Summary: This week’s cover story from the Santa Cruz Good Times features an overview of MAPS, highlighting the recent results from Phase 2 clinical trials of MDMA-assisted psychotherapy for the treatment of PTSD, a veteran’s experience as a study participant, and psychedelic peer support services provided by the Zendo Project.
Originally appearing here.
On the outside, Trish Graves has everything—a devoted husband, a beautiful 4-year-old daughter and a breathtaking piece of ranchland in quiet, spacious southern San Benito County.
On the inside, though, she is shattered.
Graves is a veteran who served in the U.S. Navy in the Pacific for eight years. Since her discharge a decade ago, she has been struggling with the effects of post-traumatic stress disorder.
She says that the past 10 years have been crippling, as she has dealt with intense and unrelenting daily bouts of anxiety, depression, fear and self-loathing. She admits that she has considered suicide. The word she uses to describe her experience is “drowning.”
But over the last year, Graves has rediscovered a measure of hope that seemed unattainable before. After spending almost all of her entire adult life under the crush of past trauma, only now is she able to contemplate a future beyond the shadow.
And that hope has arrived in the form of psychedelic drugs.
The widespread public perception of PTSD when it comes to military veterans is that the condition is linked to combat or war-zone experience. That’s not the case with Graves. In 2003, while serving in the Navy, she was raped by another service member. The rape left her not only traumatized, but also pregnant, and she had an abortion while on leave on the island of Guam. She decided not to pursue a legal case against her assailant. She was 24 years old at the time.
“The abortion is what bothers me most,” Graves says. “I had to ask permission to do this from my commanding officer. It was humiliating. He wanted to know who it was, why I wasn’t pressing charges. I think you’ve heard enough about military culture to know you don’t report these kinds of things because I didn’t want to be seen as a troublemaker. I just wanted to do my job. I just wanted to do the right thing.”
Seared by shame, she soldiered on through her tour of duty after the abortion, until her body rebelled. Eventually, she was discharged from the Navy on a medical basis. In that respect, her ordeal carried three distinct traumas: the rape, the abortion and the loss of her livelihood and social identity.
“My body just stopped working,” she says. “I mean, I could tell myself, ‘Get up.’ I could say, ‘Do this, do that.’ By my body wasn’t doing it.” So she was “separated” from the Navy, and told that she would get better once away from her military surroundings.
But she didn’t get better. Living in San Juan Bautista, she felt adrift. She didn’t do much more than sit on her sofa for days and weeks on end. She tried to cope in ways healthy and otherwise: booze, pharmaceuticals, religious devotion, nutrition, even denial. She just kept drowning.
“There was a lot I didn’t know about PTSD that I know now; that it can really change your perception of reality. You can have flashbacks one moment. You can feel like you’re living in a dream. Or you can just feel very disconnected from everything around you. It’s crazy-making.”
Desperate for something—anything—to help alleviate the punishing frame of mind that had come to dominate her life, Graves began reading about promising therapies involving the powerful psychedelic agent known as ayahuasca. She heard stories about people suffering from PTSD traveling to South America to experience the organic brew that has been used in shamanic practice in the Amazon for centuries. For her purposes, ayahuasca seemed too risky and expensive.
She was eventually led to other research linking drugs such as LSD, psilocybin (found in some mushrooms) and MDMA to breakthroughs in treatment for depression, addiction, alcoholism, and PTSD. And that path finally brought Graves to the Multidisciplinary Association of Psychedelic Studies (MAPS), a Santa Cruz-based nonprofit that is conducting the country’s only clinical trials approved by the Food and Drug Administration (FDA) for otherwise-illegal psychedelic drugs in psychotherapy. MAPS, it seemed to Graves, was offering a road map to escape the shadow.
“As soon as I heard it was being developed, it gave me an anchor in the future,” she says. “I figured, ‘OK, I can hang on until this is available. And if that doesn’t work, then I can commit suicide.”
