It’s a gripping few minutes of video. Nicholas, a young, bearded man, lies on a raised futon in what looks like a suburban den. He could be anybody’s kid home from school, dozing restlessly in a T-shirt and sweat pants, the spidery ends of dark tattoos peeking out of his shirt sleeves. As the camera pans out, we see an older man and woman in chairs on either side of him. There’s a discarded eyeshade and headphones near him on the mattress. His eyes flutter as he starts to talk, relating what sounds like a horrifying dream in real time.
“I never had a problem when I watched my friends die,” he says. “When I watched Manny, Cliff, burn alive. When everybody gets blown up, you don’t just sit there and cry like a little baby: you keep on pushing and finish your job. I don’t know how they get that into you, but they do.” Nicholas goes quiet for a moment, and the woman draws closer. “It just doesn’t feel right,” he says plaintively. “It feels cold to feel like that.”
The older man’s voice rises softly off camera, encouraging him to stay with his distress: “I think what this is, is a wave of something painful that needs processing,” he says.
Long back from two tours as a Humvee turret gunner in Iraq, Nicholas is a Marine combat vet in the midst of a mighty struggle with treatment-resistant PTSD. Among the symptoms he’s grappling with is uncontrollable anger, causing him to blow up frequently at his wife and other people in his life. With him are psychiatrist Michael Mithoefer, a professor at the University of South Carolina Medical School, and his wife, Annie, a nurse, who together have been leading research into the effects of combining doses of MDMA, a pure form of the club drug Ecstasy, with psychotherapy. They’re sitting with Nicholas for a session on the drug, having already prepped him in meetings beforehand to explore his trauma while under its effects.
Nicholas goes on to tell them, “I have this negative battle going on in my head, this part that’s just saying I’m a murderer and killer . . . that I wanted to do it, I wanted to go over there and hurt people. . . . That evilness; I don’t want any space for that in my life.”
“It’s a really important part of you that doesn’t want that,” Michael Mithoefer says, but reminds him that we all have parts that carry rage and the potential for violence: they just don’t need to be in charge. He suggests it may be time to understand that part of him and help it heal.
At first, the words don’t help; Nicholas says he can’t let them in because it makes him feel too helpless. But soon he’s sobbing, telling them a part of him wanted to die at war. “I just wanted to be done,” he says. The Mithoefers both put their arms around him as he cries, and they nod when he quiets and tells them, “I just don’t let myself feel sometimes, how much it hurts.”
The film skips ahead to another MDMA trip with Nicholas. He’s been listening to instrumental music to facilitate his inward journey and suddenly speaks up to tell the Mithoefers that its intensity has just reminded him that he was brave and strong in Iraq. “I saw myself in a whole new light,” he reports. “I’ve seen how low man can be . . . that side of the spectrum that’s so dark and so evil. There’s that other side that’s a balance to it. Accepting those things as one really just makes me feel complete.” Now, instead of burying his past in a way that’s been hurting him, he wants to acknowledge all parts of himself, the warrior as well as the softer side: he wants to reconceive of himself as a “peaceful warrior.”
We see Nicholas a final time, in a chair on a stage wearing a well-tailored suit, his hair longer, his life different, as he talks about how he wouldn’t be here today without MDMA-assisted psychotherapy. He tells the audience that since his experience with the Mithoefers, he and his wife are going to have a baby. He says, “I finally feel like I have my head together. I didn’t want my child to see me the way I was before, and I’m so grateful for this therapy.” Without it, he adds, “I wouldn’t be alive.”
Tripping into Breakthroughs
Since 2004, when the Mithoefers first started testing MDMA-assisted psychotherapy, more than a hundred vets, cops, firefighters, and sexual assault and abuse survivors have undergone treatment. The approach has proven so successful that the Food and Drug Administration has deemed it a “breakthrough therapy” for PTSD, and is helping the Mithoefers speed along the final phase of trials with hundreds more trauma survivors. More than 20,000 have already signed up to be part of it.
In addition, the Mithoefers have started training more therapists in the work. If all goes well, these therapists could be staffing licensed clinics by 2021. The FDA has even hinted at the possibility of a special dispensation that would allow some treatment to begin before the studies are finished—as early as 2019.
