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You’re listening to Insights at the Edge. Today, my guest is Dr. Rick Doblin. Rick is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies, known as MAPS. He received his doctorate in public policy from Harvard’s Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana. His professional goal is to help develop legal context for the beneficial uses of psychedelics, primarily as prescription medicines, but also for personal growth for otherwise healthy people, and eventually to become a legally-licensed psychedelic therapist.
In this episode of Insights at the Edge, Rick and I spoke about Rick’s lifelong relationship with the drugs that he studies at MAPS, and how he stresses that it’s the personal relationship that you have with the drug that matters most. Who feels it, knows it. We talked about how MDMA-assisted therapy, now in its third set of clinical trials, has been proven to help many people who have PTSD, and the mechanism of action for MDMA when it comes to healing trauma. We talked about Rick’s development of the Zendo Project, and how the project creates a safe place to support people when navigating difficult experiences while on psychedelics. Finally, we talked about Rick’s desire for a “coming out party” of people of influence who will stand up and claim that psychedelics have been an important part of their life, and how this “coming out” can help catalyze social transformation. Here’s my conversation with Dr. Rick Doblin.
Rick, in becoming familiar with you and the work of MAPS, the Multidisciplinary Association for Psychedelic Studies, it became very clear to me that you are a person on a mission. Can you summarize for our listeners what your mission is with MAPS?
Rick Doblin: I would say it’s metabolizing fear into appreciation. By that, I mean the mission is to avoid another Holocaust and to avoid another Cuban Missile Crisis, the destruction of the world through nuclear weapons, and to avoid what I experienced when I was a young man facing the lottery for Vietnam: the dehumanization of the other, a lot of what we see today, the rise of fundamentalism. The mission is to balance out the… not over-exaggerated, but we are way more advanced as human species intellectually than we are emotionally and spiritually, and therefore, we’re destroying the world, and we have the weaponry to destroy humanity, and also, we’re destroying the environment.
So what we need to do is accelerate our emotional and spiritual development to cope with the products of our intellect, and that’s what I recognized when I was an 18-year-old boy in 1971 and ’72, that I was way more developed intellectually and way underdeveloped emotionally and spiritually, and I felt that psychedelics could play a major role in helping me to grow. And when I looked out at the world, I thought that it could play a major role in helping in many, many different ways, and the fact that they were suppressed was a clue to me of their value, ironically. So at age 18, in 1972, I decided to focus my life on psychedelics and trying to bring them back as therapeutic tools, spiritual tools, and also I looked upon the war on drugs as a massive, massive violation of human rights, as a tool to suppress minorities, and as one of the worst policies with the most destructive consequences that we as a species have adopted.
Tami Simon: Well, first of all, I thought you were going to say something like that your mission was the widespread cultural adoption of psychedelic use in the culture, something like that. So it’s interesting to me that you gave a much grander and more sort of deeply rooted mission, metabolizing fear into appreciation. That’s interesting.
Rick Doblin: Yes, because the psychedelics are really just a tool. They’re not the end in themselves. In fact, the word psychedelic means “mind manifesting,” and the way we interpret that word, that doesn’t have to be just drugs. I mean, holotropic breathwork, developed by Stan Grof, the early LSD researcher, so hyperventilation to bring out emotions. There’s a lot of things that are psychedelic that don’t involve taking a drug. The psychedelics are just a tool to bring forth and manifest the mind and deeper emotions, and that’s what it’s really about.
So I think that what we’ve done as a culture is we’ve focused on the substance, the drugs, and there are certain drugs that are good drugs and certain drugs that are evil drugs or bad drugs or dangerous drugs. We criminalize certain drugs and have others legal, and what we’ve lost by doing that in that simplistic kind of thinking is that what really matters is the relationship you have with a drug or with anything else. It’s the relationship that counts. It’s what you do with it, in what context and with whom.
The best example for me, from the FDA point of view, is the drug thalidomide. I imagine that many of the listeners will know that thalidomide was a drug that was used in women for morning sickness. In Europe, it was approved. It never quite got approved in the U.S. This was in the late ’50s, early ’60s. It caused terrible birth defects. And on the basis of all of that fear of these birth defects, the one person at the FDA that has won the Presidential Medal of Honor was this woman, Frances Kelsey, and she was the one that blocked thalidomide from becoming a medicine in the U.S. and saved who knows how many women from having deformed babies. But years and years later, thalidomide is now a medicine—for leprosy and certain kinds of cancer, because it chokes off blood vessels in ways in which that can be actually helpful.
So we’ve got the quintessential “bad drug” used in a certain way, that decades later became used in a different way and now it’s an FDA-approved medicine. So it’s really about the relationship that we have with the drugs, and that’s why I think when you asked me my mission, it’s about what the drugs can do rather than about the drugs themselves.
Tami Simon: Yes. Now, it’s very interesting that you said it’s about the relationship that we have with these drugs. I’d be curious from a personal standpoint, the drugs that you work with and study the most at MAPS, what’s your relationship with each one of those? How would you describe it, as if you were describing a relationship with a person or with an organization, something like that?
Rick Doblin:Well, I would describe it first off as a sense of immense gratitude, that these drugs have helped me to do things, to feel things, to know things. Rita Marley has a great album title, Bob Marley’s wife, widow. It was called Who Feels It, Knows It. So I feel that these drugs have helped me. First off, LSD. I’m grateful for LSD for helping me to feel at all. I just was very much in my head. And I think that was a good thing, because it really helped me to think through how to respond to a murderous culture and humans that are still partly—or maybe even sometimes mostly—predators from the jungle rather than enlightened human beings. But LSD helped me to feel emotions, so I’m very much grateful for that.
