Psychotherapists, researchers and specialists say that MDMA has shifted the paradigm when it comes to the treatment of trauma. Could the medical legalization of psychedelics mean that… Ecstasy could shortly be coming to a therapist near you? KCRW’s Jonathan Bastian speaks with Bessel van der Kolk, psychiatrist and one of the world’s leading experts on trauma, about MDMA clinical trials and how trauma physically manifests within the body. Van Der Kolk is author of “The Body Keeps Score; Brain, Mind, and Body in the Healing of Trauma.”
KCRW: How widespread is trauma, not only in the U.S., but across the globe?
Bessel Van Der Kolk: “When we first find [sic] this diagnosis, PTSD, find it as an event that’s outside of the realm of normal human experience, [it] shows you how completely ignorant we were. We did not know at this point that one out of five women has been sexually molested. That one out of every four kids gets hit very hard by their caregivers. That one out of eight kids witnesses domestic violence. Recent calculations in the Journal of Pediatrics discovered that about half of all kids in North America, Asia and South America witnessed trauma before the age of 12. It is extremely common.
Psychiatry keeps labeling people as having these disorders, but generally, there's very little question about how did you get to be so weird? And people get to be so weird because they have to cope with horrendous stuff oftentimes.”
How does trauma impact individuals throughout their lives?
“Trauma causes people to get stuck. And so your brain gets set to fear that you're [going to] continue to be attacked. You sort of stay there and you continue to feel like ‘I'm about to get hurt. I'm about to get raped. I'm about to get taken advantage of.’ Your mind and your brain gets fixated on that moment, and it's very hard to take in new information.
… I started working with Vietnam veterans. And they said, ‘We don't have anything to do with the Second World War veterans, because they're all stuck in the Second World War.’ And 40 years later, the Vietnam veterans are now old men, and they're still stuck in Vietnam.
When you have been sexually molested, your body may continue to feel as if you're a kid who's getting sexually molested, making it very difficult for you to have a loving, reciprocal relationship with your partners. ... So the question is really, ‘How do you help people to get unstuck?’”
Using the example of veterans, are they currently living in a state of fear?
“It's not cognitive. I’m actually astounded how people have to pay psychologists to tell them how irrational their thinking is. They probably know how irrational their thinking is and they feel ashamed about feeling that way. But they do. It is not a conscious decision that they make or a function of [how] they're not alert or aware. It is just a way that the part of your brain that's in charge of what Antonio Damasio calls ‘the housekeeping of the body’ continues to react to stuff as if you're in danger.”
Does trauma show up physically on a brain scan or MRI?
“Well, first of all, you see trauma show up in reality. Brain scans don't take the place of reality, because brain scans are still very primitive and cannot capture all the complexities. So how does trauma show? People have inappropriate responses to current situations. They suddenly get very angry or very frightened, or shut down in response. Other people say, ‘What's wrong with you?’ So you have these automatic reactions.
That's reflected in the brain. Certain areas of the brain like the amygdala and the periaqueductal brain are constantly pumping out information saying, ‘You're in danger, you're in danger.’ Your insula, the part of your brain that's connected with your body, feels all these sensations of heartbreak and gut wrenching, [and] are the sensations that go with feeling extremely frightened. You see abnormalities in that registration of body experience. And you see people slowly learning to shut down that part of their brain so that it no longer feels those things, and [you] may no longer feel your body sensations. You no longer feel pleasure, because the same things that make you feel pain also make you feel pleasure, so if you learn to shut down your pain, you also learn how to shut down your access to life.”
It makes me think of how self-medication is used to dull difficult feelings.
“Absolutely. Since time immemorial. I had classical education — Homer wrote continuously about soldiers drinking. This has been observed for millennia. We know the army has always survived on people taking drugs to sustain them through wartime situations.”
Where does trauma show up in the body?