This year, the Journal of Contemporary Psychotherapy compared MDMA-assisted psychotherapy to talk therapies. The authors found Trauma-Focused CBT and Cognitive Processing Therapy produced clinical improvement in 44 percent of their PTSD subjects. They also found commonly prescribed drugs, like Paxil, Zoloft, and other SSRIs, were effective 20 to 30 percent of the time. But in Mithoefer’s original phase-2 study with treatment-resistant PTSD subjects, who averaged 19 years with the disorder, a remarkable 83 percent of participants no longer met the criteria for PTSD after completing treatment.
When they followed up with them 45 months later, 74 percent had held onto improvement. They also reached out to subjects from all six of their phase-2 studies at the one-year mark. When they pooled those results, 68 percent still didn’t have PTSD, and one of the trial sites in Colorado says 80 percent of its subjects stayed well.
The neurochemical action of MDMA seems custom-made to treat PTSD. It releases a jumble of feel-good neurotransmitters, including serotonin, dopamine, and norepinephrine. It puts oxytocin, the hormone that increases our positive feelings about one another, in play. And it quiets the amygdala, the brain’s fear center, while amplifying the higher processing of the prefrontal cortex. The result is an exact reversal of the hyperanxiousness of the PTSD state, and it allows people to process deeply entrenched trauma without the clouding of an overwhelming emotional response.
Like Nicholas, all of Mithoefer’s study subjects are coached by therapists in lead-up sessions to try to let go and follow the drug wherever it takes them. This way, the MDMA can help people dive unimpeded into difficult places and break down hardened defenses through a deep, visceral sense of compassion for all aspects of their selves, past and present, before trauma and after. Also, the prosocial effects that have made MDMA a base for the popular club drug Ecstasy accentuate feelings of trust in the therapists and the support they offer. It’s an effect that subjects say makes them feel deeply cared for during the experience.
The New York Times recently reported that these early study results have given hope to combat vets, some of whom are so desperate for relief from their PTSD symptoms that they’ve taken to doing MDMA illegally at home. This is concerning to the Mithoefers and their study funder, the Multidisciplinary Association of Psychedelic Science (MAPS), which is providing nearly $30 million for the research. They’re emphatic that for the treatment to work, the drug must be paired with therapy.
Preparatory therapy sessions help people feel safer on the drug and set an intention for their trip that can bring them to the heart of what they need to heal. And follow-up therapy sessions are a must, given that the powerful and often painful places MDMA takes them can trigger backlash later on—including flashbacks, heightened anxiety, and in some cases, suicidal ideation. Integrating those destabilizing feelings is critical, but doing this kind of work isn’t easy on therapists. While the standard appointment calendar of most trauma therapists revolves around weekly, 50-minute sessions, the kind of MDMA-assisted psychotherapy the Mithoefers envision necessitates a complete overhaul of their ordinary work pattern.
The MDMA protocol requires the drug to be prescribed in a clinic setting with a staff of at least two therapists, an assistant to stay overnight with the client after the trips, and a prescribing doctor. Therapists must commit to long, quiet hours supporting clients as they go inward on the drug. They must also be available afterward for three 90-minute integrative sessions following each of the three trips, which are spaced weeks apart, and for phone contact 24 hours a day for the immediate week after each.
Talking with subjects in the Mithoefer study, one hears again and again how the treatment “saved” them, and gave them back their life. Journalists are hearing similar tales and producing a steady stream of stories, on not only the success of the MDMA trials for PTSD, but the work of research teams focused on the therapeutic potential of psilocybin (the active ingredient in “magic mushrooms”), LSD, ayahuasca, and the psychedelic ibogaine, to treat depression, anxiety, addiction, OCD, eating disorders, and fear of death for cancer patients.
ABC, CBS, CNN, NBC, NPR, PBS, Chelsea Handler, The Guardian, The Late Show with Stephen Colbert, The LA Times, The New Yorker, The New York Times, Rolling Stone, Scientific American, and Time have all beaten the drum recently about psychedelics being the next big thing in therapy. Even a conservative Fox News host encouraged viewers to have a psychedelic experience before they died.
