Ecstasy for war trauma: a flashback to earlier treatments

Mother Board has a completely fascinating article on the current ongoing trial testing whether MDMA or ‘ecstasy’ could be useful in treatment combat trauma.

The piece is interesting as much for what it doesn’t say, as for what it does, and for how it ties into the history of psychological treatments for posttraumatic stress disorder or PTSD.

The trial is testing whether MDMA can assist in psychological treatment for the condition, in which a traumatic event leads to a sense of current threat and intrusive sensory impressions that are maintained by a pattern of avoiding reminders.

The most effective tried-and-tested treatments for the condition are types of therapy that are ‘trauma-focused’ that involve, among other things, a mental revisiting of the traumatic memories to ‘take the sting out of their tail’.

But this is exactly what most people who arrive in psychologists’ offices don’t want to do. This makes sense from the perspective of someone who is troubled by these memories and wants to stop thinking about them, but the avoidance actually helps maintain the problem.

This is, in part, because the person never learns to adjust to the anxiety (they don’t habituate in technical terms) and the memories remain as fragmented impressions that don’t fit into a coherent narrative, making them more likely to intrude into the conscious mind.

In other words, most people with PTSD initially arrive for treatment wanting a better form of avoidance because their current methods simply aren’t working. The mental health professional has the unenviable task of explaining that treatment involves exactly the opposite and reliving the event and experiencing the anxiety will be key.

It is so key, in fact, that anti-anxiety drugs like benzodiazapines (e.g. vallium) may reduce the effectiveness of treatment because they dull the experience of stress that the person needs to adjust to.

The MDMA trial is interesting in this regard, because ecstasy is, for many, a remarkably effective anti-anxiety drug.

So how does the drug facilitate the psychotherapy? Here’s the description from the article:

MDMA’s effects typically manifest themselves 30-45 minutes after ingestion, so it doesn’t take long for rhythms to develop in Charleston. Sessions at the clinic oscillate between stretches of silent, inward focus, where the patient is left alone to process his trauma, and unfiltered dialogue with the co-therapists. “It’s a very non-directed approach,” Michael Mithoefer told me. This allows subjects to help steer the flow of their trip. They are as much the pilots of this therapy as their overseers. “Once they get the hang of it,” Mithoefer explained, “sometimes people will talk to us for a while and then say, ‘OK, time to go back inside. I’ll come report when I’m ready.’”

That said, patients understand that if no traumas emerge, the Mithoefer’s must coax them out. But they’ve never had to. The traumas always emerge, and by now there have been over 60 sessions between an initial, smaller Phase 2 study and the present trials. Horrors are bubbling up naturally, patient after patient.

This harks back to a more psychoanalytic or Freudian-inspired idea of trauma and treatment. The goal of the therapy is to understand the inner self while the drug is intended to help us overcome psychological defences that prevent us from seeing things as they really are. In fact, this is a central assumption of the therapy.

This approach is not new. ‘Narcoanalysis’ was used widely in mid-20th Century where a range of drugs, from ether to sodium pentathal, were applied to patients with ‘war neurosis’ for exactly this purpose. Unfortunately, it was unsuccessful and abandoned.

So this is why the MDMA treatment is a gamble. All known effective psychological treatments for PTSD involve not only confronting the memories of what happened to make sense of them, but also re-experiencing the associated anxiety. A treatment with a drug that removes anxiety will, by current predictions, have limited effectiveness.

But this is also why the approach is interesting, because if it is shown to be genuinely effective, we might have to rethink our ideas about PTSD and its treatment.

Link to Mother Board article on the MDMA PTSD trial.

3 thoughts on “Ecstasy for war trauma: a flashback to earlier treatments”

  1. Check out Somatic Experiencing, a system of gradually approaching traumatic memories (and perhaps never fully experiencing them) which teaches the path into and out of anxiety.

    I have no opinions about whether using Ecstasy is more or less effect than somatic experiencing, but it’s something worth trying while the experiments with Ecstasy are going on.

  2. Please try to think of a world where therE is no war, no crime, people have work that is meaningful. Decisions are made that are efficient and serve the greater good, Corrupt politicians do jail time. Bible thumpers stop deluding the masses. and real plans are presented toward solvency and growth so the kids of today have hope for a tomorrow.

    We are all very sick of the JINGO JANGO Tax man takING our money to buy bombs. We need you to disappear, maybe fly one of your bombs into your house of cards.

    Have a NICE DAY

  3. That is an interesting caveat to the possible effectiveness of the MDMA “cure.” I think what might make it work in some cases is the ability MDMA promotes to actually break through the intense denial and avoidance PTSD victims might have. Then, further work would be necessary to re-contextualize the experiences.

    What helped me most to recover from PTSD was re-imagining the trauma multiple times, from different perspectives,in a gradual, visceral way. Allowing myself to feel safe took time but eventually writing down a complete story of the experiences was immensely effective. It is essential that we use narrative therapy as an adjunct to anxiolytics and SSRIs.

    I might also mention that the drive to “re-traumatize” oneself after the incident, the “repetition compulsion” of Freudian days, seems like an attempt to develop mastery and re-expose oneself to similar traumatic experiences. If your theory (which makes sense to me!) is correct, then allowing people to have space for that behavior is beneficial.

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