“It shows up in that part of your brain that is in charge of helping you to meet challenges. It’s the part of the brain that secretes hormones that allow your gastrointestinal system to be ready for attack, and your cardiac system and your immunological system. So the system that basically holds the trauma has effects that go up [into] in the brain, causing all these behaviors or feelings, but [also] goes down into your body. In fact, if you really are a real serious researcher in this area, you discover sooner or later, that the somatic effects are even larger than the mental effects. Even when people have relatively good mental functioning, the somatic effects of your body react like [they are] in danger, having abnormal immunological functioning and having abnormal gastrointestinal functioning is extraordinarily common.”
Over the last 30 years, how has trauma treatment changed?
“Thirty years ago, we knew nothing. There was no treatment. But what I like to say to people is that we're still very much in a state of discovery. And anybody who says I have found the answer should not be trusted. But certain very important treatment issues came in. For me, the first one was suddenly called EMDR (eye movement desensitization reprocessing). … The first grant to study was actually from the National Institute of Health, and we had very, very good results. And that for me was interesting. That the method is a very strange method. You recall your trauma. You don't talk about it, but you move your eyes from side to side, and we see these amazing changes.
What that helped me to do is to understand that the western paradigm is that talking about how bad you feel and taking drugs may not be sufficient.
EMDR don't [sic] have very good results.
Second thing studied was yoga — putting your butt in the air, twisting your body into a pretzel as a treatment for PTSD. People said he's gone off the deep end. And it turns out yoga was a more effective treatment for trauma than any drug that people had discovered. … [Being] in touch with your body and taking care of your body is a very important part of overcoming trauma. And it's the next thing I studied. … [With] neurofeedback, we can harvest our brainwaves by putting electrodes on a skull, projected at a computer screen. And you can play computer games with your own brainwaves to regulate your own brainwaves and to get more focused and attentive. That was a major advance we are still working on. And then the most recent thing is that there's an explosion of research in psychedelics that I'm a very active part of. We find that psychedelics can be extraordinarily effective.”
You underwent psychedelic treatments with MDMA. What was your experience?
“I anticipated that the experience would be pleasant, and I'd see little parts of heaven and wonderful stuff. And I was sorely disappointed. … [A friend of mine used to be] the commissioner of child services in Massachusetts. He did an ayahuasca experience. He said, ‘While I was doing ayahuasca, all the traumatized kids in the world came to visit me.’ And I was like, ‘Oh my God, that must have been horrible.’ And he said ‘It was but at the end, I was a much wiser person.’ And lo and behold, when I took MDMA, I had a very similar experience.
People have oftentimes ask me, ‘What's it like to treat only traumatized people?’ And I minimized it and said ‘Oh, have a lot of social support from colleagues or friends. It doesn't bother me.’ And as I was getting my MDMA, all the trauma stories of the trauma experiences I had taken in came back, and it was a very, very rough experience. To really get in touch with all the traumas had lodged itself in me, because of the work that I'd done. But at the end, I said, ‘Okay, that's what I've done with my life, I voluntarily took in all that trauma.’ And it really had profound effects on my self-compassion and compassion for other people, about how painful it is to feel and experience all that trauma. And that's pretty much the experience of the people who are the participants in the study.
None of them have any picnic experience. They're all hard. They go to very difficult places. But somehow, the drugs make it possible for them to feel what they are feeling and knowing what they know. At the end, people have a feeling, ‘Yeah, that's what's happened to me. And now I can go on with my life.’ There is something about experience that allows you to fully … absorb, ‘Yes, this is my experience, but it's over.’”
Do you get to re-experience those memories with love and more compassion?
“It's all deeper than that. It's in such a deep hidden part of the brain, right? There is almost no cognitive element to it. And that's part of what I'm so happy about. Because our neuroscience has shown that trauma really is stored in the areas of the brain that your conscious self can really not access very well. So all this stuff about ‘let's do cognitive therapy and not have irrational thoughts’ … that's not how it goes. We have these impressions of the sensations, despite ourselves. So we go very deep [into the] part of the brain that allows us to really view and organize what happened back then. But the issue of self compassion, clearly is a very important element of the transformative effects of these drugs.”
Was your experience turbulent?