The Untapped Promise of a Good Trip
Bill Richards, a grandfather of psychedelic science who’s still associated with Johns Hopkins’s psilocybin therapy investigations, likes to remind people that psychedelics have been used to promote healing for thousands of years. Ancient Mesopotamians did them so often that traces of the drugs still cling to their pottery. Cave paintings in northern Algeria showing human figures with psychedelic mushrooms date back to 5000 BCE. And 32 million Americans, including plenty of therapists, have taken these mind-expanding drugs.
I myself wavered at the edge of the psychedelic universe for years as a college student. Long before I knew anything about their potential for therapy, I was at a school awash in psychedelics, but I was too frightened of having a long, bad trip to try any of them. Instead, I fell into the role of “trip sitting” friends on MDMA or LSD, until eventually one begged to return the favor with what he swore would be a mild and short-acting experience on magic mushrooms. He’d stay sober and glued to my side, he promised, for the entire time. On a quiet weekend night, I agreed to a small amount, and we squashed bits of the dry, icky-tasting fungus into Oreo cookies. Like a cheerful suburban parent, he handed them to me on a porcelain plate, along with a tall glass of milk. “Down the hatch, sweetpea!” he giggled.
Once I’d choked them down—even Oreos can disguise only so much of the taste of petrified vegetable rot—I immediately lay down, expecting some head-spinning image parade. But after 10 minutes of ceiling staring and nervous expectation, it never materialized. So we gathered ourselves up and headed out into the warm night to try our luck at a campus party. When we crossed the threshold into a packed dorm room I suddenly felt overcome by a stunning and unfamiliar sensation—utter, unequivocal calm.
At this point in my college career, I’d become accustomed to being around proud geeks, some tortured for their nerdiness in high school, who’d found their intellectual nirvana and could spend hours drunkenly humiliating one another in searing, no-holds-barred debates. I found this practice and these young men, many of whom surrounded me in the room, abjectly cruel. But along with the odd sense of calm, this night I felt something else in their presence that I can still feel palpably as I write—a deep awakening to the profound depths of our mutuality.
It was as if I’d entered a room bathed in acceptance, and each person in it embodied a core of kindness and love that all their verbal battling had previously obscured for me. Now, for the first time, I saw their truth. They were good. I was good. My trip-sitting friend was so good he was glowing like a two-armed Vishnu. They were suffering. I was suffering. And whatever the lot of us had said or done to one another, whatever grandstanding or ignorances or insecurities we’d all acted on in the time we’d been together, were just inessential, fluffy distractions: the blurting of groundless fears. Nothing personal. Nothing substantial. Nothing lastingly true.
This sense of oneness and profound acceptance that overtook me is the quintessential gift of the drug that Richards unabashedly equivocates with mysticism. In his book Sacred Knowledge: Psychedelics and Religious Experiences, he remarks on how we’re on the cusp of making these mystical healing powers of psychedelics come alive again. “For those who deeply believe in the promise of these sacred substances,” he says, “it is a hopeful time.”
Back in that dorm room, I felt myself smiling, softly, at each of the other partygoers. Many smiled back, some fully, some halfheartedly. With the halfhearted smilers, I felt a deep ache arching between us—the pain of having to disguise our essential bond to one another, as some protective part in them pretends at disconnection and difference.
I knew when I started thinking this way that it was the drug. But I didn’t discount or disbelieve what was happening. It was like watching an absorbing and hopeful documentary that was speaking to a reality I’d normally failed to see. I’d dug up an unassailable truth, I thought, that was mine now forever. And if I remembered it well enough, once the mushrooms finished their work, it might just reshape, in some significant way, my world view.
I turned to my friend. “I think I’m tripping now.”
He gazed at me with delight. “It’s great, isn’t it?”
I still call up my stirring, dorm-room trip when I have to give a lecture or defend my ideas to a group of overeducated meanies. It’s become my version of imagining an audience in their underwear. So you can bet that the idea of going back to the drug these many decades later—now with trained therapists and a real intention to roll back my various irrational fears—has grown exponentially more appealing with each new story of breakthrough or revelation I hear.