Then also there’s a relationship… If I were on a deserted island and I could only have one drug, it would be LSD. The reason for that is that with LSD, you have to… The key to doing LSD is surrender. It’s difficult to negotiate with LSD. Stuff comes up from the unconscious, and you decide, “Hey, that’s a little bit too much for me. I’m going to pay attention to that later,” and it doesn’t quite work that way. But it helps you see things that your defenses might block from you, that you might not otherwise see. It brings you to the new, or the truths that you’re not quite ready for, or you don’t think you’re ready for, not quite willing.
Whereas with MDMA, I guess I’m grateful for MDMA for love. MDMA is just so beautiful. It’s so subtle, how it’s different than normal consciousness, but it’s a very subtle shift with a reduction in fear, and openness of the heart, and deep self-acceptance, and better listening, feelings of love and connection. So I guess the other way to say this is that I imagine that my relationship is lifelong relationship with these drugs. They’re not one-night stands, in other ways.
There’s a story that Ram Dass, Richard Alpert, who was with Leary at Harvard, talks about and he’s saying, “When you’ve got the message, hang up the phone,” like this was a justification for people who had done psychedelics and now were looking at meditation. So they got the message, there’s a deeper way of processing and thinking, there’s a spiritual world, and now let’s meditate and try to integrate and anchor this in our daily lives, and I think that’s very, very crucial. But I think it misses the point that we all know, that every time you pick up the phone, it’s not the same message. It’s a different person calling, or you’re a different person because it’s a different stage of your life.
So I think what I’ve found is now that I’m almost 65 and started doing psychedelics at 17, that it’s a lifelong relationship and different things are of value to me at different stages of my life, and psychedelics have been important throughout it.
There’s a whole host of other drugs that I can talk about. Some of the drugs, ibogaine for example, I’ve only tried one time. Ibogaine is a psychedelic drug used in religious services, religious rituals in Western Africa, but it has the remarkable property of helping people through opiate addiction, through the withdrawal process, and then it also can spiritualize people. I’ve only done it once in my life, in 1985. So more than about 33 years ago, and yet, that was one of the most important psychedelic experiences of my whole life. It was really grueling. It was 12 hours of vomiting and agony. But it was showing me the punitive nature of perfectionism and the way in which self-hatred and perfectionism can go together, and yet the way in which we need that constant inner critic to help us learn and grow, we just need to separate it out from the self-hatred.
So I learned that, to the extent that I’ve learned that, through my ibogaine experience, but that was only a one-time experience and it was so grueling. It took me four days afterwards before I could even trust myself to drive. The next day, I couldn’t even sit up. Third day, somebody had to pick me up. But that’s a one-time thing. Maybe one day, I’ll do ibogaine again, but I haven’t yet. So some of these drugs I have limited experience with, but it carries me through my life. I would say it’s a healthy relationship, that I have healthy, lifelong relationships that are different drugs at different times for different purposes.
Tami Simon:Now, Rick, there’s so much to talk about here, but I want to bring forward a concern right at the beginning of our conversation.
Rick Doblin: Oh, OK.
Tami Simon:A couple of Sounds True authors have said to me, “You know Tami, I’m nervous about how people are starting to use psychedelics, whether it’s in personal healing or the spiritual journey, that there’s this new floodgate opening now in our time where people are traveling down to South America for their ayahuasca journeys, et cetera, and I’m seeing,” this is Sounds True authors, two different ones, reporting this to me, “people coming into my clinical practice with some real problems, with some real unintegratable material, some split off parts of themselves that they can’t make peace with.” One person even reported that one of her clients had committed suicide. And these authors said to me, “Tami, be careful. People trust you. Be careful as you step into the territory of talking about psychedelics and healing and the spiritual journey, that you don’t lead people astray.”
So I want to start right there, Rick. How can you help our listeners be responsible in their relationships, and how can we make sure that we’re not creating harm here, even in this conversation?
Rick Doblin: Well, first off, I think that the experience itself is only a part of the healing process, and when we talk about work with psychedelics, we use the word MDMA-assisted psychotherapy or LSD- or psilocybin-assisted psychotherapy. People tend to focus on the experience, not on the integration. I would question a little bit the way you phrased it as unintegratable content. I would say that people can integrate what happens in a psychedelic experience, but they need a lot of support, both during the experience and for weeks, months, sometimes even years afterwards. Even Albert Hofmann, who invented LSD, talked about taking a major dose of LSD once a decade, and then it would take him a decade to integrate what had happened before.
So I think the concern is that certain of these experiences are not readily legally available in the U.S., so people go down to South America, as you say, and they have experiences with ayahuasca, or even ibogaine in Africa. They have these experiences in a different cultural context, they’re away for a week or so, two weeks, then they come back to their normal environment and everything’s different, and they don’t spend enough time on integrating. And the people that they had the experiences with are thousands of miles away. We’re actually starting a list called the Psychedelic Integration List on our website, on the MAPS.org website, of therapists that are open to working with people to help them integrate experiences with psychedelics that they had, either in the U.S. or abroad, that they don’t have therapists here to talk to about it.
So I think your concern that you expressed, that these authors expressed, is quite right in that you need to think of it as part of a process where you have this experience, but you also have to do a lot of preparation for it, and then you also have to do a lot of integration. I think the sad part is that there is no way that we can say we’re not going to cause any harm with this conversation. Because if we were able to say to people, “You’re suffering right now or you want to learn right now,” there’s no ideal legal context in the U.S. for this, so either you’re going to go underground, and there’s hundreds, probably thousands of underground psychedelic therapists willing to work with these drugs, but they have riskier context, or you have to go abroad, and there are things that are less than ideal about that. You ideally want to be in your normal life and you go for therapy and then you’ve got somebody right nearby to talk to them about integration.