“It was very, very painful. I was very lucky because my wife was staying close by. And the people who were my guides were very experienced, and very loving people who were trusted. … My great worry about what will happen with these agents is that people are going to be careless with them. It's critical that these agents are given in a very safe environment. And the context is really what creates the safety that allows people to go to these very deeply painful places, and you should not be by yourself. … We are already seeing the capitalist system moving in there, saying, ‘Oh, we can make money off those drugs.’ … It's very dangerous. These are potentially dangerous drugs. And they need to be given extremely carefully, with extremely good guidance and a good context.”
Do you think MDMA or other psychedelic therapies could be the most effective treatments for PTSD?
“No. That is not what I would say. I know a number of very good treatments. And PTSD is just a list of symptoms. Now, I'm not a fan of the DSM — even though I've been heavily involved in it. Psychiatric diagnoses are not really scientific diagnoses. Different things and different people benefit from different methods. And I would not say, ‘Oh, we have found the treatment of choice.’ No, we have found a treatment for people who are stuck in the past who have a fairly decent level of functioning. If you're too disorganized because of your trauma, I would not dare to give these very powerful agents to you. I would do other things first to stabilize you. And so I think anybody who is a real trauma therapist needs to know a variety of different techniques.”
As you mentioned, there is a fear that the corporate world or the wellness industry will someday say, ‘Take a little MDMA to make yourself feel better to get in touch with who you are.’ Are you concerned about that happening?
“I fear that greatly. I fear that people will be very careless about it. I had an interview with a very famous person who will probably be on your show at some point, and she said, ‘Now just give me something I could tell people to do in five minutes.’ And I said, ‘No, I don't want to talk with anybody who wants a five minute answer, because this is very serious stuff. And if you want to heal from your trauma, you need to set your life aside for a moment to really go there.’ This is like an old fashioned pilgrimage. You take the tour to go there. It's very hard work and very serious. I'd be very worried about people doing shortcuts.”
Can the brain heal itself from trauma without assisted therapies or drugs?
“Nobody heals ourselves. We heal ourselves by the context that we live in. ... If you have been molested as a kid, and your first boyfriend or your first girlfriend when you're 17 years old is somebody who's very loving, that person can make an enormous difference in helping you to rewire your brain. If your first boyfriend, your girlfriend is abusive, that only reinforces those early experiences. So people are continually continuously able to change.
One very powerful change agent, for example, is going into the army. Basic training and being able to go through all that and getting a sense of pride in your capacities, pride in your job, [feeling] fulfilled can be enormously helpful. The armed forces traditionally have been a place where very traumatized people go, and then enlist and escape their trauma.
If no terrible things happen to you, an organization like this can be very helpful to give you a sense of predictability and rules and competency and friendship and all that. … What I like to warn therapists about is that therapy can be wonderful. But therapy is only a very small part of how life can help you. It can be your yoga instructor or your body worker or your martial arts instructor or whatever, who can make all the difference for you. But it's always sort of an interpersonal process. It’s about reciprocal relationships with other people.”
Are there any last ideas you’d like to leave with us on trauma or PTSD?
“A big issue in our study is that people talk about [what the trauma was]. For many people, their trauma is their relationships: being an unwanted child [or] being used by people for their violent or sexual impulses. It's not a particular event, it's the way that your early experiences shaped who you are, as your identity. And it's not about a particular event. It's about how you experience the world and how you experience yourself as a result of how you have been treated, and how people have used you in a way. MDMA is particularly helpful to help people to get a very new perspective on who they are.
The other thing that for me is very important is that these things are located in the body, and the way you experience yourself, and how we get traumatized. People oftentimes do terrible things to their bodies. They take drugs. They have unprotected sex with strangers. They do very dangerous things. Because once you're traumatized, you often have very deep contempt for who you are. And I think the issue of learning to live in a body and to have compassion for yourself and to care for yourself, is a terribly important aspect of trauma healing. And I do think that MDMA can help with that. But a few sessions probably doesn't totally do the transformation that you need to become a true somatically and self-caring person.”