The transformation of cannabis from illicit street drug to medicinal miracle—and the booming business opportunities that have come with its evolution—have opened up possibilities for eventual legalization of other drugs long relegated to the black market by prohibition. Chief among these prospects are the wide range of chemical substances labeled “psychedelic.”
Still, “psychedelic” is more a cultural term than a scientific one. It has become a catch-all that can be applied to music, art, fashion or cinema as well as drugs. For Brad Burge, director of strategic communications at MAPS, it’s part of the job to grapple with a word that could just as easily apply to either Jimi Hendrix’s version of The Star-Spangled Banner or serious medical interventions for mental illness.
“It’s definitely a challenge,” says Burge, especially since the word “psychedelic” is in the organization’s name. “That’s part of why we exist. We could have been called something else, something that doesn’t bring up a whole host of connotations that we’ve absorbed from media and TV, whether it’s Timothy Leary or fractal patterns on the computer. What we don’t want to do is avoid the term, because then all of that stigma just stays there. Instead, we use it as an education opportunity and try to unpack it.”
It can be a maddeningly imprecise label, because the drugs that are often called “psychedelic” are fundamentally different from each other. “In most cases,” says Burge, “they are just completely different chemicals. One of the reasons we’ve lumped them all together is how they’ve been historically used, as a tool for introspection, consciousness alteration, spiritual work. So, ‘psychedelic’ is more of a term on how they’re used than how they work.”
Though the organization has worked with other drugs, MAPS has dedicated most of its efforts to MDMA, the psychoactive agent known by the informal names Ecstasy or Molly. Burge says that much of his public relations heavy lifting has been convincing the public that the terms are not interchangeable—that what is sold on the street as Ecstasy or Molly may or may not be MDMA.
MDMA may be the most promising drug in treatment settings because it tends not to bring on visual or auditory hallucinations.
“One of the things that MDMA does,” says Burge, “is that it turns down the activity in the amygdala, the part of the brain that governs the fight-or-flight response. People with PTSD tend to have a hyperactive amygdala. That’s why psychotherapy is so hard for people with PTSD. Anything that remotely reminds them of their trauma is interpreted as happening right now, in the moment. Really, what MDMA seems to be doing is enhancing the effectiveness of psychotherapy.”
MAPS is now entering Phase 3 clinical trials, which will include a larger pool of test subjects. The organization has stated that its goal is to get FDA approval of MDMA as a psychiatric prescription drug by 2021, which may seem quite far in the indefinite future for people who suffer from PTSD like Trish Graves.
After going through the screening process with MAPS, Graves underwent three separate day-long therapy sessions in San Francisco, spaced out over several weeks, which included supervised doses of MDMA.
In her first experience, she came in with expectations, having read accounts of other people in similar therapeutic settings.
“It wasn’t what I expected at all,” Graves says. “The whole time I kept thinking, ‘I must be doing this wrong.’ From what I read, people were supposed to lay down and relax with some music playing, or eye shades or something. But all I wanted to do was talk. I was talking, talking, talking.”
In the second session, the dosage was higher and the experience was even more intense. She felt she was communicating with her long-dead grandfather who was expressing love and support to her, but at the same time was also “cutting me into pieces. But I could see that he needed to do that. I needed to disconnect from who I was, and he was putting me back together again.”
After three sessions, Graves says, she was able to separate from her pain in a way that was impossible before. Each of the experiences was unique, and she is still seeing a therapist to help her “integrate” the experiences. “It all keeps unfolding,” she says. “It’s taught my brain how to think in a new way.”
The experiences with MDMA have provided her with the kind of detachment that people involved in meditation have long talked about. “It was kind of like three long meditations,” she says. “It was able to teach me that kind of detachment, so that I can say, ‘This is happening, and it feels really bad. But it’s not you. It’s just something that washes over you. You can endure it. And you can even be curious about it.’”
