To start her treatment, I gave Sophie two MDMA capsules, then helped her put on glasses and headphones to encourage her to confront the images, associations, or emotions that the drug was causing. Since the effects of the medication can be disorienting or intense, I stayed nearby. In about an hour, Sophie announced that she was in a cabin, the place where her father had started beating her. She was smiling on her bed, she said, when her alcoholic father suddenly blinded her. The blow threw her to the ground so hard that she lost control of her bladder and passed out briefly. She had replayed this scene hundreds of times, but where the footage once seemed overwhelming and chaotic, it now felt safe enough to be explored. She described a strange sense of relief that washed over her. Where raw terror once consumed her, she could now discuss this event with clarity and insight.
Not only was she finally able to revisit and process a traumatic memory, but she was also able to express the 7-year-old’s grief, for the life of torment that had been inflicted on her. Usually critical and desperate, Sophie’s descriptions of memory were startling, filled with compassion for herself as well as her father. She spoke of a fishing trip they took together when she was young and how her father himself had been abused, things she had never talked about before. After nearly seven hours on drugs, the discussion moved away from the abuse and turned to a clearer reflection of her life course. It was not a typical medical visit; it was undeniable progress. Reflecting on the session, Sophie said she was finally able to face and relive her abuse without fear, digest it and better understand how it changed her. She cried. She forgave her father. Then, above all, she forgave herself.
The deep experience seemed to have lasting effects. After her third and final treatment, Sophie’s PTSD score went from severe to nonexistent. “This event in the cabin doesn’t make me cry anymore,” she recently told me. “I am now brought to tears by the things of love that have happened to me over the years.”
Not all experiences with MDMA, of course, are exactly like Sophie’s. Some patients have suffered so much trauma, whether from combat, a parent, or a spouse, that a few sessions with the drug just isn’t enough. We must continue to chip away at memories – both during drug use and during more conventional psychotherapy – by slowly building the self-compassion and acceptance necessary to digest the trauma. Some patients scream when they trigger images that come back to them. Others dance or sing, embracing their lives from a more positive perspective. No session is the same, and not much that goes inside or outside the office adheres to anything like your conventional psychiatric practice. On the one hand, the sessions themselves are a lot more, eight hours or more for MDMA. The biggest challenges within the study itself may be the placebo-controlled nature of the study (half of the people are given a sugar pill) and the need to cut down on almost all of the participants’ psychiatric medications severely. sufferers that may have been on them for a decade or two. Other strange effects of this new paradigm are also occurring: where I have already answered phone calls from fellow psychiatrists asking for drug doses and side effects, I now get inquiries about the best playlists or how. interact with someone when they are deeply in a traumatic memory. .
The only thing I can say for sure about MDMA is that, for the first time in many years, my waiting room is no longer a revolving door with solemn faces; he is alive with the possibilities of recovery. As a young medical student, one of the reasons I was first drawn to psychiatry was my belief that a psychiatrist and a patient could together explore the depths of the psyche and help heal it. . I have worked with patients to decode the memories, dreams and thoughts that arose from their subconscious, and have appreciated the transformative capacity of talk therapy. Then, seemingly overnight, psychopharmacology changed a lot of that. Responsible for repairing “chemical imbalances”, psychiatrists were forced to move away from the therapeutic partnership and turn to the role of a detached expert fixing biochemistry. Sometimes I felt like I was perpetuating a fraud, prescribing drugs that often didn’t work, for diseases that I was struggling to improve.