I'm going to talk about some things today that
have been touched on already, and that may be a little hard to talk about, and I want to try and do it as thoughtfully as I can. I'm going to talk about complex trauma, and what happens when that meets what you might call “psychedelic enthusiasm.” And just some things that I've observed and learned, and that have kind of emerged recently in the media,
as some of you have noticed. I want to start by, you know, of course, Bessel is someone who has long drawn our attention to the complexity of trauma and developmental trauma, and how people – a lot of the trauma we work with
as clinicians is rooted in, you know, early, really deep harm in relationships of neglect – emotional neglect, physical neglect – as well as abuse of different kinds. Of course, it’s rooted in war and sexism and capitalism and racism, and all kinds of ways that people and their families are
being dominated, exploited and harmed in various ways. PTSD doesn't begin to capture
what a lot of our clients are dealing with, and what a lot of people – if we let them into
our research studies, which did happen in a phase 3 study – that they're
struggling with. Another person I want to invoke at the beginning, in addition
to Bessel, and all he's done in this, is Judy Herman, longtime colleague of ours here, who will be speaking tomorrow, author of the classic book, “Trauma and Recovery” – before “The Body Keeps the Score,” “Trauma and Recovery” was – and still is, you know – a classic and very, very important book in this field, and the work we do. And Judy really talks a lot about complex trauma and people who have been deeply wounded by situations of captivity, and domination and exploitation, humiliation. And how people can internalize that, and how it can play out
in their relationships in the world, but also in their relationships in therapy. And another key concept that Judy talks about
is what she calls “the dialectic of trauma.” I think this is so important to keep in mind.
We live with the dialectic of trauma, and sometimes we do it in blind spots,
as individuals and as organizations, and that's some of what I want to focus on today. The dialectic of trauma has to do with, on one hand, at times being flooded and overwhelmed
by the horror of what you've been through. And then, at other times, feeling disconnected from that. Doubting it’s really true. “It wasn't really that bad.”
“Am I just making all this up?” “Am I just trying to get attention” – those kinds of things. And this doesn't just happen within traumatized individuals, it happens in communities. It happens in entire cultures.
It happens in the field of psychotherapy. And, you know, it’s happening in this psychedelic work. And I want to talk a little bit about that. An important thing about complex trauma is that it’s not just symptoms that people experience within themselves, and some of those have been talked about today, but it really has a relational aspect, where people can
get caught up in reenactments of their trauma. And these reenactments can be not just around acts of commission, like the most egregious things, for example – well we'll get to that in a minute – but also
acts of omission. So people reexperiencing neglect,
reexperiencing abandonment, reexperiencing being blamed – sometimes implicitly, sometimes explicitly – by their therapist for difficult things that are emerging in the session. These reenactments are really some of the hardest
and most important work that we do as therapists. How do we acknowledge for ourselves, you know,
what contributions we've made to this situation? And how do we repair it? And that’s so important. In terms of this idea of “psychedelic enthusiasm”… (I know, when did I start, I meant to do my own clock. How much, how far am I in, Bessel? Seriously? Wow, time flies.) Okay. Okay. Sometimes it’s called “The Michael Pollan Effect.” Sometimes we might call it “The Rick Doblin Effect.”
I mean, Rick is incredibly visionary and inspiring. And it does show up in this work, you know,
as we’ve seen as therapists. And I’m forgetting who talked about it earlier today, but people show and they say things like, “Nothing else
has been enough.” “I’ve got to get more healing or I’m not gonna make it.”
People are showing up like, “This is it. If you don’t help me with this MDMA,
if you can’t help me with this ketamine, I’m gonna die.” And, “You CAN help me.” You know, they’ve seen the stories in the media.
They’ve seen “this is great,” “this can really heal people,” You know, “ten years of therapy in eight hours.”
They hear these things out there. And so there’s been a lot of encouragement,
but also a lot of hype – – about what these medicines can do. And a lot of desperation of people with complex trauma is bumping up against that that hype and those hopes for rapid, deep healing. Recently, there’s been some attention to brought to people
who have been harmed in this work. So there’s a podcast called “Power Trip,”
[by] New York Magazine and Psymposia. And this is a podcast that was put on by people
who are avowed anarchists, and who, I would say, are clearly quite biased,
and upset about things. But also, I think they’re shining really important light on some things that have been going on in the “underground” world, and that even have happened to people in the MAPS studies. So, I just want to address that briefly, that there
is a lineage in this work of – you know, the best of psychedelic-assisted psychotherapy
is good trauma-informed therapy, right? You are empowering people, you are connecting to them,
you are supporting their autonomy. All the beautiful things that Susan and Francis, and Michael and others, and Anne have talked about, and the way this work can be done. But there is also a lineage of people doing this work
who are on power trips. And who are into “breaking down people’s ego,” or think they know better than the client what they need to experience. And they have hurt people,
and they are continuing to hurt people. Right now, today, there are underground therapists,
and above-ground therapists, who struggle with these things, and who are on power trips and are hurting people.
