While the prospect of entering old age, say beginning when we hit seventy, comes with some serenity, so too does it come with fear. Those of this age group have seen the ravages and indignities that could befall themselves having witnessed the experiences of their families and friends, as well as their exposures to cultural and social representations (movies, novels, art, TikTok, Facebook). Their fear ranges from mild concern to outright panic, and their reactions range correspondingly. Those with mild to moderate fear might take up exercising or some brain work, see their doctors regularly, and adopt wearables. Those in utter panic will consider much more drastic actions. In all cases, the reactions to these fears boil down to fighting destiny. 

Lionel Shriver, in her novel, Should We Stay or Should We Go, takes on the case of the panicked, and imagines what they might be willing to do to avoid the horrors that can attend old age and how their actions could turn out. She does this through the story of Cyril and Kay Wilkinson.  

The Pact 

Cyril Wilkinson and his wife Kay make a pact. On Kay’s eightieth birthday, when Cyril is already eighty-one, they will commit suicide together. Cyril, a physician in the British National Health Service (NHS) secured a supply of secobarbital as the means to their ends. It was 1991. They have planned well ahead; another twenty-nine years will pass before Kay’s eightieth in 2020. 

Motivating the pact was the death of Kay’s father after “a good four years of steady deterioration, followed by a solid ten of nothing but degradation” from dementia. (p. 7) Kay recalls “how he was physically so unpleasant,..managing the nappies alone was such a trial, because he fought and kicked a great deal, and sometimes, which was mortifying, got a soft little erection—honestly,  my own father.” (pp. 2-3) Then “the chasing and corralling and undressing…I was halfway between a daughter and a sheepdog. And in between these and many like events, pictures of Kay’s father kept popping up in her head, such as one showing him “naked below the waist, purple with rage, and covered in feces.” (p. 9) 

They had just arrived home from his funeral service and were reflecting on what they had been through. At one point, Cyril says, “Your father frankly made me suicidal—or homicidal—or both. Half an hour in his presence passed like a mini ice age,” and then promises Kay, “I will do almost anything to keep the two of us from acceding to such a fate.” (p. 12) Kay is dubious. 

That’s what everyone says…Everyone looks at what happens to old people and vows that it will never happen to them…Somehow they’ll do something so their aging will proceed with dignity…Everyone thinks they have too much self-respect to allow a stranger to wash their private parts…Then it turns out that, lo and behold, they’re exactly like everyone else! And they fall apart like everyone else, and finish out their miserable end of their lives like everyone else. (pp. 12-13) 

Cyril counters, “in order to retain agency over your own end of life, you have to be willing to give up some small portion of it that’s not particularly rubbish.” (p. 31) But, he admits the plan amounts to “placing a high-stakes wager.” (p. 32) Kay dithers over the next few months, but then her mother begins showing signs of dementia; “I’m all in,” she tells Cyril. (p. 17) 

The Pact Wobbles 

Cyril and Kay proceed through the subsequent twenty-nine years, with Kay raising their three children, retiring, finding new work and passions; Cyril going on and on about politics, the NHS, old people; and both watching their remaining parents pass on, traveling to far-flung locations, becoming grandparents, aging. Then the day arrives; happy birthday, Kay? 

The four years preceding Kay’s eightieth birthday overlap both the decision of the United Kingdom (UK) to leave the European Union (“Brexit”) and the Covid-19 pandemic. Thus, during the time Cyril and Kay are beginning to wonder whether they will actually leave or remain on Earth, the UK is deciding whether to leave or remain in the European Union. And while Cyril and Kay are seemingly willing to die rather than fight the ravages of old age, millions of people are willing to fight the ravages of Covid-19 rather than die. These juxtapositions pop up often giving the Wilkinsons’ decision added poignancy, and play a part in their newly manifesting doubts about the pact as the established date of its execution nears.  

At this juncture, Shriver conjures twelve different endings that still take the form of high-stake wagers. Through these alternative paths, we see if the wagers are well placed. We also gain insights on common and contemporary issues concerning aging, as well as on some hypothetical and futuristic possibilities. Among them are these: 

• The surprises still left between people after more than forty years of marriage 
• The possibility of a person with dementia as happy 
• Whether being sensible and prepared for old age is always rewarding 
• The prospect of outliving enjoyment, purpose, or interest in life 
• What life might be like when a drug reverses aging and makes elderly people twenty-five years old again, forever 
• Elder abuse within an institution and within a family 
• The adventurousness and desperation people approaching old age can exhibit 

Though each of the alternative endings comprise individual chapters, they are not wholly independent of one another as they each borrow ideas, paragraphs, dialogs, and sentences from the others. Some of them peel off into separate tales. Shriver does not limit these through lines to just those within the book. In one case Shriver samples another of her books, So Much For That, and in another, she riffs on an American in England who bloviates on BBC 4 and in a widely-circulated newspaper, who happens to be Shriver in real life. These interminglings make for more dynamic prose, and add some coherency to all the different alternatives presented. 