It’s intriguing, isn’t it? The idea of making huge strides in the span of a few trips with a treatment that, rather than requiring daily maintenance on drugs, or emotional sustenance in weekly therapy, might just last a deeply healing decade or two, or maybe even a lifetime.
So why have we left it on ice for so long?
A Brief History
If you’re a therapist of a certain age, all this new excitement around psychedelics may feel like déjà vu. From the ’50s to the late ’60s, researchers and therapists were already working with LSD, mescaline, and psilocybin, and seeing the same effects being documented today. That was before their work was shuttered and psychedelics assigned the strictest of drug statuses—Schedule 1—which precludes research without a special license from the FDA.
The word psychedelic is derived from the Greek and translates as “mind manifesting.” After 1938, when the Swiss chemist Albert Hofmann synthesized LSD, early researchers were hopeful that the drugs could produce therapeutic breakthroughs and illuminate the neurochemical underpinnings of psychosis. Hofmann, who was working for the chemical company Sandoz at the time, famously absorbed a large dose of the drug by accident and had a terrifying trip involving a nighttime bicycle ride. But soon after, the son of the head of Sandoz’s pharmaceutical department discovered that lesser amounts of LSD were useful in psychiatry for helping repressed thoughts and memories bubble up. The CIA took notice, hoping to turn it into a “truth drug” before ultimately finding it too unpredictable. By the 1950s, potential therapeutic uses were already under serious study.
Two Canadians tried scaring their alcoholic patients straight by giving them large doses of LSD, but the trips turned out to be more pleasant than frightening. So they changed their tactic and created homey rooms, in which they’d sit with clients and help elucidate a mystical experience that might be profound enough to loosen alcohol’s grip. Soon Stanislav Grof, a Czech psychiatrist, who’d go on to invent holotropic breathwork for attaining different states of consciousness, was taking a similar tack to treat heroin addicts in Prague.
By this time, the ’60s counterculture was flourishing, and Harvard psychologist Timothy Leary was encouraging the general public to take LSD, mescaline, and psilocybin, insisting the drugs were safe, and famously advising people to “tune in, turn on, and drop out.” The fear began to grow that psychedelics were hastening the decline of cultural values. President Nixon, given to demonizing both the era’s countercultural paroxysm, which he labeled “the age of anarchy,” and Leary, the person he considered its de facto leader and “the most dangerous man in America,” agreed. Soon after, the FDA effectively halted psychedelic research.
MDMA has a different origin story. Though synthesized in the early 20th century by the pharmaceutical giant Merck, it wasn’t tested on humans and didn’t make it into psychiatric circles until the late ’70s and early ’80s, when Alexander “Sasha” Shulgin, a chemist who’d worked at Dow in the 1950s and synthesized products so profitable he was given free rein to pursue his own interests, set his sights on psychedelics. Shulgin had a curiously good relationship with the DEA, which eventually granted him an investigative license to synthesize his own psychedelic compounds. He designed new psychedelics by manipulating old ones like mescaline, birthing an era of designer drugs—and he reintroduced the empathogen MDMA, which he tested on himself and promptly gave to San Francisco Bay Area psychotherapists.
But much like LSD, psilocybin, and mescaline before it, once MDMA went beyond the therapy community to become widely disseminated at parties and clubs, the government took note, this time under Ronald Reagan; and in 1985 the DEA declared an emergency ban on it, putting it out to Schedule 1 pasture.
Rick Strassman, a psychiatrist and researcher at the University of New Mexico, managed to get the FDA and DEA to release the hallucinogen DMT to him in the ’90s for his studies of addiction treatment for alcohol. (DMT is a derivative of one of the plants found in brewed ayahuasca which is also being studied for its therapeutic potential.) Since then, the US psychedelic science scene has come roaring back, thanks in part to some very deliberate messaging by the now careful community of researchers and its funders, like MAPS and the Heffter Research Institute, which underwrites the Hopkins work. The ’60s’ free-for-all and Leary’s calls for everyone to partake have been replaced with a principled stand, asserting that these drugs need to be purposefully used and prescribed as therapy.