I just talked to a friend of mine last night, who had a ketamine experience with someone who was just utterly intrusive and constantly telling her what to think and do. And, you know, she was a sweet person, on one hand,
but she was on a power trip. And so in the MAPS studies, three kinds of harm
have been pointed to, I think, recently. And it’s been painful for me, because I have such –
I’m part of the MAPS studies, I’m one of the therapists, and I have deep respect and care for Rick [Doblin] and
Michael [Mithoefer] and all of us who are involved with MAPS. But in this “Power Trip” podcast they talked about – the most, the case that gets the most attention is someone who was in a rela-, ended up having sexual intercourse repeatedly with one of her therapists from the study But long before that – there's excerpts of the videotapes
from the MDMA sessions in the trial – we don't have all the information, but there are
some things that are pretty clear, and her autonomy was being trampled on, in a BIG way,
from the start, before it ever got sexual. Though, even there, there were places where she’s reliving rape and the male therapist is literally lying on top of her. There’s all kinds of really disturbing things that I know
that some of you have seen. How many people have seen this stuff?
(Yeah, so maybe not a majority.) So, sorry to focus on difficult things, but I think,
you know, there’s some need for it. And, but there's also, you know, things that are – that's egregious, right, those things that, if you've seen that video, if you do hear it and watch it. But there's also people in that podcast who talked about things that are more common – reenactments for complex trauma – and that don't
require a therapist to be on a power trip, that don't require us to point fingers at anybody.
Of course, that’s not really that helpful anyway, but But basically – there's someone who's talked about “open
heart surgery” was their metaphor for their experience. That they went into the study, they got so opened up – and in some ways it was beautiful, in the ways we've heard – but they ended up feeling that they were left holding the bag. They ended up feeling abandoned. They ended up feeling re-traumatized. Now, are they – and is the “Power Trip” podcast – accurately describing what happened in those sessions? Probably not, you know, I'm not saying that we can
just believe whatever they're saying. But certainly, it's very clear that they ended up
feeling abandoned. That they ended up feeling that they had been harmed. And they describe not having experiences of repair. To this day, from what I can tell. And so, this is important too. It’s not just about the headline-grabbing stuff around whether someone was sexually violated or something like that. There’s this potential for reenactments of abandonment
and neglect, not repairing harm that comes. And this can happen in a research study, you know, and we don't have time for all the details. You know, Libby and I have worked with clients and – and there's ways this can happen subtly. We did work with someone we – it went great, , she thought it went great, and part of her experience was, “Wow, this is such good trauma therapy,” that she dropped her therapist after the study. Didn't tell us. And really struggled and, you know,
could have died of a fentanyl overdose. So, you know, no one committed suicide yet,
but this person almost died. And this was something that, you know,
I have personally experienced and I feel some culpability, and so I don't want to be up here claiming
that I'm like "above it all." No. And there were little signals that we missed
about her relationship to her therapist. And so, as we look forward, and people are, you know,
really excited about getting this out here, and we think about what happens after it’s approved, we really need to think about, “Well, who are the vulnerable complex t[rauma] folks who are going to get caught up in reenactments?” They can get caught up in them with their ongoing therapists, who may get into deeper water than they've ever been in before. Then there's the whole adjunctive therapy.
In a way this MAPS study is like adjunctive – it's an adjunctive therapy kind of model, right?
It’s a three-month or so model. And, you know, we've really learned that like, “Hey, if it's someone with complex PTSD, they better have a good therapist and a good solid relationship to them before they
come into the study.” Because if you – you could do beautiful work,
but if you open them up, or they open up, and then they could be left feeling abandoned. You know, there could be some real harm there. And so these are just things that I want to point to,
and I think that there's a lot more attention that needs to be paid to this, in terms of who is selected – quote “selected” for the studies. Who’s, who's admitted into a psychotherapy process
with these medicines. And then the training, you know. It's one thing for MAPS to say, “Hey, we've gotta train 20,000 therapists” or whatever, some huge number of people. How many of these therapists are really going to have the training, the supervision, the peer supervision, to handle
serious complex trauma? And so what does it really mean to, quote, “train all these therapists”? I think we really need to think about standards of care, standards of training, who's qualified to work with complex trauma? Who's not? And how do we address that in a post-approval world? And what is the role of organizations like MAPS to really
take responsibility for what they're unleashing into the world – which is good, but also, there's real vulnerability there. And so those are the things that I wanted to focus on today. And there's a lot more that can be said about different details and things, and there's policy implications. And, you know, are we really going to trust, ethics,
the review boards that – the licensing boards, so like how good of a job are they doing so far
protecting people? Not good. Not the therapist or their clients, right? So, what's it going to look like when a lot of complex trauma people who are desperate for help coming and getting opened up with these medicines, getting caught up and reenactments, and how, how are we going to deal with this? So those are the things that I wanted to focus on today.
Thank you.