So while we have the system of prohibition that we have, and we’re trying to gradually undo it, that’s going to take multiple decades more. So there always is going to be now a certain level of risk, unless somebody gets lucky enough to be in one of the studies. We’re moving into phase three studies for PTSD with MDMA. Other groups are going to be working with psilocybin for depression. So there will be contexts for a limited number of people, but we’re just talking about hundreds, not thousands of people. There’s millions of people with PTSD in the U.S., and a lot of them have exhausted the available therapies and medicines that have not worked for them.
Just to give you an example of how profound that problem is, two years ago, June 30, 2016, there were 868,000 veterans receiving disability payments from the VA for PTSD, and almost 600,000 more receiving disability payments for anxiety, depression, and other mental health disorders, at a cost to the VA of roughly $30 billion every year. So that’s just war-related PTSD. There are more people with PTSD from sexual abuse, from accidents, from operations, from abusive parents, simple assaults, all sorts of things.
So there’s an enormous number of people who need help, who have not been able to get the help that they need from what’s available, although many people have found relief from the currently available therapies and from the currently available SSRIs. That has helped a bunch of people, but there’s all sorts of people that are desperate and looking for solutions. The solutions are not easy to find in our cultural context under prohibition, and people are willing to go to extremes. And there is going to be some risk involved in that, and I think we have to acknowledge that.
I think the best thing to say to people is, “Beware of the whole idea of a one-dose miracle cure.” I think that was one of the downfalls, you could say, of the ’60s, in that some of the advocates started saying, “All you need to do is take LSD once and then you’re enlightened, and then you’re somehow more advanced than everybody else.” And I think the one-dose miracle cure idea is really dangerous, because first off, it focuses on the drug. It doesn’t focus on the preparation or the integration, and it also feeds the delusion that there’s a very simple solution, in a few hours.
Now, occasionally some people will get cured after one session of MDMA, get cured of their PTSD, or people will get cured of their depression after one session of psilocybin or LSD, or people will be cured of addiction to opiates after one ibogaine session. So that can happen. But really, that’s very rare. I think what people need to prepare themselves for is a long journey of slow, incremental progress. And then, I think we’re less likely to have these kind of situations.
Now, the suicide that you talked about, the person that went and had a psychedelic experience and committed suicide. Those are tragic. We’d have to know a lot more about that situation. Had the person ever attempted suicide before? Was this their first suicide attempt? Or had they been dealing with lifelong depression and then they went and took ayahuasca and that brought things to the surface and they weren’t prepared for that?
So we monitor people very carefully after the psychedelic experience. The experience takes place during the day, from roughly 10 in the morning until six at night, and then we have people spend the night in the treatment center. And then there’s more integrative psychotherapy the very next day. Then we monitor them several times over the next week before they come back in for another in-person session, by phone calls to check in and see how they’re doing. We help them realize that if they’re struggling to integrate stuff, they can call at any time, day or night. They can even have another psychotherapy session, extra that’s not in the protocol, to help them deal with things.
So I think the risks are really there, and it is important to acknowledge. I would say again, going back to the mistakes of the ’60s, the government at the time was willing to exaggerate the risks. I mean, they were even saying that you took LSD and you have chromosome damage and you’re going to have deformed babies. They were willing to exaggerate the risks and then deny the benefits. And in the response, I would say Timothy Leary and others exaggerated the benefits and minimized the risks.
I think as we talk now, 50 years later, about how to integrate psychedelics into our culture, the thing that we most need to do is to be clear about the benefits and not exaggerate them, and talk a lot about preparation and integration, and then also be clear and honest about the risks and not to minimize those. If we can develop that sort of credibility and that sort of story that we’re telling, I think we’ll have a much better chance of succeeding 50 years later and successfully integrating psychedelics into our culture.
Tami Simon: Do you believe, Rick, that we’re in the midst of a psychedelic renaissance the way some people have described this time that we’re in right now? Do you see it that way?
Rick Doblin: Yes, I do. In fact, I think I was probably one of the first people who started talking about a psychedelic renaissance. If you look at the amount of studies, there’s more psychedelic research now than at any time in the last 50 years. I just got off a phone call earlier this morning from an oncologist who’s working with his cancer patients and saying that they need more tools than they have in oncology to deal with existential distress for people facing death. There is so much interest right now in psychedelics that it’s not an exaggeration to say that it’s a renaissance in research and even moving more and more into the traditional world.
Just to give you one example, in 1990 is when MAPS, when we first approached the Veterans Administration about the use of MDMA for PTSD, and at the time, that was just Vietnam vets. We had therapists and psychiatrists working inside a VA that wanted to do work with us, and the head of the VA at that time, the city VA, said no, refused. Ever since then, every few years, every five years or so, we try again with a different VA somewhere around the country. Always the people closest to the patients would say, “Yes, we want to explore this,” and the political people would say no.
Now that’s 28 years later, and the first person actually that said no the MDMA inside a Veterans Administration center is now one of chiefs of psychiatry at one of our phase three sites, and we’re working with the National Center for PTSD at the VA. They’ve permitted some of their therapists to work with us, for us to fund them to blend MDMA with their existing therapy. So I think there is a renaissance. I think the FDA is the organization that deserves the most credit for that.
So I think yes, the FDA, actually, in 1992 had a meeting to discuss whether to open the door to psychedelic research. We had presented the FDA with a protocol for MDMA for cancer patients with anxiety, and in 1990, the group of people at the FDA that regulated psychedelics switched to a new group of people and they were willing to put science first. They approved a study by Rick Strassman with DMT, but that was kind of a negative study. He wanted to see if DMT caused schizophrenia or could cause delusions. It’s easier to get studies approved that are looking at risks or looking at negative things than looking at benefits.
So then we wanted to study MDMA for something positive, helping cancer patients address their anxiety, and the FDA had this advisory committee meeting. The National Institute on Drug Abuse had a two-day meeting before that, of all of their animal researchers looking at psychedelics in animal models and asked them the question, would they be open to human research? And the NIDA people, not known for their endorsement of positive uses of different states of consciousness, they said that their animal studies were becoming increasingly irrelevant, because unless you could have human studies to correlate with the animal studies, you didn’t know how to interpret the animal data.
