February 4, 2019
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A new kind of treatment for PTSD, MDMA-assisted psychotherapy, may be just a few years away from legalization. What could it do for Black patients struggling with trauma? Brittany speaks to one woman about her experience with MDMA in therapy.
Follow Dr. Monnica Williams on Twitter.
- To learn more about MAPS, visit maps.org
- For more information on ongoing clinical trials regarding MDMA-assisted psychotherapy and PTSD, visit clinicaltrials.gov and search for “MDMA” and “PTSD.”
Sara: So I’m sitting on the couch, there’s nice warm, fuzzy, blankets sitting on the couch for me.
And then I grabbed the pill.
It was a blue pill and it's like the matrix like, oh, red pill, blue pill.
And I take it. And then I lie down on this couch and just listen to the mix… wait for the effects of the drug to kick in."
Brittany Luse: I know what you might be thinking: this woman sounds like she’s about to get high at a party.
But this is actually all a part of a research study.
A study that will help determine whether taking that little blue pill in therapy could help Black people cope with trauma.
-- theme in --
From Gimlet Media This is The Nod. A Black culture podcast brought to you by Blackness’ biggest fans. I’m Brittany Luse.
--theme out --
So the woman who was about to take that pill… her name is Sara.
And she’s a therapist.
We’ll get into what exactly was in that pill later.
But taking that pill was part of her training as a therapist in a research trial. A research trial that’s exploring possible treatments for racial trauma.
And I didn’t really know much about racial trauma, until I talked to Sara.
I mean don’t get me wrong, I’ve always known that being a Black person in America can be traumatic…
But I didn’t know that there’s a mental health term for what everyday racism can do to you.
To help me understand what exactly racial trauma is, Sara told me a story from her childhood.
Sara: So I grew up Kentucky, southern girl. Girl from the countryside, for sure.
Being from the country, there's not much to do, so you just hang out with your friends on any given day. so it was just another day, like a Friday night where I'm hanging out with one of my white girlfriends and we were probably listening to Dixie Chicks...And we're just talking about school, things that nine year old girls have conversations about. She starts talking about like, oh, yeah. So my mom is just so shocked that you’re… says you're so well-behaved for a black kid. And that you're so good and you're so smart. And from her experience, black kids are always bad or loud, or get into a lot of trouble.
And she laughed it off and I laughed it off too just because I didn't have the language to articulate what was happening. Or the understanding to know what was happening. But I just knew in my body that something was weird and something was off.
Brittany: When you say you knew in your body, what did that feel like?
Sara: Frozenness. It was like everything kind of paused. Everything was still. And that was the end of the conversation and then we proceeded to maybe eat pizza or watch a movie.
Brittany: Does that experience still affect you?
Sara: Oh, yes. I think these experiences don't go away. Sometimes they become residue that just becomes part of your experience. And sometimes they creep up in moments where you don't want them to.
I know this frozen feeling: you never know what to do or say in the moment. And you get the joy of replaying that moment for the rest of your life… often at the least opportune times.
For a long time, Sara handled these moments the same way I did: you push the experience to the back of your mind. Maybe you talk about it with friends, sometimes you even laugh about it.
But never too much beyond that. You never really acknowledge that it’s a wound, or a hurt.
Sara: How my family deals with kind of mental health issues is to pray about it. And I come from a lot… a lineage of strong black women. And I think this idea of the strong black woman and how you kind of have to sacrifice everything for your family then like your needs kind of come second to everything other than the family... so I think that growing up, a lot of those beliefs and values were really instilled in me to be the strength. And to kind of have this fight and you've got to do it by any means necessary.
Brittany: It's interesting because my mom was a social worker and she still keeps her therapist licensing up.
Brittany: So I grew up with therapy being a valid option but still, also like God and Jesus are very important and you must be the strength and backbone of your family. And what it does, it doesn't really leave much room, I've found, for conversations about anxiety or depression. How did your family talk about that when you were younger?
Sara: There was no talk about that. I think silence is a lot of what happens.
But today, Sara has a way of talking about that frozen feeling…
Sara: So I think racial trauma can be one way to describe the accumulation of incidents like that...
Brittany: You use the term racial trauma. Like how do you explain racial trauma to someone who's never heard that term before? How do you how you talk about that?
