EEarlier this month, an advisory panel rejected MDMA-assisted therapy for PTSD, potentially killing the US Food and Drug Administration’s (FDA) approval of the drug commonly called ecstasy. In a public meeting with FDA staff, panelists said the research did not adequately account for abuse risks, nor did it prove the drug’s effectiveness in combination with psychotherapy.
This decision dealt a major blow to Lykos Therapeutics, the for-profit public benefit corporation of the non-profit Multidisciplinary Association for Psychedelic Studies (Maps), which sponsored the trials. More broadly, the rejection was described as a drastic setback for the psychedelic movement as a whole. For several years, it seemed that greater acceptance and new legal spaces for psychedelics were a certainty. Then scientists appeared at the FDA hearing and everything went dark.
As practitioners and leaders in the field of human transformation, and in creating and managing organizations that serve individuals experiencing complex psychiatric symptoms, we believe in psychedelics as a force for good. Yet, for us, this FDA decision is the natural and expected outcome of a basic and fatal conceptual error that our brothers and sisters in the movement have adopted. Joining larger trends within the behavioral health milieu that focus on eliminating distinct symptoms through drugs and through expert-driven techniques, today’s psychedelic movement teeters on the edge of unpsychedelism.
What do we mean by this? Psychedelics free our minds to newness, which frees us from habitual patterns. The general term for this property is “brain plasticity,” and this may be the core reason that these substances can also affect areas of psychological suffering related to habits of mind—those that experienced psychiatrists label as depression, anxiety, addiction, and, yes, , PTSD. Psychedelics are pro-imagination, pro-creativity, pro-innovation – qualities that research shows are at the root of personal growth.
But to approach these remarkable substances as solutions for a specific brain disease, treatable by pharmaceutical and therapeutic approaches similar to surgical excision, is not plastic at all, but strictly protocolized, directed at human suffering as something impersonal. It approaches symptoms like the “check engine” light in a car – something that needs to be figured out and fixed by the right tool for the specific dysfunction.
We think the problem of an anti-psychedelic approach in the psychedelic movement started when organizations like Maps and Lykos grafted psychedelic drugs onto a common rubric where psychiatric illnesses go hand in hand with therapies that claim to definitively treat them.
Research on therapies proves that no specialized approach is more effective than others. What works is not some magically specific approach, but what psychoanalyst Jon Allen refers to as “plain old therapy”. The most effective medicine is to be seen and cared for by compassionate others.
Traditional psychotherapy is interested in building a non-formulaic, non-prescriptive, transformative space from which someone experiencing profound insecurity can find new perspectives on and relationships to their discomfort. “Plain old” sound practitioners, ceremonialists and underground “space-holders” in the psychedelic world have been practicing within a very similar ethos for decades now. They often deploy elements of sound and subtle imagery as non-formulaic guides through an experience.
Formulation, diagnosis and the imposition of expert opinion are often seen as obstacles to growth and are never the starting or focal point of care. The use of a drug and a symptom-reducing technique is an anxiety to the setting of a good psychedelic “space-hold” or well-run psychotherapy session.
The treatment for symptoms of PTSD and trauma has become a central focus of psychedelic care. But what do we mean by trauma? Often we mean existential concerns, such as betrayal, disillusionment, helplessness, alienation, which give rise to a loss of meaning. Care that promises a quick cure for PTSD symptoms trades the old-fashioned orientation to these life problems for an emphasis on bodily responses such as cortisol, the vagus nerve, and fight-or-flight.
This “biomania,” as Allen calls it, turns “trauma” into a product of the industry of psychological suffering, subtly labeling vulnerable individuals—who often report feelings of shameful brokenness—as fixable by experts, and thus broken until they experience the expert receive care. Maps Executive Director Rick Doblin vision of “net-zero trauma by 2070” is an example of how psychedelics aligned with this trend, promising a kind of utopia through a drug—until the FDA intervened.
We suspect that the main reason MDMA therapy failed the FDA panel is that plastic, tailored and ever-changing models of care do not fit the assumptions of the pharmaceutical industrial complex, whose profit-making ideas have captured government regulators along with elite academics. Forcing the deeply existential round peg of trauma into the square hole of a compound for symptom elimination only raised many questions about efficacy. For psychedelics to return to being psychedelically effective, we must use them to subvert the larger factory orientation in psychological care, not join it. In other words, researchers and practitioners in the psychedelic space need to get more plastic, not less.
MDMA, like any psychoactive drug, helps someone receive better comfort and care. It is a way to access an experience; it is not a medication. A skilled “space holder” can facilitate a new lens, a plastic moment, an opportunity for contemplation. They can help someone build a new relationship to their suffering, perhaps a less consuming and more generative one. In this way, the facilitation of human transformation can be compared to the treatment of metal: initially subjected to a burst of high heat that sends its atoms into a kinetic frenzy, followed by a gradual cooling process during which the metal atoms settle into a perceptible . lattice, which leaves the metal pliable, softer, less easily broken. It is an all-consuming process that is fundamentally transforming.
A biomanic approach does just the opposite. It is reductive in practice, automated approach, prescribing a few cures for an extremely complex event occurring to extremely complex people. Usually, totalizing in thought, and always about getting a person from sick to normal, it lacks plasticity.
The philosopher Thomas Kuhn, famous for his study of paradigm shifts, believed that such shifts occur when one form of thought accumulates enough anomalies and contradictions. We hope that the FDA’s rejection of MDMA, despite its efficacy, presents such a contradiction, and thus provides an opportunity for psychedelic-as-psychotropic advocates to take a more innovative, less conformist approach. The current crisis in the medical world’s pursuit of a panacea for trauma may free their minds from what really helps people change: an approach that sees each individual’s suffering as deserving of a unique response.
It also highlights what doesn’t work: the perspective that suffering is a disease that can be surgically removed from the psyche by experts with the right prescription. As psychedelics refers to creative, flexible approaches aligned with a greater wisdom, nothing could be less psychedelic than this approach.
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Ross Ellenhorn is a sociologist, psychotherapist and the founder and CEO of Ellenhorn, a psychiatric program with offices in Boston, New York, and Los Angeles. He published three books; is the latest Purple Crayons: The Art of Drawing a Life. Dimitri Mugianis is a harm reduction activist, musician, poet and author, with over two decades of experience as a psychedelic practitioner. Ellenhorn and Mugianis are the founders of Cardeaa psychedelic program operating in New York City and Treasure Beach, Jamaica
