Does ‘Ecstasy’ Live Up To It’s Name?

http://www.latimes.com/local/la-me-mdma-20140316,0,4729638.story#axzz2wFf3Afb4

“By some estimates, as many as 4,000 therapists were using MDMA in their practices before federal authorities banned the drug.”

MDMA, the active ingredient in Ecstasy, heals the traumatized brain, or so some patients and therapists believe. No science exists, only anecdotes. Is it compassionate to try a compound in which the stories sound compelling, even though it is illegal? This is the dilemma posed by this article which grabbed my attention both because of the ethical dilemma, and the intriguing neurochemistry. Let me start with the latter. Can we imagine a chemical which makes traumatic memories, memories from war-torn environments, memories from childhood sexual abuse, somehow seem less shameful and more open to discussion? Yes, I can imagine that. I can see how if the amygdala is suppressed, then the sting, if you will, of the memory is diminished, and thereby a narrative can flow without the obstruction of judgment or horror. As to the ethical dilemma, this is more troubling to me. Both sides of the dilemma make sense. On the one hand, people who are suffering need relief, and sometimes we have to think out of the box to obtain that. On the other hand, science is critical to advancement and so we should advocate for meticulous research before walking into territory which could cause more harm than good. Yes, it is true, that my professors did LSD research on autistic children, to see if the LSD would help with social skills, and so using illicit drugs for medicinal purposes is not a new idea. Yet, these professors used government funding to explore, what turned out to be, a failed experiment. For the clinician to advise MDMA ingestion, without the rigors of a clinical trial strikes me as well-intention, but misguided. The seduction that a medicine or a diet can alleviate human suffering creates an industry of hope and opportunity. If there were no side effects, like our relatively new gluten-free fad, then I am happy to emphasize the lack of science and encourage people to have their own trial. However, in the case of MDMA, fooling around with brain chemistry is a very scary proposition. I am waiting for the science, even though, as the article reminds us, no one seems to want to fund this. Having said that, I would rather use our current tools than to step over that anecdotal line which says,  “well, it worked for me, and so it might work for you too.” Ecstasy, the drug, in my clinical experience, is a wish for some, true for others, and a nightmare for the rest of the folks. I repeat. I am waiting for good data.

See also ……

Flashback to the 1960s: LSD in the treatment of autism.

Sigafoos J1, Green VA, Edrisinha C, Lancioni GE.

Author information

Abstract

Between 1959 and 1974, several groups of researchers issued reports on the use of d-Lysergic Acid Diethylamide (LSD) in the treatment of children with autism. This paper reviews that literature to consider how the authors justified these studies, as well as their methods, results, and conclusions. The justification for using LSD was often based on the default logic that other treatment efforts had failed. Several positive outcomes were reported with the use of LSD, but most of these studies lacked proper experimental controls and presented largely narrative/descriptive data. Today there is renewed interest in the use of psychedelic drugs for therapeutic purposes. While this resurgence of research has not yet included children with autism, this review of the LSD studies from the 1960s and 1970s offers important lessons for future efforts to evaluate new or controversial treatments for children with autism.

PMID:

 

17608329

 

[PubMed – indexed for MEDLINE]

Unspeakable Tragedy: Again, and Close to Home

LAX, such an obvious target for violence, was struck today, in the international terminal, where it appears the gunman was 23 years old and male. Those traveling, I can only imagine, were shocked and terrified. The parents and family of the gunman, also must be devastated. The wounded, terrified with physical and potentially life-threatening injuries. Those of us, watching on the news, thinking if we know anyone flying today, may also be a bit shaken, as I am. For no logical reason, the proximity of LAX makes this tragedy add on to the vulnerability, which feels new, that this rapid succession of violent crimes is creating. Newtown, Connecticut, the Boston Marathon, Virginia Tech, years ago, all come flooding back to my mind. On the one hand, we go through security at LAX, suggesting that harm can happen, and on the other hand, most airport travels are free of violence. Certainly, after the shooting is probably one of the safest times to be at LAX, and yet the fear must be enormous. Now, what about the gunman’s family? How can they possibly put this into perspective? Why is this gunman, like all the previous perpetrators male? Why is he, again like previous perpetrators, also under 40? Is there something about the young-adult male that makes him more prone to, what seems like, random violence? And what about the victims with physical wounds? How will they make sense of their new life, of this hinge moment in theirs? Some PTSD experts, such as our local Robert Pynoos MD, says that PTSD is like a pebble thrown into a lake. The closer one is to that pebble, the larger the ripple. So too, this tragedy at LAX, ten miles South of my office, makes me closer to that pebble than I was in Boston or Newtown. Proximity matters, he would teach us. Twenty plus years later, his teachings help me understand the workings of the mind. Thanks.