Destiny’s Grandparents 

None of the alternative endings stand out as the one they should follow. Shriver, though, offers other ways of accommodating the challenges and frights of approaching old age. Throughout the chapters, and with mostly dialog between Cyril and Kay as they think through their choices and decisions, she puts an emphasis on destiny, risk, and bravery.  

When Kay is arguing against the pact, she tries to impress upon Cyril that destiny has a part in what becomes of them, and that they cannot control all of it. “Our destiny isn’t wholly in our hands. I realize you don’t like that about the world, but there’s an upside: our destiny isn’t wholly our responsibility, either. Or, if we end badly, our fault.” (p. 241) Shriver emphasizes the point by making destiny a component of each alternative path they take. Destiny can’t be completely controlled, so embrace it, or at least accept it, Shriver may be saying.  

As they did with their original plan for Kay’s eightieth, the Wilkinsons would have to wager that the outcomes of any of their alternative paths would be more preferable than the status quo. Kay acknowledges that this reality has been the case throughout their life when she asks Cyril, “every decision we make is a gamble, isn’t it?” (p. 202) So, why not give them a go? 

The pact Cyril and Kay make can seem brave, but Shriver is not having it, and especially not when compared to the bravery needed in old age. “Real bravery and nobility,” Kay tells Cyril, “entail losing everything you love by degrees like everyone else, and taking what comes like everyone else, and dying when you least expect it and when you don’t want to, like everyone else.” (p. 75) “Buck up,” Shriver could have added. 

We should stay: it’s destiny, with risks, be brave, eat your ice cream.  

Should We Stay or Should We Go
HarperCollins, 2021: 266 pages 

Image Credit
Title: The Voyage of Life: Old Age 
Artist: Thomas Cole, 1842 
Source: Obelisk Art History  Public domain 

John O’Connor, whom I happened to interview on May 5, explores a similar dynamic unfolding amid today’s psychedelic renaissance—a movement rife with magical thinking that he sees as something of a religious revival—in his delightful and enlightening new book A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon. 

Some Westerners are appropriating sacred plants while divorcing them from the traditions that gave them meaning—“colonizing them in reverse,” as American ethnobotanist Glenn Shepard puts it (p. 211). For example, ayahuasca use, despite widespread belief, may not date back thousands of years. Instead, O’Connor argues that the practice “rarely existed where Indians remained isolated from Western meddling” (p. 222). Its expansion beyond the Río Napo began relatively recently with Jesuit missions in the early 17th century and later accelerated through 19th-century rubber camps along the major river systems of the Amazon Basin. Through Western tourism, ayahuasca has come to be portrayed as “an ancient ritual for slaking our insatiable thirst for Indigenous salvation and/or for increasingly extravagant highs” (p. 223). 

During our meeting, O’Connor told me he does not “think there’s ultimately harm in appropriating a plant if you find it therapeutic, useful, or even life-saving—which a lot of people are reporting these drugs can be.” 

At the same time, he said, “we need to have an honest, good-faith conversation about where these drugs come from, what their actual Indigenous uses are, and what they are.” 

To write the book, which explores humanity’s broader relationship with psychedelics, from ancient religion to modern medicine, O’Connor worked with the Uitoto people to retrace an expedition undertaken some 50 years ago. Into the Colombian rainforest—home to begonias as red as blood and butterflies as wide as hubcaps—ventured scientific researcher Dennis McKenna and his older brother Terence, the visionary whose “tangled beard hung like an oriole’s nest past his chin” (p. xix). Weary of the war on drugs and fueled by utopian fantasies, Terence’s army of psychonauts sought a legendary hallucinogen that would turbocharge their DNA and “hasten a return to our preindustrial and preliterate past” (p. 284). 

In reality, Terence and his disciples did not transform into “eternal hyperdimensional beings” or travel via “flying saucers of the mind… ‘into the plenum of being’” (pp. 94, 30). Nor did they propel “human evolution forward to its next stage” by connecting to “the mind of nature itself” (pp. 284, 11). But they did experience auditory and visual hallucinations that led them, in a manner not unlike schizophrenia, “to adopt a new narrative interpretation of the world” (p. 95). 

