I began researching companies involved in the psychedelic-assisted therapy space over a year and a half ago. I believed any system undergoing innovation and change has huge potential for growth. Mental health represents a significant unmet need, and has only been exacerbated by the pandemic. I actually used to think psychedelics were used exclusively by “hippies and druggies” going to Phish and EDM concerts. Nothing could be further for the truth.
I slowly came to the realization that these alternative medicines have the potential to effectively address mental health “issues” where traditional Western medicine and modalities fall short. That’s not to say they are completely useless—from what I am gathering, they also have their place. What is most effective, it seems, is taking a truly holistic approach to treating mental health, leveraging the right modalities at the right times and circumstances, instead of shunning one in favor of the other. It would be stupid to build a house if you have a prejudice against hammers but really like drills—you need all the tools. Same with mental health. And for that matter, any type of health.
I’ve tried reading as much as possible about this subject. One of the best books I’ve read so far, not just related to psychedelic-assisted psychotherapy, but self-improvement in general, is A Dose of Hope by Dr. Dan Engle. Although it is “fictional” since the protagonist and his experience is an amalgam of patients who have undergone this treatment, it still does an incredible job of explaining what trauma is, what MDMA-assisted psychotherapy is like, and the types of revelations that arise from it. The author is emphatic about this journey not being easy, but it is through suffering that we are able to derive meaning.
Disclaimer: I’d like to stress that MDMA is still a Schedule I substance per the 1971 Controlled Substances Act, meaning it is illegal. However, it is undergoing the second of two Phase III trials being conducted by MAPS, the Multidisciplinary Association for Psychedelic Studies (the first of which was very successful) and it is believed it will be approved in early- to mid-2023 for treatment of PTSD.
Below are notes and a few transcriptions from the book that I thought were particularly interesting. If this subject is of interest to you, I highly recommend reading the book yourself.
INTRODUCTION
The mental health crisis plaguing our culture today does not stop with suicide. The epidemics of depression, anxiety, PTSD, addiction and chronic pain are simply expressions of a psychiatric system that is largely devoid of effective methods to deal with the deeper issues underlying the symptoms.
Namely, these underlying issues are core emotional wounds, unmet needs of the psyche, isolation or disconnection form one another, a lack of faith in something greater than one’s own self, nervous systems stuck in fight or flight, and the empty promises of material success, to just name a few.
When it comes to treating chronic, severe PTSD, the current standard of care model (psychotherapy and medication management) has a roughly 35% improvement rate.
Compare this to chronic, severe PTSD treated with MDMA-assisted psychotherapy. It has roughly a 70% cure rate (“cure” here is defined as the patient no longer meeting the criteria for PTSD).
At face value, that sounds pretty good as it appears to double the benefit rate. Except it’s better than that. MDMA-assisted psychotherapy is orders of magnitude better.
A cure in this context means a person no longer has symptoms meeting the criteria for even having PTSD at all. So we are roughly going from a 35% “improvement” rate to a 70% “cure” rate.
This is no small change. This is as big as it gets in the field of mental health.
NOTES
If you’re on SSRIs (selective serotonin reuptake inhibitors), it takes up to 6 weeks for them to leave your system before you can begin MDMA-assisted psychotherapy treatment)
After undergoing treatment, your personality doesn’t change—instead, “you become a more enhanced, integrated version of yourself…you’re going to be more in touch with who you are”
It is revealed that although the protagonist, Alex, never suffered “serious abuse” during his childhood, he did endure other forms of trauma, including neglect. Alex describes his symptoms as such—”I’m lost. I’m lonely. I’m sad. And I don’t know what to do about it.”
Dr. Dan explains further — “What we now know is that there’s actually a much larger landscape of trauma. There’s something called complex trauma, which is a more and less acute process, but just as impactful for someone”
“There’s also attachment trauma, which involves someone not having secure attachments, which can be very traumatizing for a person, especially children.”
“For example, maybe your parents didn’t give you the love that you wanted or needed. Maybe you got picked on at school a lot. Maybe a bully was harassing you, so you had to find a new way to keep yourself safe.”
“If we have trauma like this in our lives, it’s usually holding us back, and this therapy can help.”
“We all have patterns of avoiding certain things. We avoid things that are uncomfortable, or we don’t want to look at. Those avoidance patterns can be anything that keeps emotional discomfort at bay—for example: drugs, alcohol, overeating, self-sabotage, avoiding vulnerability, intimacy in relationships, social media, playing video games, or anything else that we will use to anesthetize or try and numb out emotional pain.”
“For this medicine (MDMA) to be effective, you have to be ready to uncover your truth and willing to change because of it."
“A big part of therapy is understanding how the ego—the protective self—has overstepped its bounds. For many people, therapy is about recognizing how their fear of dying keeps them from growing in their life.”
“Son, I get why you’re afraid. That’s just your fear fucking with you. Fuck with it right back. Go take that stuff, and deal with your problems” (the protagonist’s grandpa encouraging him to undergo MDMA therapy)
“We can’t force a flower to open; we can only give it the right conditions for it to happen.”
“Set your intention in motion, have faith that it’s going to happen, but let go of your expectations as to how and when it’s going to happen, and surrender to what comes up.”
“Another lesson I learned that helped me was finding meaning in the suffering.”
“Trust the body and mind to heal itself.”
“I’m afraid to feel my feelings.”
The parts of your Nervous System not under your conscious control
Sympathetic — a network of nerves that helps your body active its fight-or-flight response
Parasympathetic — a network of nerves that relaxes your body after periods of stress or danger
“Most people run around constantly in sympathetic overdrive, meaning they are in a constant ‘fight, flight or freeze’ response…The reasons why are far beyond this conversation, but I believe they come back to a core belief of ‘not being enough.’ Most people just don’t feel like they are enough—good enough, rich enough, smart enough, enlightened enough, etc. This takes a huge toll on both the body and the mind.” Alex: “That’s why I’m here. I never feel like I’m enough.”
