was empty. Years later, Amza still experiences the anguish of seeing that empty crib. It’s strange, says Amza, that he has no memory of the child’s parents, nor can he recall if he even ever spoke with them again. He wonders whether his mind blocked the memory of the bereaved father and mother because the memory of their pain was too much to bear with his own.

Over decades of active clinical practice, other painful memories have seared his soul:

“A 54-year-old wife receiving a diagnosis of ALS and telling her significantly older husband, “See? After all, I am the one who will go first.””

“The 33-year-old physician dying of brain and lung metastases from breast cancers. As she struggled to breathe, partly unclothed as the doctors and nurses—including me—worked around her, her last words were an unnecessary and almost unbearable apology, “This is so embarrassing.””

Professional silence can only add to the burden of such professional heartbreaks. And while the cost of silence may not be directly measurable, it is an obvious contributor to high rates of burnout, diagnosable anxiety, and depression among healthcare professionals. In findings presented by the American Psychiatric Association, it is reported that suicides among physicians are the highest of any profession.

What we have come to realize is that those of us developing the field of psychedelic palliative medicine should do no less than the courageous patients we are working to serve. We need to match the voices of those pioneering palliative patient-advocates. As a healing industry, we need to learn how to more openly share in both the doctor’s and patient’s emotional and spiritual journeys. We need a shift in how we express ourselves so that our own emotions are considered a strength for better medicine and better pharmaceutical development. Many studies decry the medical profession’s loss of “bedside” manners, which might simply be a shorthand phrase for the medical field’s discomfort with honest conversation.

The head of palliative care at MD Anderson Cancer Center, Eduardo Bruera, MD, has written a guide for palliative care physicians urging the medical profession to remember that sometimes “the most important instrument” in medicine is “a chair.” That chair, Dr. Bruera believes, holds the power to break professional silence simply because it puts the medical team member at eye-level with the patient—and this level of conversation, he says, can help achieve better outcomes.

Thomas Hartle, Erinn Baldeschwiler, and other brave psychedelic patient-activist leaders remind us what great healers know by heart: that openly and unashamedly engaging in dialogue and breaking the professional code of silence may not contribute to a cure, but it most certainly contributes to healing.

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