Armed with the spore prints they’d brought back from La Chorrera, the McKenna brothers were “among the first, if not the very first, to successfully cultivate magic mushrooms at home, sparking a major leap forward in psychedelic history” (p. 202). In 1976, they published Psilocybin: Magic Mushroom Grower’s Guide; this April, half a century later, President Donald Trump signed an executive order expediting research into the therapeutic benefits of psilocybin and other substances of its ilk. 

O’Connor mentioned that one such mind-altering drug, ibogaine—made from the root of a Central African shrub—has shown promise in treating post-traumatic stress disorder and substance use disorders. 

“That’s great,” he told me, “but it also has a habit of slowing people’s heart rates considerably,” among other life-threatening side effects.  

“People are diving into these treatments as if there are no potential risks,” O’Connor, who teaches journalism at Boston College, added. “They don’t work for everyone—they’re not a magic bullet.” 

The remainder of the interview, which follows, has been edited for length and clarity.  

Why did you choose Terence as the focal point of the book? 

I hadn’t heard of him, and I pride myself on knowing about eccentric, overlooked weirdos from the psychedelic ’60s and ’70s. I was doing a lot of retail therapy online during the pandemic, as were many folks, and I came across his book, True Hallucinations (1989), totally by happenstance. I hadn’t known anything about it, bought it, and put it on the shelf for two years.  

I finally opened it one day and started reading. I had some preconceived ideas without really knowing anything about Terence or his subject. I thought it was probably some hippie-dippy thing about machine elves, and it sort of is that, but that’s not all it is. It’s a great narrative and just fascinating—it just captured me. 

Terence postulated that psilocybin mushrooms “played a crucial role in human evolution, giving our remote ancestors a jolt in language and cognition” and “turning Homo erectus into Homo sapiens.” While there’s nothing in the fossil record to support Terence’s “stoned ape theory,” according to anthropologist Laura Weyrich, advances in proteomics and DNA-sequencing technology could potentially indicate whether ancient hominids at least ate psychedelic mushrooms.  

How plausible do you think stoned ape theory is? 

When I first began looking into it, I was like, “Oh, this is so ridiculous.” I was embarrassed to ask these various paleoanthropologists, archaeologists, and researchers about it. I was like, “Oh my God, I can’t ask this, but I have to.” But it turns out that, as a thought experiment, many of them also found it interesting. It’s not something that I think is ultimately really provable. You could find some tangential scientific evidence, but you’re probably never going to get a smoking gun. 

Terence had a lot of theories—some relatively sane-seeming, like the stoned ape theory, and some completely batshit theories that have no basis in science or reason. But I sometimes liken him to Sigmund Freud, or maybe some of the kookier analytic philosophers, where you read it, it sounds kind of good, and then you get to the end and think, “Well, that’s probably 95 percent bullshit, but it still enriches my worldview.” I feel more enriched for having read it. That doesn’t mean it’s true, and I don’t put much credence in it, but it’s fun to entertain, and I do think it enriches the way I think about the human mind and human possibility. 

You also mention how “what drove [you] to write this book was in part a procession of deaths and their aftermaths” you and your wife endured starting in 2019. Would you elaborate on that? 

About a year into writing the book, my son, who was four at the time, fell ill unexpectedly, out of nowhere. He was in and out of the hospital during those days. It really brought us face to face, for the first time as parents, with real suffering and grief, and with being totally out of control when it came to finding a remedy for him. There was just no help to be found anywhere. I started thinking about grief and suffering, and how much of it was around us.  

Then there was this kind of cascade of deaths—just a lot coming at once over the span of a couple of years. It made me wonder what psychedelics, at least on a therapeutic level, potentially have to offer people: some relief.  

Another thing: My father was, weirdly, at the same time, starting to consider psychedelic-assisted therapy to treat his depression and longstanding addiction to alcohol. Maybe a year before, I’d given him Michael Pollan’s book, How to Change Your Mind: What the New Science Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018). Because my dad had been in and out of therapy, rehab, and 12-step programs for many years, I was like, “I don’t know if you’ve heard of this, but I’ve been reading about non-traditional approaches to treating alcohol addiction, including psychedelics.” I don’t think he ever read it, but it did start a conversation between us. 

What surprised you most while researching the book? 

Reading Terence, I hadn’t realized that psilocybin mushrooms were not indigenous to La Chorrera—that they were essentially a foreign import [1], and not something used by the people there, certainly not by shamans. 