So in 1992, the FDA said, “Yes, we will open the door to psychedelic research, and we will put science before politics, but the researchers are going to have to follow the exact same procedures that we would ask Big Pharma to follow for any new drug that they wanted to develop into a medicine,” and our response was, “Great. All we want is a fair playing field.” Ever since 1992, the field has been growing and FDA has been our main ally, and not because they’re pro-psychedelic but just because they’re pro-science. So now we’ve reached a point where the EMA, the European Medicines Agency, is open to psychedelics. There’s just a fantastic situation with more research now than at any time in the last 30 years, 50 years, really.
So the other sign that it’s a psychedelic renaissance is that we’re actually doing research now that we never did 50 years ago, and that’s what’s called phase three. Phase three research is the final stage of research where you do large scale, multi-site, double blind, placebo-controlled studies and the goal is to develop definitive proof of safety and efficacy in order to obtain approval for prescription use, and so we’re moving forward into phase three for MDMA-assisted psychotherapy for PTSD. Other groups are moving forward into phase three with psilocybin for depression.
In the ’60s and ’50s, there were no phase three studies. Those were all academic research projects trying to understand how these drugs worked or what they might do in patients. Those were called phase two studies in patients, but it never got to the point of these phase three studies to make these drugs into medicines, and that’s where we’re at right now. We anticipate by 2021 that MDMA will be approved as a medicine for PTSD by the FDA and ideally by the European Medicines Agency, as well, as will psilocybin. So we’re definitely well along into a psychedelic renaissance.
Tami Simon: Now, for people who are hearing about MDMA, which is also known as ecstasy in common language, being used for PTSD for the very first time, they’re like, “Really? How does that work?” What’s the mechanism of action, so to speak, on how MDMA helps heal people who have PTSD?
Rick Doblin: Well, fortunately, if you go to MEDLINE right now, which is the PubMed, the world’s repository of scientific literature, medicine, there’s over five thousand papers there on MDMA. So we do know quite a lot about the mechanism of action. MAPS itself has not funded these studies, because to make a drug into a medicine through the FDA, you need to prove safety and you need to prove efficacy, but you don’t have to have a clue about mechanism of action, and a lot of the drugs that we have, we don’t really know how they work, anyway.
So before I explain mechanism of action, I just want to say that for those people that might be surprised to hear that ecstasy is being used as a therapeutic drug, from the middle ’70s to the early ’80s, the drug MDMA under the code name Adam was legally used in therapy. It was similar to drugs that were illegal, so it was kept quiet for fear that it would be made illegal, but it was legal and it was used in therapy. One of the people that used MDMA in a therapeutic context decided that this drug should be available to more people, that it could be used in other contexts, that we could make a lot of money at it, and so he turned MDMA into ecstasy. Then ecstasy started getting used in bars in Texas, the Starck Club and others, and ecstasy attracted the attention of the DEA, and then in 1985, it was criminalized.
So what we’re really trying to do. I started MAPS in 1986, right after the criminalization of MDMA, we’re trying to restore the therapeutic use of MDMA, which was in existence before it became a party drug. But the mechanism of action question. So for PTSD. PTSD, posttraumatic stress disorder, changes people’s brains. What it does is it increases activity in the amygdala, which is the fear processing part of the brain, so that fearful memories are always not far from the surface and there’s all sorts of triggers and reminders that people have. And people, to cope with it, they become emotionally numb or they become hyperreactive. PTSD also changes the brain in terms of the prefrontal cortex, where we think logically, put things in association. It reduces activity in the prefrontal cortex with people with PTSD, so that they’re more emotionally fearfully reactive and they’re less logical about things.
MDMA does exactly the opposite. MDMA reduces activity in the amygdala, so that emotions that are fearful, that are linked to memories of trauma, once people can look at them, once they think about them, they can do it from a more peaceful place. And they can, in some ways, release the fears and anxieties that when the trauma happened, they had to suppress, because they had to focus on survival, and yet the fears stay with them. MDMA also increases activity in the prefrontal cortex, so people are able to think more logically. Every person who is in a red hat, if they were attacked by somebody in a red hat, every time they see a red hat they get fearful. So in their prefrontal cortex, they’re able to separate out that that’s not always a signal of danger.
MDMA also releases hormones of oxytocin and prolactin, which are the hormones of nursing mothers, of love. It helps people feel connection and trust, and it helps build the therapeutic alliance. And then MDMA also increases connectivity between the hippocampus and the amygdala, where emotions are moved more into long-term storage, where the hippocampus is connected to memory. So people are able to take these emotions that have been trapped, in a sense, in short-term memory because they’re so fearful, and are able to process them into long-term memories. And then MDMA also stimulates activity in serotonin, dopamine, and norepinephrine. Which has a cascade of different effects but also in some mysterious ways, we’re not exactly sure how, contributes to this [feeling] like you’ve tapped into a well to the unconscious, and emotions emerge and thoughts and feelings emerge into awareness that have been suppressed. We find that under the influence of MDMA, people’s memory for the trauma is enhanced, that they actually can recall a lot more of what happened to them from a position of safety and awareness that it’s not happening right now.
So all of those factors combine to create MDMA as the ideal drug for PTSD, and I should add that MDMA acts fundamentally differently than the classic psychedelics. When you say mechanism of action for psilocybin or LSD or mescaline from peyote or ayahuasca, what is being discovered through modern brain scan research is that there is a resting state ego awareness. It’s called the default mode network of the brain. It’s the part of the brain that’s when you’re scanning the horizon or just thinking about things, you’ve got no particular agenda. It’s your ego, it’s your self, it’s sort of looking at what you need from the world, who you are. It’s the anchor of us in time and space.