Sara: So if you're walking in a store and you're being followed by a store clerk that's like a racist experience. And racist experiences also don't always translate to racial trauma. But an example of racial trauma could be when you experience discrimination in the workplace because of your race and that discrimination manifests into a depression or anxiety… when you're not able to sleep at night, when you're not able to experience white people as safe, when you're constantly in environments, trying to make sure that you're protected… that is what racial trauma is.
What Sara is saying is that trauma can be caused by the accumulation of a lot of different racist experiences. Not just hate crimes, but everyday things like workplace discrimination.
Which is wild because that exact scenario… a ton of racism at a previous workplace that culminated into really bad anxiety and depression... that made it feel impossible to go to work…. that happened to ME.
But I would’ve never known that experience had a name.
And I would’ve never called it “racial trauma.”
And the thing is, the average American therapist probably wouldn’t either.
That’s because the DSM-5 -- like the holy bible of diagnosing mental disorders-- makes zero mention of racial trauma.
Specifically, it’s not listed under Post Traumatic Stress Disorder.
Right now the DSM only defines PTSD as being caused by a specific traumatic event,
Not a whole bunch of experiences…
But… there are some mental health professionals - including Sara - who say racial trauma should be recognized as a kind of PTSD.
And they’re looking into whether it could be treated… With that little blue pill that Sara took…
Dr. Williams: Right now there are a couple studies that have come out that MDMA, which is the active ingredient in ecstasy, given under the right conditions, seems to actually help people with trauma.
Dr. Williams: Yes. MDMA.
Dr. Williams: Yes, MDMA.
This is Dr. Monnica Williams. She been studying racial trauma for almost a decade…
And some of her latest work is looking into whether MDMA psychotherapy can help treat it.
To be clear, MDMA is not the same as ecstasy or molly.
Those are street names for MDMA -- but, because you’re buying them on the street -- they’re usually full of a bunch of other stuff, too.
We’re talking about pure MDMA here. It’s a substance known for increasing feelings of trust.
Dr. Williams: Now, it is combined with therapy, so it's not like you just take it …
Brittany: And then you go on your merry way.
Monnica: Right. Exactly. Otherwise everyone who went to a rave would have their PTSD cured. So..
Dr. Williams first heard about this research a few years back.
She got a call from the people behind a non-profit called MAPS, or the Multidisciplinary Association for Psychedelic Studies.
They research potential medical uses for psychedelics and marijuana.
And at the time, they were doing studies on whether MDMA-psychotherapy could treat PTSD. But, like a lot of clinical trials, their participants were overwhelmingly white.
So they asked for help from Dr. Williams to make the studies more racially diverse.
Dr. Williams: I thought it sounded completely nuts. And I remember thinking I want nothing to do with this. I had never equated psychedelic drugs with mental health care... as something that could actually help people.
Brittany: Had you done any work with MDMA or psychedelics at all?
Dr. Williams: No. None whatsoever. My idea of a chemical party is like a fruity drink with an umbrella in it.
Brittany: You know what? Honestly, me too.
What ultimately won her over was watching some MDMA-psychotherapy sessions, and seeing how the patients changed.
Dr. Williams: You could just look at these patients and you can see they were so not well at the beginning. You know, feeling jumpy and anxious and restless and afraid.
And then after the treatment, it was just such a difference. People would just say these amazing insightful things that, you know, as therapists we always cheer when people say these kinds of things like they might say, "You know, I realized that this trauma happened to me because I was in the wrong place at the wrong time and had nothing to do with me as a person and I'm not a bad person. I just had a bad thing happen to me." And we're like, yes, exactly. But sometimes these things take a long time to get to in conventional therapy. And to see people like just suddenly have insights like that after one MDMA session was amazing.
To understand why this was so amazing, you have to know a little bit about how PTSD is currently treated…
To treat PTSD, many therapists turn to a technique called “prolonged exposure.”
It involves helping a patient confront a traumatic memory that they’ve been avoiding.
The idea is that -- by facing the memory head on -- the patient becomes less afraid of it.
Williams: Now that treatment is very challenging at times for clients and even for therapists because the client has to recount their trauma in detail over and over again. And that's hard and that's really what they're afraid of. So a lot of people don't come for help because they just don't think they can do it.
And this is where the potential of MDMA-psychotherapy comes in.
MDMA can decrease feelings of fear and defensiveness
and increase feelings of trust.
So it could potentially help patients confront traumatic memories with more openness.