Psychedelic research is currently underway at an impressive list of top-rate research universities, including Johns Hopkins, Harvard, UC San Francisco, UCLA, New York University, Yale, and the Imperial College of London. Practitioners being trained to provide psychedelic therapies are encouraged to follow a protocol common to all the studies: pay careful attention to preparation work with participants, set aside a room that’s warm and calming, encourage them to bring in a meaningful memento for the session, refrain from being directive when the participants are tripping, and ask them to don eyeshades and headphones that play instrumental soundtracks to support them going inward.
“Now I Never Want to Die”
A participant in one of these carefully designed research studies was Rachael Kaplan. She was 31 at the time, and had been in and out of therapy for almost two decades, trying countless treatments to alleviate her crippling PTSD symptoms. A survivor of childhood abuse, including sexual abuse that had started at age four, she found simple errands, like going to the grocery store, terrifying. She’d wake in the mornings, she says, afraid of existence itself.
Kaplan was painfully aware that other people could feel a sense of ease in their bodies, but not her. Her abuse had started so young that she didn’t understand such a feeling, and instead would be driven by her sense of extreme unease to dissociate and hurt herself. Plagued by nightmares and debilitated by flashbacks, she was hospitalized twice for suicidal ideation, and she thought about killing herself daily.
Over the years, she’d tried EMDR, residential treatment, and medications that did little to help her. She’d met with acupuncturists, energy workers, and equine therapists—so many therapists, in fact, that she trails off talking about them. It was a lot of effort with little progress. “I was so terrified from my childhood trauma that my system wouldn’t let down its guard enough to allow anything from the outside to affect it,” she says. In fact, she started thinking that she might be psychotic. “It was easier to blame myself,” she explains, than face the truth of what had happened.
In her 20s, she started a counseling degree, but the PTSD got in the way of her finishing it. She was still taking classes at Naropa, the Buddhist-informed liberal-arts school near her home in Boulder, when she stumbled upon a talk about the stunning early results of MDMA-assisted therapy. Then a friend told her that a trial was happening right there in Boulder, and her heart leapt. “Truthfully, I was willing to try almost anything at this point,” she says. “But this actually sounded amazing. I kept thinking, this has to help.”
To be approved for the study, she met with therapists and a doctor, and went through medical and psychological assessments. Schizophrenia, psychosis, heart problems, and a bipolar history—all of which the drug can exacerbate—were study disqualifiers. She was thrilled to learn she’d been chosen, but then terrified. “Taking something where I wouldn’t be in control of myself, not knowing how it would affect me, I was really scared,” she recounts. “And working with two people I’d really just met? I’m supposed to be vulnerable with them and take a drug with them after such a severe history of trauma? It was very hard.”
Kaplan had three preparation sessions with the two therapists who’d be with her when she’d take the drug for the first time, and for all the integrative sessions that followed. “In those preparatory sessions, they reassured me that they’d keep me physically safe so I could let go on the medication. And they validated my fears that, yeah, it’s a scary thing to do. That in itself was helpful.”
Kaplan couldn’t sleep the night before her first session. In the morning, she gathered the meaningful objects she’d been asked to bring—she chose a blanket, candles, photos of her dog and of friends who loved her—and entered a room with peaceful pictures on the walls, a couch made into a soft bed with more blankets, and flowers in vases set nearby. The therapists pulled two chairs up to the couch. Kaplan’s blood pressure was taken, and a doctor she’d met in the preparatory sessions came in to give her the pill. She lay back, put on headphones, and tried to relax. It was half an hour before she felt anything at all.
She and the therapists had spoken beforehand about setting an intention. Hers was to learn whatever she needed to do to heal her trauma. But she says she was disappointed that the drug didn’t make it easy to do this, even with the two therapists by her side. It wasn’t as tough as an initial talk therapy session, but it also didn’t feel like a breakthrough. She wondered if the drug was working, or if maybe they’d given her the placebo. On the upside, she adds, “I did feel closer to and safer with my therapists than I normally would have, and that was really helpful. Something about the drug helped me start to trust them in a deep way.”
In the week that followed, she had intense flashbacks to her abuse and made use of the phone calls and the integration sessions to work through them. Going into the second session, she says, she no longer thought she’d fall apart or lose total control on MDMA, but now she was worried about other things. “I wondered what would come up this time. When I took the drug the first time, I could actually feel my defenses softening. I thought maybe they’ll soften even more this time, and then what? It’s like consciously unarming, and that makes my whole system freak out.”