What the classic psychedelics do is they don’t really do what I described with MDMA with the amygdala or the prefrontal cortex, but what they do is, they reduce activity in the default mode network, which acts as a filter. So the filter of incoming information to what’s relevant to us in our human life from birth to death, what are our needs, that filter is weakened, and we get flooded with all sorts of perceptions, including emotional material that we’ve tried not to see, that we’ve suppressed, but that’s highly charged. Stan Grof has talked about LSD as a nonspecific amplifier of the unconscious, and that’s a good way to understand how modern neuroscience is looking at effect of these psychedelics on the default mode network. MDMA is not so nonspecific, in the sense that it’s more filled with emotions of self-love, self-acceptance, of connection, of reduction of fear. So that’s what we understand about mechanisms.
Tami Simon: When it comes to the research results, how many times does someone need to have an MDMA-assisted session? In general, what are you finding, for the recovery from trauma to be lasting?
Rick Doblin: Well, yes, thank you for asking that question, because a lot of people don’t really understand the differences between classic SSRIs or other antidepressants that you’re supposed to take every day. But in our therapy model, people only take MDMA three times. What we have is a three-and-a-half-month model where MDMA is taken once a month for three months. We actually say it’s between three to five weeks apart, so it’s not exactly one month, but it’s three eight-hour, day-long sessions of MDMA. And there’s 12 90-minute non-drug psychotherapy sessions, three before the first MDMA session as preparation, and then three of these 90-minute sessions for integration after each MDMA session. And then two months after the last MDMA session is what’s called the primary outcome measure, and that’s where we compare the control group with the MDMA group and we need to show statistically significant differences at that two-month point. We also look 12 months out, just to see how durable it is. We’ve also then looked at, in some studies, three and a half years out.
So basically, what we’ve discovered through our phase two studies and we’ll see to what extent we can replicate this with phase three studies, but in our phase two studies with 107 PTSD patients who had MDMA three times. Early on, we only gave it twice, but now we do it three times. The placebo group of chronic severe treatment-resistant PTSD, roughly 22% of them no longer had PTSD at this two-month follow up, which is actually really good for therapies for chronic severe treatment-resistant PTSD. But then when you add the MDMA, it gets up to 56%, so it more than doubles, that people no longer have PTSD. Then when you add a third session, people are up to 61% no longer have PTSD. But, at the 12-month follow up, it’s two-thirds of the people no longer have PTSD. So what’s happened is, three sessions have started a healing process that people continue on their own.
Now, what I’m talking to you about is averages. There are non-responders, there are relapsers. It doesn’t work for everybody. Of the one-third that still has PTSD at 12 months, most of them have had reduction in symptoms, clinically significant reduction in symptoms, but they still have PTSD. But some of them it did not work for, and those tend to be, what we’re trying to understand is those people that have what’s called high on dissociation scales. One of the classic defenses when you’re traumatized is to split off, to dissociate. So the more that that has been sort of solidified in people’s life as a coping style, dissociation, the harder it is to treat them, the more time they might take. Also, in dealing with complex PTSD, combined with childhood sexual abuse, parents that they couldn’t really trust, those people are also harder to treat.
So what we’re anticipating is that there will be this three-session model, and that will work for most people, but for those people that it doesn’t work for, we would wait maybe six months or a year before administering any more MDMA, because we want to see if we’ve started this natural healing process. Then for those people that relapse, usually what happens is that they have had some other traumatic incident happen in their life, some other stressor that has caused them to relapse. So we think that in the end, there’ll be some sort of a limit and people for PTSD will not ever get MDMA more than like 10 times in their whole life. But for most people, we think three times will work. Again, it’s MDMA-assisted psychotherapy, with the emphasis on psychotherapy. So the MDMA is embedded in a long-term, trusting therapeutic relationship and that’s what really gives it the healing power.
Tami Simon: Now Rick, I’m imagining someone who’s listening who says, “You know, I can’t wait until 2021. I have a type of trauma that has been resistant to traditional approaches. I’m ready to get going. This conversation has been so exciting for me, and I have a sense there’s something I need, that MDMA could help me with in my healing.” What would be your guidelines for such a person who’s ready to go rogue?
Rick Doblin: Well, first off, I would say we’re about to start phase three in August, next month. If you go to the MAPS website under Participate and you sign up on our email list, there’s a checkbox once you get to putting in your email where you can say, “I want to be notified when the studies start.” We have over 20,000 people on that list, sadly. But I’d say sign up for that. Maybe you could get into one of the studies.
Tami Simon: I was with you until you told me I would be the 20,001st person, and then I felt a little disappointed.
Rick Doblin: Yes, well, that’s very true. OK, so somebody came up to me at Burning Man last year and they said, “You saved my life,” and I said, “How did I do it? What happened?” They said, “Well, you have your treatment manual,” so we have a standardized psychotherapy, and we have developed that, we’ve described it in a treatment manual that we’ve put up on our website on the MDMA research page. This guy said, “I was a vet, I had PTSD. I read your treatment manual. I found a friend, I found some MDMA, and I took it, and now I feel better.” There are people that can heal themselves in that way if they establish a trusting relationship with their friend. But you never know, are you getting pure MDMA or not? There is one place in the United States that’s licensed by the DEA called Drug Detection Lab [ecstasydata.org], and they can accept anonymous samples of drugs and analyze them. It’s like 125 bucks, and you can find out what’s in whatever pill or capsule or whatever you’ve got.