Dr. Williams: Having seen people getting both kinds of treatment, prolonged exposure, where the person is recounting in excruciating detail their trauma over and over again and watching people get better with MDMA therapy, this method seems much more humane. And if treatment doesn't have to hurt like that, then it shouldn't.
The research on MDMA-psychotherapy for PTSD is still pretty new, but the FDA has called it a “breakthrough therapy.”
And it could become legal as soon as 2021. The results from earlier trials look promising: About 70% of MDMA psychotherapy patients no longer meet the criteria for PTSD after just 12 months. And those improvements lasted up to four years, mostly without additional treatments.
Dr. Williams: My interest was is this treatment useful for people of color who have PTSD and have experienced racism?
So in the summer of 2017, Dr. Williams joined with MAPs, the psychedelics nonprofit, to open another research site in their study.
The site would be the only one to focus on how MDMA-psychotherapy could treat PTSD specifically within Black, brown and other marginalized communities.
Brittany: There's so many barriers, right, for black people to get proper mental health care, period. Like I could see a skeptic sort of saying that MDMA treatment and having research behind that could feel like far down on the list as far as to-dos for getting black people proper health care. I'm wondering, what do you think makes this MDMA treatment such a priority for you?
Dr. Williams: Affluent white people everywhere have been getting better from their PTSD and black people have been left out. And we should have access to that same effective game changing treatment as everyone else.
So, after recruiting a team made entirely of therapists of color… Dr Williams began her study at the University of Connecticut.
And from the get go, she said her team had to deal with a ton of microaggressions --- the kinds of incidents that -- sadly and ironically -- could contribute to someone developing racial trauma.
Dr. Williams: The white male M.Ds are in charge of everything. And they call the shots and theirs are the priorities. So it became very clear very soon that our study was not a priority.
Brittany: And how did that show up? Like what did that look like to you?
Dr. Williams: I mean, it was almost impossible to get anything done. I mean, even something as simple as asking the admin if she would print something out on her computer, well, she couldn't be bothered. Or several times our staff was harassed by nurses who said, what are you doing here? Demanding that a doctor be called to confirm that they're allowed to be there and doing our research in our research space.
We reached out to the University of Connecticut about Dr. Williams’ descriptions of the treatment of her team by University staff. And they said they had no comment.
Dr. Williams no longer runs the study at the University of Connecticut. The research now takes place at her private practice.
And here’s how it works:
The participants go through twelve weeks of therapy sessions.
And only three of those sessions involve MDMA.
During those MDMA sessions, there are always two therapists in the room.
The participant takes the pill and lies down on a couch. They put on eye shades and headphones, a listen to a playlist.
They might talk from time to time with the therapists about what they’re experiencing.
Or ask for help processing their feelings.
The treatment takes pretty much all day. And it can be tiring, so participants stay overnight at the treatment center.
And the next morning, they continue processing their experience with the therapists.
And many of the therapists can actually relate to their experience.
Because, as part of their training, many of them choose to go through the MDMA-psychotherapy themselves.
Dr. Williams: That being said, nothing anybody described to me completely prepared me for the experience myself. So it wasn't at all like I thought it was going to be.
Brittany: Wait, how did you think it was going to be?
Dr. Williams: I don't know. I guess I just thought, you know, I would take this and would lay down and maybe I would have kind of mental images of multi-colored paisleys. And then I'd get all these fantastic nuggets of wisdom from spirit guides or something. And then I would feel happy and content. I guess that's what I thought.
Brittany: What actually happened?
Dr. Williams: So as soon as the medicine kicked in, there was like this lightning bolt in my brain that said basically, you've turned your whole life into work. And I was like, nooooo.
Brittany: That's deep.
Dr. Williams: And then also I recognized that one of the ways I had dealt with feeling disempowered and vulnerable was to gain as many competencies as I could. And um.. it was like I had built this big wall of competencies, of lots and lots of things I could do really, really well to protect myself. And at the same time, it had cut me off from other people.
Brittany: How much have you talked to other Black women who've taken this drug? Rather, undergone this treatment?
Dr. Williams: Well, I only know two other women, black women, and those are the two on my team, the two other therapists.
Brittany: So nice to meet you, hello, so good to meet you in person
Sara: Hi I’m Sara…
This is one of those therapists, Sara.
You heard her earlier, talking about that “frozen feeling.”
We asked to speak to Black participants who’ve done the therapy,
but so far, there are none that have completed the treatment at Dr. Williams’ site.