“These breathing exercises—pranayama—are a very effective way to get you back to a parasympathetic state—a calm, relaxed ‘rest and digest’ state.”
How does the medicine work?
MDMA impacts the brain thus:
Decreases activity in the amygdala, the fear center of the brain (overactive in PTSD)
Increases activity in the hippocampus, the part of the brain involved in processing memories
“These two effects allow for better recall of all the associated parts of a particular set of memories without as much fear and resistance. The medicine also increases activity in the prefrontal cortex which helps to process and organize information during a state of reduced fear.”
Ultimately, what MDMA offers is a chance for restoration, to bring everything up that is weighing on your soul, face it, and give yourself permission to heal it and learn from it. This, then, can lead to greater integration into a more mature, stronger experience of self.
The medicine is truly remarkable for working through difficult emotional experiences. When utilized in a safe environment with intention of personal healing, this tool can help open emotional blockages in the body and heart, increase feelings of emotional safety and connection to others, help shed light on negative self-talk patterns, and help one move into forgiveness towards self and others.
Before undergoing MDMA-assisted therapy, Dr. Engle notes one must have an established integration practice and a relationship with at least one good therapist. “Integration is the work you do before and after the MDMA session to ensure that you get the most out of the medicine. MDMA is not a magic pill and works best as part of a larger program undertaken to do the difficult emotional work. The following is a sampling of effective integration practices:
Talk therapy
Eating healthy & clean
Sleeping 8 hours a night
Working out
Daily nature walks
Energy work
Massage, especially somatic massage
Acupuncture
Float sessions
Sauna/spa
Epsom salt baths
Meditation
Yoga
Capturing your emotions through journal, art or movement
More notes from the book:
[During the MDMA session] “It seems like the story I’ve told myself about my life isn’t entirely true.”
“One of the greatest gifts of this medicine is it gives us the ability to have a closer experience of our own personal truth.”
“The only way out is through.”
You’ve started to peel back a veneer on reality and are now seeing and feeling life in a whole new way.”
“Depression comes from a denial of one’s own emotions.”
The following section struck a chord:
Talk therapist: “There are other forms of trauma, and they can be just as bad, if not worse. There are physical traumas, emotional traumas, social traumas, and attachment traumas. A major source of trauma for many people is chronic emotional neglect.
For example, there’s a lot of research that’s shown that such neglect can be just as damaging to children as physical abuse and sexual molestation. I can think of one famous study that followed children from birth to twenty years old. The researchers thought that classically abusive behavior like yelling and hitting by mothers would be the strongest indicator of mental instability in their adult children.
Instead, they found that a mother’s emotional withdrawal had the most profound and long-lasting impact. Neglect. Not physical or even sexual abuse.
Another example, there was a landmark study called Averse Childhood Experiences study, which found that only one third of people had not suffered some sort of serious trauma as a child.
The trauma numbers for our society go far beyond what most people realize. Childhood trauma—from all sources—is a serious epidemic.”
“Trauma is about the nervous system’s response to an event, not necessarily the event itself. Events can affect each of us very differently.”
“People who feel the emotions from trauma and work through them are able to release it. But for those that do not work through it, the trauma can—in essence—get stuck in the body.”
“In people with stored trauma, there signals [fight, flight, or freeze] are firing all the time. There is no conscious influence; people who have unresolved trauma constantly feel on edge for no apparent reason…The overall effect of trauma is usually described as a loss of feeling of aliveness, motivation, excitement, and purpose. This is because trauma robs people of agency. Self-leadership. The feeling that you’re in charge of yourself.”
”People who have parents that ignored their needs learn to anticipate rejection and withdrawal. They cope by blocking out their anger or rage or fear or shame and by acting as if it doesn’t matter. But ‘the body keeps the score’: it remains in high alert, prepared to ward off blows, deprivation, or the experience of core wounds like abandonment, rejection and betrayal.”
“To get ride of the bad feelings, they lose contact with all other feelings.”
“This medicine does not erase bad memories or even neutralize them. It opens you up and brings the bad memory and corresponding difficult emotion to the surface, so you can actually feel it and let your body have the healing response it could not have when the event happened. The medicine helps you match the emotion to the experience.”
“The road to heaven usually goes through hell first.”
“We must go on this journey ourselves, but we can’t do it alone.”
“I feel embarrassed to say this, but I don’t even think I knew how to feel my emotions. I had always pushed them away, or pushed them down, or mostly distracted myself. I had no idea how much Netflix I watched, how much time I spent on Facebook and Twitter, or the hours of video games I played until this week. My whole life was distractions.”
“We have to both recognized suffered trauma, but then also take complete responsibility for dealing with it.”
“It’s okay to see your parents as flawed.”
“Most parents traumatize their children, completely unintentionally, mainly because they were traumatized by their parents, and the outlet to relieve their own pain is by doing the same thing to their kids. If they were humiliated as children, then they humiliate their kids, for example.”
“There are generations of trauma flowing down onto you from your family.”
I won’t go any further with my notes, as by now you’ve probably gotten an idea of what the book is about. If trauma and/or MDMA-assisted psychotherapy is of interest to you, I suggest reading this book. I learned a lot, and it has given me confidence, or shall we say, ‘a dose of hope,’ that psychedelic-assisted medicine will completely change the mental health landscape. MDMA, or any other psychedelic medicine, is not itself a panacea, or ‘magic pill,’ but rather a highly effective tool for facilitating the healing process. You still have to do your own work. But that is a price worth paying if you want to become healed—a better, enhanced version of yourself.