But again, I would say to people that it’s a difficult situation you’re in. I’ll say this, years ago, 10 years ago, somebody called me up and he said, he was your hypothetical person that you just described, “You know, I’ve got terrible feelings, I need underground therapy.” I referred him to a therapist that did not do underground work but that I thought was great, and he worked with that therapist for three or four months. Then he called me back and he said, “It’s working, but not enough. I still want underground therapy.” The more we talked, he explained that he had had epilepsy, he’d had seizures at different times of his life, and it’s possible, although it’s very rare, that MDMA or classic psychedelics could trigger a seizure. So I said, “I don’t think you’re appropriate. I can’t really help you,” and then I didn’t hear anything for three months.
Then I got a call from the police in his hometown, and they say, “Did you know this person?” I said, “Yes, he called me up, he wanted therapy, and I couldn’t refer him to anybody, and that’s the last I heard of him.” The police said, “Well, he’s committed suicide and he’s left you a suicide note.” It turned out that he committed suicide the very next day after I said I couldn’t refer him to an underground therapist, it just took police three months to call me. The suicide note was beautiful. He said, “I don’t blame you, I blame the system of prohibition. You can use this note, you can tell people about it. I might’ve been one person saved if psychedelic therapy was legal.”
So I recognize that there are people… You started out earlier, we talked about someone who went for psychedelics and then committed suicide. There are people who commit suicide because they can’t get psychedelics. So it’s a difficult situation, and the most important thing is a safe context to explore difficult emotions: with friends, with therapists, with any kind of safe context, family members. It’s a difficult, tragic situation, and every day, people ask us for therapy and we just are saying, we’re trying to do this as fast as we can to make it into a legal prescription medicine. But until we do, people face these very difficult choices.
Tami Simon: One of the parts of your work, Rick, that got my attention is something you call the Zendo Project, where you help people who are going through a difficult journey while having ingested a psychedelic, work through whatever’s come up for them. You set up the Zendo Project at various festivals or events. So I wonder if you can talk some about that and how you train volunteers to help you with the Zendo Project?
Rick Doblin: OK, yes, great question. Thank you for that. Well, I became aware of psychedelics in 1971, when I—the full story—when I first started taking LSD in ’71- ’72, and I started to understand their therapeutic potential at a point in time where the backlash had already happened. I learned about MDMA in 1982, when it was both an underground therapy drug under the name Adam and also a popular recreational drug, or increasingly popular, under the name ecstasy. So learned about MDMA before the backlash, and that’s why I got politically involved and so deeply involved with MDMA.
But now, as we are in this psychedelic renaissance and we’re moving into phase three studies, and even before, when we were first starting this work with phase two with patients, I started thinking, “What are the causes of backlash, and how can we avoid them?” The cause of the backlash in the ’60s was really the connection between psychedelics and the counterculture. The way in which a lot of people used psychedelics, had kind of unitive, mystical experiences, had other experiences, and then thought, “Well, why do I want to go kill people in Vietnam? They’re not that different from me. What are the real reasons that we’re trying to do this?” So the psychedelics got wrapped up into the counterculture, got connected up with the environmental movement, with the women’s rights movement, even the civil rights movement, the antiwar movement, and the culture reacted in a way and shut things down for decades and decades.
But now, I think that that connection between psychedelics and the counterculture is no longer really prevalent. I mean, we have so many people that took psychedelics in the ’60s and didn’t go live on a commune, that lived fully in society, had families, had jobs, did great. We think of Steve Jobs as someone who said that LSD was one of the most important things he ever did and started the richest company in the world, Apple Computer. So the reason for backlash now would be parents worried about their kids, and a lot of young people do use psychedelics at festivals.
So I started thinking if we could provide a safe, supportive environment for people that take psychedelics in a recreational context—not only kids, but mostly young people—and help them through the difficult spots so that they don’t need to go to the emergency rooms, they don’t need to get tranquilized, or they don’t need to come in contact with the police and get arrested. That if we can take these people having difficult psychedelic experiences, and in a safe, supportive environment help them learn from them and grow from them, that would be one of the most important things that we could do to prevent a backlash.
We started, actually, in 2000 reaching out to Burning Man and saying, “I want to bring multiple people, therapists, to help.” Burning Man reacted negatively, and they said, “No way, we don’t want that because that means we would acknowledge that psychedelics are being used, and we’re worried that the police would use harm reduction as a sign that we know psychedelics are used and then would try to shut us down.” So it didn’t work until 2003 that Burning Man said yes. In 2001, though, we started our first harm reduction psychedelic project at Hookahville in Michigan, and later we started working at Boom Festival in Portugal, where drugs are legal. They’re decriminalized in Portugal, so they could be up front about the psychedelic harm reduction. Burning Man is doing great now. We’ve treated over four thousand people from the Zendo Project. Burning Man is now comfortable. Last year, we treated in one year roughly 670 people, and everybody at Burning Man got a flyer to say that we were there, the Zendo Project was there.
So what we have been able to demonstrate is a successful harm reduction model, and the way we train the therapists is by teaching basically four key principles. We try to have people who are already trained as therapists, but we’ll work with people who are not therapists who have had substantial experience of their own with psychedelics and know what it’s like to face difficult things. The first principle of the Zendo Project is create a safe space, and what that means is that it can be physically safe, you’re out of the commotion, but it’s really the human relationship, whoever is there with you. We had 900 people, roughly, apply to volunteer at the Zendo Project at Burning Man, and we selected about 260 of them. We staff a facility 24/7 for the whole week of Burning Man.
So the first thing is, create a safe space, help people feel that they’re not going to be arrested, they’re not going to be taken away, that they’re not going to be attacked. Their attention is directed inward, into what’s happening with them, and so they are, in a sense, in a real genuine sense, defenseless from people from the outside, so you have to protect them and help them feel safe, and also that means that they’re safe with the emotional content, that you’re not reactive yourself. If they start talking about a rape and you’ve been raped and you don’t want to think about it and they start talking about it and then you are like, “Don’t go there,” or you communicate your own anxieties, that’s part of not creating a safe space.