Although Sara hasn’t done the full 12 weeks of treatment, she did experience a therapy session with MDMA.
Brittany: So how did you feel about the idea of taking MDMA as a part of therapy?
Sara: I'm a very open-minded person. I guess I'm not really afraid of the unknown. I'm more curious about it. And I think that curiosity really creates a sense of safety for me. Now for my friends, they still I don't think understand what exactly it is that I do. Or like why it's helpful. I've had some friends say, "So people are coming to be in this research and they come to therapy and they get high, and that's supposed to be helpful?" There’s already a lot of mistrust that’s going on… and I think that it’s important for me to have this knowledge as a POC, so I can be able to articulate from experience what this medicine would be like for people of color.
Sara told us all about her MDMA therapy experience,
starting from the very beginning...
When she arrived that morning, she went through a bunch of preliminary testing…
Then her therapists asked a lot of questions about how she was feeling.
Sara: Like how close do you feel to the therapist. Or if you're suicidal...
Since participants could be revisiting traumas -- and potentially confronting them more directly because of the MDMA --
some difficult feelings might come up.
That’s why the therapists are in the room the entire time.
That morning though, Sara said she was feeling centered.
Sara: I was pretty chill. Pretty chill. Pretty open. Also, a little nervous about kind of what would come up because I have a history of all of kinds of traumas.
Brittany: Did you think that this treatment would work on you?
Sara: I thought that it would have some type of effect and I didn't know how deep of an effect, I would say it had on me, or it would have on me. The deep part is what I was not anticipating.
After the break, Sara goes deep, and we go with her.
Sara: I could feel my heart beating faster, and I’m like oh shit, it’s happening
Sara: So I’m sitting on the couch, there’s nice warm fuzzy blankets sitting on the couch for me. And we get settled and one of the therapists grabs a bowl with the pill. It was a blue pill and it's like the matrix like, oh, red pill, blue pill.
And then I grabbed the pill and I take it. And then I put on my headphones that has a pre-selected playlist. And I put on my eye shades and then I lie down on this couch and get in my warm blanket and just listen to the music and wait for the effects of the drug to kick in.
I wasn't feeling much in my body so I'm like, okay, when is it going to start? I would lift up my eye shades and look at the clock and that was my barometer for kind of keeping track of how things changed over time.
So I would keep lifting up my eye shades to see if things looked different around me or to see what like time it is. And I would know like, okay, around 9:45 is when I definitely should be feeling something.
I physically started to feel different. I could feel my heart like beating faster and it felt like my mind was racing.
I'm like, oh, shit. It's happening.
I was having so many thoughts at one time, and my brain was making all of these new connections. It was hard for me to keep up because normally, in a conscious space I am able to have a thought and then filter the thought, and then figure out if I'm going to say the thought or say a modified version of the thought. All of that was gone in that moment.
Things seemed like they were moving so fast.
My body felt heavy and it felt like it wasn't matching my mental process.
And the only way that I knew how to describe it was that it felt like I was dying. It felt like I was about to die, but it felt really oh - like it felt like my time was up, and it was fine.
The moment I decided to let go was really with the help of the music.
The melody was light, it was bright.
Then I have the most euphoric experience where I felt really connected to the world, to life both here and beyond.
And I was able to connect with my deceased grandmother on my mother's side.
So it wasn't that I saw a human version of her. It was very much the energy of her.
her death was traumatic for my family in a lot of different ways... Because she died in a fire... And my mom is still trying to grapple with the complexity of her death. And so my grandmother kind of came to me and gave me some words to give to my mother that she's fine. That she's fine. She's so light and free.
And then she takes me to this place that the only way I know how to describe it is kind of all there is.
This space of openness and oneness at the same time.
it's a place that I call home.
It was the most bizarre experience I've ever felt in my life. It was almost like moving through space.
Atoms of yellow.
And so I was able to move through this space in a very fluid and freeing way.
No body, no me. I'm just life in its essence.
Freedom is the only way I know how to describe it. It's beyond anything I've ever felt in my body. It's probably the best I've ever felt in my body, that there was so much joy in the sense of like ease and peace and relaxation, that there was no ... like I no longer had to exist in the space of shoulds and oughts and you need to do this to be safe. Or you need to do that in order to succeed. It was just I could be, I could just exist.