Despite her fright, Kaplan never thought about stopping. Her new intention? “Get past whatever’s keeping me from deeply connecting with myself and loving myself. Go wherever I need to heal my trauma.”
This time, she got her wish.
“I felt the medicine from the beginning, and I saw myself being surrounded by angels. It was the most beautiful feeling of love and peace and light,” she explains. “For the first time in my life, I could feel what it was like to be connected and safe with other people and in my body. It made me more able to talk about my trauma, and as I did, I felt a lot of love for my present self and for my younger, traumatized self. I was able to let that love and the love and support of others in, for the first time ever.”
When her final session came around, Kaplan was ready to go all in. She asked to have the initial dose and a booster dose (usually given later in the session) together at the start, and aimed for what she calls “the dark place.” She says, “I knew there was something I wasn’t facing and my intention this time was to go there.”
At first, she hit a wall and couldn’t get close to the darkness, but then the drug zoomed her through to a place where previously unspoken, troubling scenes of her childhood trauma took shape. Her therapists leaned closer and held onto her as she gave a second-by-second accounting of the abuse, helping her name it for what it was.
If the horrible memories that were unfolding had been conjured in talk therapy, she says she’d have been too overwhelmed to process them. But floating in the feelings of love and safety that the MDMA was accessing in her, she believed that the memories could no longer overpower her, and she stayed with them. “With trauma, it’s so easy to go to self-hate when you’re processing this kind of stuff, so to do it while awash in love was really powerful,” she says.
All these years later, her voice still cracks when she talks about that final trip. “I’m still profoundly grateful for that experience,” she explains. “I saw what was keeping me stuck and in so much pain—and holding myself in love while I experienced it, all that was new and different.”
This revelatory trip wasn’t a silver bullet. In the weeks that followed, she dissociated again and had more flashbacks, even some fleeting suicidal ideation. But she managed to work through it all in the integration sessions, and by letting herself grieve. She’d kept her primary therapist throughout the study trial and further integrated the effects with her. She found the newly arrived-at sense of love and connection held fast.
“It was the most profound healing I’ve ever experienced,” she reports. “Now I never want to die. I feel safer being around people, being in the world. I feel like I can actually rest in my body. There’s something so powerful about having been to such a dark place and coming out the other side. I now have this trust in myself that no matter what happens in life, I’ll be okay.”
Kaplan has completed her degree at Naropa and is now trained in transpersonal psychology and wilderness therapy. And her friends have noticed a big change: she talks more. “I’m still fairly quiet, but while I used to be so scared to talk to people, now I want to connect more and do things with them. I even love shopping for my food!” she says.
The psychiatrist Roland Griffiths and a team of researchers at Johns Hopkins are investigating the effects of psilocybin-assisted therapy with cancer patients to help ease anxiety and fear of death. Along with other sites, they’re also testing its healing potential with addiction and depression.
But Griffiths, who is a meditator, has an additional interest: understanding the spiritual component that seems to undergird the therapeutic progress most of their study subjects make on the drug. To start, he’s looking at what devoted contemplatives who’ve been mediating for many years might get out of it. Does it bring them new insights, or merely reflect back to them something they already know through their spiritual practices? Are the revelations it provides any different, any deeper?
Jonathan Foust, a meditation teacher, trainer, and former president of the Kripalu Center, a popular Massachusetts yoga and meditation retreat, gave it a go. “While they were exploring the psilocybin experience for those with terminal illness and chronic addiction, they found that virtually everyone who participated had a peak spiritual experience,” Foust says. “Now what effects would such an experience have on those who’ve dedicated a good proportion of their life to meditation? For me, the effect was profound, transformative, and deeply inspiring.
“Through many years of meditation, I’ve had many insights into the nature of reality. At the same time, I can’t deny the profound insights I had with this experience. It’s deeply corroborated my life purpose. From my perspective, as someone practicing the Buddhist tradition, the sense of ‘I’ and ‘my’ begins to fall away on psilocybin. You open to profound insights into how we perceive the world. I had a recall of some early traumatic experiences that was extraordinarily helpful for showing me how I viewed the world through a traumatized perspective.”