So you create a safe space. Once you’ve done that, and we teach about all the different ways that you do that, and we have medical supervision also to check people out to make sure they’re not having physical problems, then the next thing is that we teach, it’s called sitting, not guiding. The key aspect of that is that we are not the guide, we meaning the people sitting with, the therapists, the support people. The guide is the person’s own unconscious, and things emerge in a way that is unique to each individual, and our job is to help people process that, but not to direct that. We don’t know the goal. We don’t know where they need to be. We don’t know what they need to feel. We don’t know the order. We just are supporting.
So we are sitting in kind of a meditative way with people and then… A lot of times, people will have their eyes closed, listening to music, going inward. But when they come out and they want to talk, then we will sort of sit with them and help them process whatever they’re processing. So it’s a key aspect of the attitude of the sitters, that they’re… It’s arrogant in a way to say you’re the guide and you know where people need to go. It’s not like being a wilderness guide where you’ve been out on the trails before and the mountain is an exterior mountain. These are interior mountains of people’s unconscious and their own history, and the symbols mean different things to different people. So sitting, not guiding.
Then the third part that we teach, it’s called talk through, not talk down. What that means basically is that you don’t try to distract people to talk them down from what they’re feeling, like, “OK, you’re on a drug, it’s going to get over in a few hours. Think about things that are beautiful. Here’s a flower. You know, think about this, think about that. Don’t worry about the trauma that you’re trying to tell us. That’s only in the past.”
So we don’t talk people down. We’re not trying to take people away from their experience. We’re trying to help them face it and look at it, and so we talk through. So it’s, “What is it that’s scaring you? You see a vision of a skull. Tell me about it. What’s behind that? Accept that. You feel that you’re dying. Well, OK, you’re not physically dying, we have medical staff here, but it’s like an ego death or emotional death. Let it happen. Go through it. These fears that are coming up that you don’t want to face, you’re better off facing them because they influence your life even more when they’re unconscious than when they’re conscious.” So we try to direct people’s attention towards what they’re worried about, rather than talk them down.
And then the fourth principle, which in some ways I think is the most important to help people really frame this in their own minds, is that difficult is not the same as bad. Many people are trained or they believe that once things start getting difficult, once a psychedelic trip starts getting difficult, then they’re going to have what we all know is called a bad trip. What makes a bad trip bad is not the content, but it’s the resistance to the content. It’s the unwillingness to explore it and to feel it. I mean, one time when I was having a terrible LSD trip early on in my late teenage years, I was so resisting the feelings that I felt like my brain was an electric wire but that things were blocked and my brain was just heating up and it was going to be melting because of the resistance. I actually felt like a nasal drip and I thought, “Oh, my brain is coming out my nose.” It was terrible.
So it’s the resistance that’s the problem, and so when we say difficult is not the same as bad, what that means is this may be painful, this may be very, very difficult. Some of the PTSD patients have said, “I don’t know why they call this ecstasy,” because when they’re actually releasing the trauma, they’re experiencing a lot of the trauma for the first time because they had to shut down when it was happening and focus on survival. Once people understand that it’s OK to have a difficult experience, there is a way to emerge from it stronger, then I think people are really fully ready to work through difficult experiences and then those are the key four elements that we train people in. We do playacting, roleplay, all sorts of things to turn this into longer training. Sometimes we have two-day trainings. At Burning Man, we have like a three, four-hour training. It all depends.
But I think the Zendo Project is something that we’re extremely proud of, but it’s very sadly limited by the fear of concert promoters, festival organizers, that harm reduction methods will be used against them. I think that’s slowly changing, but that’s… From a policy point of view, when Biden was a Senator before he was Vice President, he passed what’s called the RAVE Act, the Reducing Americans’ Vulnerability to Ecstasy, and it had the unintended consequence of giving the impression that harm reduction methods were criminalized. But we are now seeing in America a broader acceptance of needle exchange. There’s even going to be safe injection rooms to avoid overdose deaths in certain cities of America. So I think harm reduction is becoming more accepted, but it’s still controversial and needs a long way to go.
Tami Simon: Rick, just a couple of more things I want to sneak in here before we close our conversation. I know that one of your strategies at MAPS is to have a big coming out at some point of very successful people, celebrities, people who are willing to stand and say, “Psychedelics have been important in my life and my journey, and I want to say that, come out of the closet.” Where are you at with this big psychedelic coming out party? Can you release some of the names? When’s it going to happen?
Rick Doblin: Well, there was one extremely prominent person that said that he would come out with a thousand people. This was maybe six years ago, and then maybe three years ago, two or three years ago, he said he’d come out with a hundred people. So we still don’t have that list of people that are all willing to come out together. But I guess I would ask you and the listeners to think about, when we look at the gay rights movement and what has been so successful about that. Now, we of course with the new Supreme Court people, we may have a rollback of that, but what I think really propelled them into the progress that they’ve made was coming out, just people saying, “You don’t know my sexual orientation, but you know me for what I’ve done in the world and you value that, and now I’m gay, I’m homosexual,” and that’s changed people’s attitudes.
So I think the coming out model that we’re talking about with psychedelics, we’re not quite there yet, ready to release a whole group of names, but there are more and more people over time that are willing to do that. But I guess I’d ask everybody to just think about what they imagine to be the risks of them doing so, for those of your listeners that actually have had these beneficial experiences with psychedelics, and maybe the more you think about it, maybe you can come out to your family if you haven’t already, or to friends, or in increasingly public ways, because I think that coming out is going to be absolutely essential for social transformation.
One of the beauties of doing clinical research is that we have now an increasing body of people that have had these profoundly healing experiences in a legal context, and so they don’t have to be so worried about coming out. But it will take people willing to take risks in doing so, and so I wish I could release the list right now. But we’re working on it and hopefully in the next year or two, we’ll be able to have that kind of New York Times full-page ad with all these people saying, “I benefited from psychedelics.”