Another revelation was what “shamanism” actually looks like in the Colombian Putumayo. Terence talked a lot about this sort of psychedelic shamanism. A lot of people do today, too. But it’s just not at all what it seems to be. The Indigenous perspective on and use of things like ayahuasca, or yagé, and other psychedelic plants—at least in the Putumayo, where Terence and Dennis spent much of their time—is vastly different from how I think they’re generally understood or used in the U.S. These substances were generally not used for healing. Until European contact with Indigenous peoples throughout the Amazon Basin, ayahuasca was mostly used in the hunt—to have luck in finding animals—or sometimes to find lost objects or communicate with family members or other tribe members over long distances. But it was definitely not a therapeutic application. That’s starting to shift a little bit now, though, because of this strange sort of cross-pollination that happens so often in history where it’s now being fed back into an Indigenous context. 

I think I went into the book as something of a Terence fanboy. I cooled on him a bit once I spoke with Colombian anthropologists and ethnobotanists and realized how taken out of context many of his proclamations were on psychedelics and the “shamanic” experience. But, by the end, I sort of warmed to him again because I realized that his ultimate project, I think, was really about human wellness and flourishing. I think that’s what he wanted ultimately, even if he went about it in a strange, myopic way focused almost exclusively on the psychedelic experience through psilocybin mushrooms. That’s where I part ways with him. I think the best place from which to grapple with grief, loss, and suffering is through love, tenderness, and compassion—not through machine elves at the end of history, which was, more or less, Terence’s take. 

I was also interested in your discussion of “diagonalism”—what scholars William Callison and Quinn Slobodian characterize as the social-distress-born alliances between the far left and the far right uniting wellness gurus, anti-vaxxers, and conspiracy theorists. 

I was just reading an article by the American political scientist Francis Fukuyama; he calls it this horseshoe meeting of the minds—this ideological vortex where people with otherwise totally divergent political opinions are meeting in the middle on certain issues. The far left, the Make America Healthy Again movement, the Multidisciplinary Association for Psychedelic Studies—even just the friendship between [MAPS founder] Rick Doblin and former Texas Governor Rick Perry [co-founder of the nonprofit Americans for Ibogaine], who had one of the most conservative legislative agendas in recent memory. That friendship seems genuine—and maybe even necessary to advance these drugs beyond their current legal status. 

In 2023, MAPS hosted the world’s largest psychedelic conference, which you describe as laden with snake oil pseudoscience and lacking in diversity, equity, and inclusion. Almost a year later, an FDA advisory panel rejected MDMA-assisted therapy for PTSD, citing safety concerns and questions about data validity. Critics alleged that MAPS’ drug development arm failed to disclose data showing sexual misconduct by therapists and increased suicidality among trial participants. A former MAPS volunteer called MAPS an exploitative and abusive cult that functions “more like a religious movement than a scientific organization.” Similar concerns emerged at The Johns Hopkins Center for Psychedelic and Consciousness Research. An ethics complaint accused founding director Roland Griffiths of “acting as a ‘spiritual leader’ rather than a scientist” and influencing participant outcomes through religious symbolism. 

Additionally, a Columbia psychiatrist reviewing the field noted a relatively high rate of  irritability, anxiety, insomnia, and other adverse events, and called for more “rigorous assessment” of psilocybin-assisted therapy.  

How do we balance the potential of psychedelics to promote empathy and well-being with the risks? 

Terence said a lot of completely bullshit things about psychedelics—even dangerous things at times. You see that in the movement today, where a lot of these wild, unsubstantiated claims are being made about drugs that, yes, have real healing potential for many people, but for others, such as my father, don’t work at all—and arguably cause more harm than good. 

We should be sane and sober about this. We can champion these drugs while still having a lucid conversation about their efficacy, limitations, and safety concerns. 

[1] One of my favorite passages from the book is “Darkly gilled, with distinctive golden halos and pink veils around slender stems the color of bruised flesh, they were easily identifiable as Psilocybe cubensis… Likely brought to the Americas by Spanish missionaries via the dung of zebu cattle—rangy saltwhite beasts with enormous, scythe-like horns—Psilocybe did especially well in the humid pastures of La Chorrera. Amazonian shamans, who knew more about psychoactive plants than anyone on earth, had no use for these foreign imports. To Terence, however, they were living manifestations of the divine” (p. xx). 

A Short, Strange Trip: An Untold Story of Magic Mushrooms, Madness, and a Search for the Meaning of Life in the Amazon 
John O’Connor 
New York: Sourcebooks 
2026