Last spring, the psychiatry journal Lancet published the findings of a MAPS Phase 2 trial for MDMA therapy that included military vets, firefighters and police officers. Of those who had suffered chronic PTSD, about two-thirds reported dramatic decreases in symptoms, to the degree that they no longer met clinical criteria for a PTSD diagnosis.
Phase 3 trials are currently taking place at 15 sites across North America and in Israel to further investigate MDMA’s effectiveness in treating PTSD. MAPS is also involved in a training program for prospective therapists in the treatment, hosting training events and drafting a code of ethics for therapists who might use MDMA in their practices.
MAPS keeps its administrative headquarters on Mission Street in Santa Cruz, but it has staff and researchers stationed all over the world. “It’s been like a startup,” says Burge. “The last seven years have been an explosion. Our biggest challenge has been the organizational growth.”
If putting the word “psychedelic” in the organization’s title wasn’t enough of a public perception issue for MAPS, what about that Santa Cruz mailing address? In the big world on the other side of Highway 17, Santa Cruz is often stereotyped as a free-range habitat for hippies and acid casualties from the ’60s. A globally minded organization looking to lend scientific credibility to the study of psychoactive drugs might find that an association with Santa Cruz would undermine that credibility. That would be wrong, says Burge.
“Given that our work is being taken a lot more seriously by the mainstream now,” he says, “I wouldn’t say it’s having much of a detrimental effect. In fact, it really legitimizes MAPS in the eyes of the right people. And the people who might judge MAPS (negatively) for being in Santa Cruz don’t seem to care.”
On top of the MDMA trials and programs, MAPS is also continuing to build up its Zendo Project, which trains individuals in “psychedelic harm reduction,” mostly for people using psychedelics recreationally at events and music festivals. The project’s biggest effort remains Burning Man, where they send a couple hundred volunteers to provide 24-hour support, working with on-site law enforcement and medical staff. With Zendo, MAPS is again involved in a rebranding effort, trying to remove the stigma of Woodstock-style “trip tents,” and replacing it with a professionally staffed space for compassion and safety.
“I think psychedelic harm-reduction should be an essential part of first aid and general crisis training,” says Burge. “The principles apply not just for psychedelic states, but for any sort of difficult psychological state.”
Still, if all goes according to plan, the MDMA therapy program is likely to emerge as the organization’s biggest contribution to bringing psychedelics into the light of legal therapy. Once Phase 3 is over, the FDA will assess the data to make a judgment on whether MDMA is useful as a prescription treatment in psychotherapy. If the drug gets FDA approval, it will then be up to the agency to take MDMA off its list of Schedule 1 controlled substances deemed to have a high potential for abuse and no legitimate medical uses.
Even in the best-case scenarios for groups like MAPS, MDMA will not be the kind of drug you’ll be able to pick up at the Costco pharmacy window on your way home from work. Treatment will necessarily be under strict conditions and supervision of trained therapists. Still, the therapy has the potential to change the lives of people like Graves, who now have few options. Reflecting on her own experience, Graves feels the need to evangelize on behalf of MDMA treatment.
“I can’t wait for more people to get the relief I’ve experienced,” she says.
Before 2018, on a rotation of antidepressants, she says she felt, “like I was a robot. I wasn’t alive. And now I feel alive. That’s a big thing for me.”
The improvement in her condition has come at a crucial time for her as a parent. Her daughter is just now reaching the age where she’s discovering the world around her. “I feel such relief that I’m now able to engage with her. Before, I always felt so far away. She would talk to me and I knew I needed to answer her, but I couldn’t even open my mouth,” she says. “Now I’m laughing with her, playing with her.”
Graves is not out of danger yet. Managing PTSD is complicated, and she still has days when she’s not well, she says. “It’s not an overnight thing. But I’ve changed a lot in a very short period,” she says. “It’s really scary to say that I feel like I have a future. I don’t want to get my hopes up. It still all feels really new.”