When he’s teaching meditation, he concentrates on suffering and the end of suffering. Because the drug reacquainted him with his suffering, he says, “It’s reinforced my commitment to try to make a difference.”
Manish Agrawal, an oncologist affiliated with Johns Hopkins, became interested in incorporating psilocybin in his work after seeing a series of videos of terminally ill patients in a psilocybin study. One features Tony, a middle-aged actor from New York with prostate cancer that spread to his lymph nodes. The diagnosis caused panic attacks and a fatalism that he says was oppressive. He thought about his illness all the time.
Once the psilocybin had taken over, Tony’s concerns faded away, and he felt himself transported to “a place of infinite space.” He says, “The most glorious part of this trip was this connection to this thing or power that was out there. It was incredible, and it took my breath away. I have an inner grounding now that’s just there. So the anxiety comes, and I deal with it and move on.” Since the experience, he says his outlook has remained positive—about both life and death. “My sense is that I’ll be going to that place that I was [on the trip], and there’s nothing wrong with going there.”
Agrawal regularly sees patients like Tony with advanced cancer. “For most, it’s a very hard stage of life,” he says. “I see a big need for people to make this time of suffering into something meaningful, but many of us never fully deal with our death until we’re faced with it.”
Agrawal imagines oncologists like himself becoming prescribers at psilocybin-assisted therapy clinics attached to cancer treatment centers. The experience would closely mirror the MDMA-psychotherapy protocol. But he believes psilocybin delivers a decidedly mystical experience, making it more appropriate for those at the end of life.
When asked if he hesitates to give an already physically and emotionally vulnerable cancer patient a powerful psychedelic drug, he demurs. “We oncologists give a lot of bad drugs to a lot of people. I prescribe chemo nearly every day. It’s important to put the benefits of drugs like psilocybin into context. They’re relatively safe, and the psychological impact is profound.”
What If Clients Get Addicted?
Not everyone is enthused about the rebirth of psychedelic therapies. Some addiction professionals are concerned that their jobs will get harder if drugs like MDMA and psilocybin are relieved of their Schedule 1 status, citing the reasons for which the government affixes that status to drugs in the first place: they’re thought to have no true medical use, carry a high risk of abuse, and be unsafe, even under a doctor’s supervision. These clinicians also raise concerns that psychedelics and empathogens are too potent, neurochemically messy, and potentially damaging for psychologically fragile addicts who need steady, long-term intervention.
The Fix, an addiction-community magazine, reports that heavy users of MDMA are at risk for high blood pressure, fainting spells, verbal and visual memory impairments, paranoia, sleep and panic disorders, and depression. Colleges like Brown University report that a third of users abuse the drug. Deaths from the drug are rare, but dangerous hyperthermia and brain swelling, exacerbated by the heat of dance clubs, has been reported.
Still, psychedelics and empathogens are rated markedly safer in harm comparisons with drugs like cocaine, heroin, alcohol, marijuana, methamphetamines, and benzodiapenes. These comparisons measure whether the drug causes harm to the self or the drug-taker harms others. In fact, MDMA ranks about a tenth as harmful as alcohol. It comes out marginally less safe than LSD and psilocybin, but less risky than anabolic steroids. According to last year’s Global Drug Survey, mushrooms containing psilocybin are the safest recreational drug of all. Of 12,000 users in the previous year, a mere two percent required medical intervention.
This question of risk is also on the radar of research institutions around the world looking to psilocybin-assisted therapy as a way to treat drug addiction. Among them is Johns Hopkins, which has been studying its effectiveness with long-term smokers. The University of New Mexico has been looking at its effects with alcohol addiction, the University of Alabama at Birmingham with cocaine, and the Imperial College of London with heroin.
Sara Lappan is working on the trials in Alabama, which are pairing cognitive behavioral therapy with psilocybin to treat cocaine addicts, many of whom are so undone by the cycle of addiction that they’re living on the street. Researchers suspect psilocybin may increase insight and motivation in addicts—and decrease their cravings. Lappan says that because it delivers a sense of awe, it can help users feel like a whole and connected being, not the thrown-away, isolated addict the people she sees often feel that they are.