Understanding Transformation

 

 

“Literature provides a framework for understanding this transformation. Harold Bloom, the Sterling Professor of Humanities and English at Yale University, said that Shakespeare’s characters were “free artists to themselves” in his soliloquies. As the characters self-overheard their life’s stories, they were able to take control of their narrative and change their existential trajectories, whether good or bad. Likewise, as I accumulated more experience with the physical pains associated with the non-integrated memories that resurfaced while I told my story, I was able to eventually emerge from the restraints and walk back out into the world”

Read more: http://www.psychcongress.com/blogs/eric-arauz/august-10-2013-1235pm/addressing-trauma-treatment-serious-mental-illness#ixzz2by9068Fz

Moral Injury

 

Moral injury, a concept implying that one’s behavior goes against one’s morals, both individually and collectively. Behavior in one setting. like murder, is considered evil, but in the context of war, taking a life, is understood in a different way, and yet, it brings up the possibility of profound guilt, which, in my mind, is almost identical to moral injury. The idea that one can feel good about a behavior in the moment, but upon reflection, can have crippling regret, is the power of the human psyche to re-evaluate one’s actions with superego ideals, leading to despair, with the challenge of subsequent forgiveness. Suicides are high in our post Iraq and Afghanistan veterans, and so it is possible, but not proven, that this high rate of self-destruction, is due, at least in part, to a particular crisis in moral injury. Perhaps the behaviors of our returning soldiers, in retrospect, is too painful for words, too outside the concept of forgiveness. So, the question is whether the term “moral injury” furthers our understanding of these veterans, or whether it is redundant, given our established diagnosis of PTSD. I think “moral injury” focuses on guilt, whereas PTSD focuses on hyperarousal. Both are key components to the disabling psychological trauma which many of these veterans experience. “Moral injury” adds on to the multifaceted way in which those who have gone through an experience, so outside of mundane human activity, are left with a mind filled with confusion and anxiety. Understanding this suffering, perhaps by crystallizing a part of it under the term “moral injury” is one step further to helping those who suffer alone, join a community of empathic souls.

Lost Years Stimulated By Turning 50

Tea, turned 50 in December, but she is still fixated on this number. “I finally figured it out,” she tells me with great enthusiasm. “Yes,” I say, nodding that she has built up suspense. “Well, as you know, my son died twenty years ago and for me, the world just stopped. I was in a grief period, of course I still am, but I was really in another world for so many years, that turning 50 does not seem real to me. Everyone looks at me with a sense of recognition about how hard it is to turn 50, but I know that I am experiencing something that they do not connect to. I feel the loss of so many years where all I could think about was my son. That distortion, if you will, made me lose the normal tracking of time, such that I cannot latch on to my age. Sure, I have the other issues of aging, both body and brain, but that is not what is getting to me.” Tea relates this to me, as if she has solved a challenging puzzle. She is enthusiastic and not sad about her disclosure. “You know, it makes me sad to hear you talk about your son and particularly sad to hear how you feel you have so many lost years because of it. I am a bit perplexed as to why you don’t sound sad as you talk about it. At the same time, I can understand that you had an itch, which was the mystery of the meaning of turning 50, and now you have scratched it.” I say, knowing that we have discussed on numerous occasions how talking about her son is sad for both of us, but that does not mean we should not talk about him. “Yes, I do feel like I scratched an itch. That nails it. Before, I just felt so uneasy about my age, but it did not make sense to me, because normally I am not sensitive in that way. Now, it makes sense to me, so I feel better.” Tea, has done self-analysis, in a way in which she is communicating to me that the tools from our work together have helped her dig into her mind and test out hypotheses, until she lands on a concept that feels satisfying to her. “It must be so hard to ‘lose’ so many years, and have the people in your world not appreciate your feelings. I mean, I can connect with what you are saying, but it still must feel lonely.” I say, highlighting an old discussion about how Tea feels so alone in her grief. “Maybe you lost many years, but now that you have turned 50, you will be starting to appreciate time in a different way.” I say, highlighting that maybe this self-discovery will yield a deeper presence for her. “I can only  hope,” Tea says, now looking sad, but appreciative of our discussion.

The Yoga Intervention

http://www.traumacenter.org/about/..\clients\MagInside.Su09.p12-13.pdf

This article, by a well-respected expert, asserts that yoga heals the mind by working with the body. That makes sense to me.

Grief and Dread: Thinking About 9/11

“Grief and dread,” are the words echoed in the memories of 9/11. The paradigm of trauma, the events of September 11th, exemplify the characteristics which often lead to PTSD. This was a sudden and unexpected tragic event. If there were terrorism on the tenth anniversary, yesterday, this would not have been unexpected, but it could have been a tragedy. The grief is the loss, but the dread, is how out of control our lives can be, despite routines that we do day in and day out. It was World War I that made psychiatrists sensitive to this issue of trauma; this issue of the particular pain of sudden and unexpected harm. It is psychologically easier to have a diagnosis of cancer, giving fair warning, if you will, to the person about their upcoming demise. Trauma, however, feels so unfair. There is no way to prepare; there is no way to slowly change your mindset from contentment to helplessness. It happens way too fast. Time is an important dimension when it comes to receiving bad news. The mind seems to need some preparation, such that without that, there is an uncomfortable jolt to the mental apparatus. Consequently, the unexpected nature of these events like 9/11, make them etched in our collective minds, such that we will always be able to swap stories about what this terrorism meant to us on that day. We are forced to remember that our old paradigms can change in a moment. Once we “learn” that, we never forget. Trauma and memory often go together. The association between the event and the shock, causes a deeper imprinting in the hippocampus, the area of the brain responsible for memory. This long-lasting memory also causes the dread; the dread of knowing there are a lot more experiences in life that we simply cannot prepare for. This brings us back to the moment; the moment is all we have. We all know this, but sudden, unexpected, tragic events bring us back to this truism. We have to plan for the future, but we certainly cannot count on it.