I kind of experienced the sense of freedom and fluidity, but then I'm coming back into this body with all of its invisible wounds. And to come from freedom back to wounds? I was not happy. I was not happy at all.
There was a slave woman… I was with her in this back house. It was nighttime and she had an opportunity to run or to escape.
But she stayed.
And I could not make sense of why she stayed.
And there was no dialogue that happened between us, so I'm just kind of watching her in this kind of movie.
I think that was metaphorical for me. My great-grandfather was born out of a rape between a slave and a slave master. So there was some of that residue that also came up for me in my experience that I had to learn how to deal with.
For so long I've been able to dismiss certain experiences as "Oh I'll deal with that later" or I'll push that experience to the side or I'll push that hurt to the side, I'll push that pain to the side. And I wasn't able to rely on those defenses to process the pain. So I literally am confronting things in a very raw way for the first time in my life."
There were moments that were very challenging for me, so challenging…. They had to contact the... lead therapist of that site, ... I was experiencing a lot of suicidal ideations. So she just had to come and check in with me and make sure that I was settled in my body.
The processing with my body looked like me sitting me sitting on the ground and just allowing my body to rock back and forth as a way to settle my body.
And then they got me some duck soup and I ate that but still was processing pretty much the entire night.
Brittany: A night monitor stayed with Sara that night as she slept.
And she talked through the experience with her therapists the next morning.
The therapists made sure to check in with her every day for the next week.
To be clear, there’s no data yet that establishes suicidal ideation as an adverse effect of the MDMA-psychotherapy.
This was just Sara’s experience.
And today, she is no longer feeling suicidal.
She also said, in the weeks after the therapy, she experienced immense highs. There were days, she said, when everything around her felt beautiful. And she felt light and grounded.
Sara: What was released was the frozenness that I had experienced in my body, that everything for so long had been a secret or was not OK to talk about... And I just -- I was able to feel again, I was able to move again. So it was like I was able to breathe again. To take off my Super Woman cape and set it down for a second and take a break and really experience the complexity of my experience. it's like, you can do all these things and you also are a human and you also feel and just because you experienced pain doesn’t mean you're weak.
Brittany: The experience of taking it and everything that you processed and released and went through, what did that experience do for you?
Sara: Something that was unexpected for me in this experience was this sense of freedom that I was able to experience and these new emotions that I was able to experience because I think that to be able to experience that is something that I know in my social circles, people don't experience that joy on a day to day basis.
Brittany: Do you think that that's something that white people have an easier time doing?
Sara: Yes. Yep, 100%. 100%. They don't have to worry about the things that people of color have to worry about. They don't have to worry about when a police pulls them over if it's a life or death situation for them. They can imagine a world of joy and happiness because they see that represented in the media. They see that in the workplace. And so, a curiosity that I have is that will people of color experience the same freedom while they are going through this treatment? Because I think that what I was able to experience, that freedom, that joy that I was able to experience, if I could gift that to black folks in particular… it'll help.
Brittany: Ever since I spoke to Sara, I haven’t been able to get that concept of freedom
out of my head. The prospect of feeling that liberated is thrilling. I mean who wouldn’t want to experience that?
And I know... this therapy isn’t some silver bullet that’ll solve racism.
I’ll always have to deal with the everyday indignities of Black life-- being mistaken for another Black person at work, or being closely followed by a store clerk… And the constant threat of state violence.
Each of those experiences adds to a weight that I’ve carried for most of my life.
And what I think this treatment could offer is a break from shouldering that…
A chance to feel a sense of safety and freedom I’m not sure I even comprehend yet.
And doesn’t every Black person in America deserve to feel a little more free?
—theme music —
The Nod is produced by me, Brittany Luse, with Eric Eddings and Kate Parkinson-Morgan. Our senior producer is Sarah Abdurrahman. We are edited by Emanuele Berry. Additional editorial support from Jorge Just.
Fact checking by Max Gibson. The show is mixed by Cedric Wilson.
Original scoring and sound design also by Cedric Wilson.
Additional sound design and scoring by Bobby Lord. Our theme music is by Calid B.
For additional music credits, check out our website, gimlet media DOT com SLASH The Nod.
And if you want to learn more about the science of MDMA… Science Vs --- another Gimlet show -- did a really great episode all about it.
We’ll link to it in the show notes.
There, you’ll also find links to learn more about Dr. Williams’ trials with MDMA psychotherapy.
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