Beyond the psychospiritual effects, Lappan explains that psilocybin has neurochemically important, anti-addictive properties. It’s an agonist, and works on serotonin levels in the brain that affect dopamine levels, effectively blocking their uptake. Press-a-lever studies have been undertaken with mice using psychedelics. Those mice, like the ones who famously pushed their levers nonstop for hits of cocaine and heroin, have been given unrestricted access to LSD or psilocybin, but they turn away from their levers after the first experience, showing no interest in tripping again.
Bill Richards quips about the difference between an addictive substance like heroin and a psychedelic by saying “one is for forgetting and one is for realizing.” He believes that most adults can handle such a distinction.
So far, a statistically significant number of those receiving psilocybin in the Alabama study have had longer periods of prolonged abstinence than their control group. And like the therapists in the other MDMA and psilocybin trials, Lappan has witnessed subjects undergo profound experiences on the drug. She’s held onto some who wept cathartically, one who spoke emotionally to a loved one who’d passed away, another who took an oddly revelatory ride through his intestines. It’s a way of working that’s satisfyingly faster than the therapy she’s done before.
In July, psychiatrist Rick Strassman at the University of New Mexico called for caution in a Scientific American op-ed after a few members of the psychedelic research community had advocated relaxing government restrictions on the drugs. He wrote that outside the structure of specialized treatment settings, “psychedelics are no less abusable, acutely debilitating and liable to result in psychological damage—sometimes severe and unremitting—than they ever were.” Strassman is calling for the drugs to be removed from Schedule 1 so they can be administered under medical supervision and studied, but he wants a new schedule number to be implemented, one that will restrict them from sale to the general population, meaning only those with specialized training could administer them.
Stephen Delisi, assistant dean at the Hazelden/Betty Ford Graduate School of Addiction Studies and a psychiatrist with a background in trauma, confesses to liking how MDMA-assisted therapy for PTSD “promotes highly trained people doing an established program.” He says, “Psychedelics are different from other drugs of abuse: they’re not potent activators of the dopamine system. But we still need to hold the field accountable for maintaining fidelity to these evidence-based practices. What happens if clinicians begin to ignore the treatment protocol, or people feel they can begin treating themselves?”
Setting Clients Free
After seven decades, it seems that psychedelic-assisted psychotherapy will soon be upon us: the cloud of suspicion and disapproval hovering over it has dissipated, as it’s being ushered through by generations of government officials and scientists who may well have once taken—and liked—the drugs themselves. Given the right rollout, with clinics that hold up the researchers’ strict standards, it has the potential to revolutionize not only how we treat trauma, but eventually other common issues, like depression, anxiety, addiction, OCD, and eating disorders.
It’s been nearly 30 years since SSRIs came on the scene, but despite their ubiquity and their pairing with a variety of talk- and body-centered treatments, research shows that trauma, depression, and anxiety rates are soaring, and suicide numbers have dramatically spiked. Could the ineffable insights psychedelic and empathogenic drugs bring—the sense of spiritual grounding, of uber-connectedness, of vaporized defenses, of ultimately being part of something more than the terrible traumas and daily difficulties of our lives—finally deliver clients to the states of self-acceptance and belief in the less onerous world we ache to help them find?
Therapists affiliated with the MDMA-assisted psychotherapy trials all told me the same thing: they’re chomping at the bit to do this work full-time. In fact, the satisfaction of seeing people who’d lived with unremitting trauma and fear suddenly be free of it made the idea of returning to the ways they’d conducted therapy before simply unacceptable. “What’s the alternative?” one woman asked me. “Keep working with someone for years when you know—you know—their lives could turn around in a couple of sessions?” Perhaps it really is time for this profession, as the blundering Timothy Leary once said, to “grow with the flow.”
PHOTO © COURTESY OF MULTIDISCIPLINARY ASSOCIATION FOR PSYCHEDELIC STUDIES (MAPS)
CategoriesScience & Research Clinical Practice & Guidance Issues & Developments Anxiety & Depression The Field Trauma
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