San Benito: Emerging From the Darkness

Summary: reports on the emerging field of MDMA-assisted psychotherapy highlighting the potential benefits this treatment has for healing PTSD.

Originally appearing here.

On the outside, Trish Graves has everything—a devoted husband, a beautiful 4-year-old daughter, a breathtaking piece of ranchland in southern San Benito County.

On the inside, though, she is shattered. Trish 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 said that the past 10 years have been crippling, as she has dealt with 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 2018 is different. This year has brought her a measure of hope that had seemed unattainable before. She has spent almost her entire adult life under the crush of past trauma, but only now is she able to contemplate a future beyond the shadow. And that hope has arrived in the form of psychedelic drugs.

Trish doesn’t fit the mold for what most people might think of as veterans suffering with PTSD. Her story is different. In 2003, at 24, in her first year in the Navy, Trish was raped by a fellow serviceman. She got pregnant by that rape, and then had an abortion while on leave on the island of Guam. “The abortion is what bothers me most,” she said. “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, until her body rebelled. “My body just stopped working,” she said. “I mean, I could tell myself, get up. I could say, do this, do that. By my body wasn’t doing it.” Eventually, she was “separated” from the Navy. She said she was told that she would get better once away from her military surroundings and back in civilian life. 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.” She began reading about therapies involving the powerful psychedelic agent known as ayahuasca and heard stories about people suffering from PTSD traveling to South America to experience ayahuasca. That led her to other research linking such drugs as LSD, psilocybin, and MDMA to breakthroughs in treatment for depression, addiction, alcoholism and PTSD. And that path finally brought her to the Multidisciplinary Association of Psychedelic Studies (MAPS), a Santa Cruz-based non-profit that is sponsoring FDA-approved clinical trials on the use of MDMA in psychotherapy. “As soon as I heard it was being developed, it gave me an anchor in the future,” she said. “I figured, OK, I can hang on until this is available. And if that doesn’t work, then I can commit suicide.” After going through the program’s screening process, Graves underwent three separate day-long therapy sessions in San Francisco, spaced out over several weeks, under supervised doses of MDMA, the psychoactive agent found in the illegal street drug Ecstasy. In her first experience, she came in with expectations, having read accounts of other people in similar therapy. “It wasn’t what I expected at all,” she said. “The whole time I kept thinking, I must be doing this wrong. From what I read, people were supposed to lay down, relax, with some music playing, or eye shades or something. But all I wanted to do was talk. I was talking, talking, talking.” 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 put me back together again.” After three sessions, Graves said, 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 said. “It’s taught my brain how to think in a new way.” In October, the peer-reviewed Journal of Psychopharmacology published results of the most recent MAPS-sponsored trial of using MDMA in psychotherapy. For those who had suffered chronic PTSD, more than three quarters (76 percent) reported dramatic decreases in symptoms to the degree that they no longer met clinical criteria for a PTSD diagnosis.

MAPS sponsors studies of a wide variety of psychedelic drugs, but only holds FDA-approved clinical trials with MDMA. Brad Burge, the communications director at MAPS, said psychedelic agents such as LSD, psilocybin, ayahuasca and MDMA are often lumped together, but are, in fact, categorically different drugs.

“It’s hard to say what they all have in common,” said Burge, “other than they have the capacity, when used in a certain way, to bring forth subconscious material, whether it’s emotions or memories or experiences in the body. That’s why they can be used in psychotherapy.”

MDMA may be the most promising drug because it tends not to bring on visual or auditory hallucinations.

“One of the things that MDMA does,” said 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 comes 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 into its third phase of 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.

For Trish Graves, 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 said. “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.”

Before 2018, on a rotation of antidepressants, 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. Now I’m laughing with her, playing with her.”

Graves is not out of danger yet, she said. Managing PTSD is still a labor. She still has days when she’s not well. “It’s not an overnight thing, but I’ve changed a lot in a very short period. It’s really scary to say that I feel l
ike I have a future. I don’t want to get my hopes up. It still all feels really new.”