Tami Simon: Yes. Now, Rick, I want to circle back to something we talked about in the very beginning of our conversation, this idea you mentioned from Ram Dass. When you’ve picked up the phone, once you’ve got the message, go ahead, hang up the phone and do the slow work of meditation, psychotherapy, chanting, spiritual practice. You’ve had this profound glimpse through a psychedelic, but now, in order to create change that will be sustainable, to work the muscle of your own inner life. And in my own experience, and this gives me a chance to come out…
Rick Doblin: Oh, great.
Tami Simon:…once again in yet another way to the Sounds True audience, I had very profound experiences, under a handful when I was a young person, with psychedelics. They were extremely formative for me, informative, breakthrough, gave me some big initial mystical insights. But then I had the experience of, “I think I got the message. Now I’m going to dedicate myself in a different way to a slow type of gradual transformation process throughout the rest of my life.” And I notice when I think about psychedelics now in my life, I have a sense of being quite sensitive, like it doesn’t take much for me to feel very, very, very, very deeply in a big, expanded way, so I haven’t been drawn to it. And yet when I heard what you said, “Albert Hofmann said once a decade,” it brings me to this question: How does somebody know, I think I’m ready for another psychedelic infusion in my life, or not? Maybe I’m in a place where I feel kind of fragile, or I just am a sensitive soul and that’s not what’s needed.
Rick Doblin: Well, yes, how do you know what your inner voice is telling you to do and whether that’s really a good advice or not? I think again… Well, let me tell you first off about a research project that I think is one of the most important going on in the world right now with psychedelics. In the Zen tradition, there’s a lot of people who have a story similar to what you just shared, early experiences with psychedelics and then they decided to get involved with meditation, and a subgroup of these people were involved with Zen meditation.
So in Switzerland, there’s now a study that is taking lifelong Zen meditators, whether they began with psychedelics and then gave them up or whether they never did psychedelics, but these are now taking lifelong Zen meditators in their 50s, 60s, and 70s, some even a little bit older. Taking them to Zen meditation retreat at a Zendo called Felsentor in Lucerne, Switzerland, and they actually go to the University of Zurich for brain scans before and after this five- or six-day meditation retreat. During the middle of the meditation retreat, they get a pill that’s either psilocybin or placebo, and then there’s a crossover months and months later, so everybody who got the placebo gets the psilocybin.
And what they’re finding is that even these lifelong meditators who thought that they had gotten the message either from psychedelics or from some other way when they were young, that there’s new progress that they’re able to make as a result of the psilocybin. That they can actually learn to deepen their meditation practice, even when they’re lifelong meditators, with just one more psilocybin experience later on in their lives.
So I think we are seeing within the Zen tradition, which has been fairly anti-“drug as intoxication”, that there’s a growing acceptance of blending occasional psychedelic experiences with lifelong meditation, and that people are reporting that they’re able to make progress in their meditation practice. So I would say to people that it’s an individual decision. There’s no right answer. It’s just, are you drawn to this? Is it worth your… Are you curious about exploring it? Maybe because you’re different, you’re not the same person as you were when you had your early formative LSD experiences. You’ve had so much life experience, plus, you’re now looking at death at a different way, from a different perspective and what you want to accomplish.
So I don’t think there’s a right answer for people, but I think that more and more, we’re starting to see that there are more than one message that people get and that it can make sense to try psychedelics again later in your life, but it’s very important to take time out from your life. Tami, you talked about being very sensitive. So it’s not something to think about as, “Oh, I’m going to just trip over the weekend and then I’ll go back to work on Monday and everything will be fine.” When I think about doing a large dose of LSD, I think about it as a five-day experience, to give yourself time to really take yourself apart and to slowly, slowly put yourself back together again in a new way. I think the older we get, in a way, the more time we need to give ourselves for the integration process, the more that we have to deal with.
I would just encourage people to, if they are called in that direction, to really just explore whether they can assure themselves that they have pure drugs and a safe place and give themselves enough time. For some people, it’ll be worth it and other people will say, “Ah. I learned it before. It really wasn’t worth it,” and I think that will be a valid conclusion for some people, and other people will say, “Wow. It started a new chapter in my life.”
Tami Simon: Rick, if we’re part of the psychedelic renaissance right now, you’re at the vanguard. Thank you so much for being with us here on Insights at the Edge. Thank you so much.
Rick Doblin: Well, Tami, thank you for helping us share and educate lots more people. I really appreciate it.
Tami Simon: And if people want to connect with you, what’s the best way? And with MAPS.
Rick Doblin: Well, MAPS, M-A-P-S.org. We are a nonprofit organization, so we’re looking to increase our membership. We’re funded entirely by donations. There are no investors. Even though some people give millions of dollars, some people give $10 or $20 or $30, and everything is worth it. And then there’s places on the website for people to send in emails, askmaps@maps.org, and we will try to respond to every single one of them. We just encourage people to get in touch and to think about taking an active role in being part of the psychedelic renaissance, and consider becoming a MAPS member. We have newsletters, bulletins, and research updates, things like that.
But I’d say the most important thing is for people to become informed, to really understand what’s going on. And then to the extent that people want to, to come out to those close and ever farther away from them, so that we create an opening in this culture that really can sustain the movement towards psychedelic medicine, and then eventually psychedelic spirituality, and then eventually towards a post-prohibition world.
Tami Simon: I’ve been speaking with Rick Doblin, the founder and executive director of MAPS, the Multidisciplinary Association for Psychedelic Studies. Rick, thank you so much for being a guest on Insights at the Edge. Thank you.
Rick Doblin: Wow, thank you too, Tami. Great. ‘Bye.
Tami Simon: SoundsTrue.com, waking up the world.
