Psychedelic Therapy Will Not Save Us

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It was tempting to imagine that therapists of the psychedelic movement were going to be cut from dramatically different cloth than that of my parents’ generation. They are not so fine after all. The cult of personality, and the penchant for victim blaming in the field, seems to be unkillable.

I took part in an MDMA session during the Covid confinement.

mdma

I’d been stranded in Paris following the unfortunately timed coincidence of the sale of my small house in the Loire Valley. I’d already signed the contract when the pandemic arrived. My intended return to the US was thwarted. All of my belongings had to be moved into storage willy-nilly. I moved into a friend’s Paris apartment, expecting to be there a month.

A year later, Paris was still under effective martial law. City services had all but ceased. There was garbage everywhere. Rats appeared on the streets. I was mugged twice in my own small quartier. I became extremely depressed and anxious; I was losing my mind.

During this time, I interviewed a woman doctor, a one-time psycholytic therapist, for a newsletter I was writing. She invited me to visit her and her husband at their home in another European city.

The circumstances around the experience were challenging. I had to obtain paperwork to be permitted to travel more than a few kilometers outside Paris. I had to prove I’d been vaccinated at a time when vaccinations were hard to come by. Fortunately, an infectious diseases doc with whom I was acquainted made that possible. I was so grateful to be invited, and to be among people after over a year of total isolation — people who appeared to welcome me into their home even though they did not know me, no less — that when the experience deviated into something unexpected and off-piste, I wanted nothing more than to dismiss the idea anything was awry. At first, I was too confused to disclose what happened.

After a year, I’ve begun to comprehend the experience in terms of the dimensions of what can occur in the psychedelic space when practitioners whose own drug use, and persistent adulation by their clients and disciples, leads them to believe they are larger than life. Normal rules of conduct do not apply. In retrospect, that is what happened here. In such hands as these, the dangers MDMA poses intensify a participant’s vulnerability exponentially — at her own peril. MDMA is an empathogen — a drug that produces feelings of emotional communion, oneness and emotional openness. Interpersonal boundaries can blur.

The husband’s statement of his feelings of attraction to me — along with his wife’s blandishments, “you’re beautiful” — early in the session as the drug effects came on, unmoored me. I was supposed to trust them. Could I? I recall my exact thought was: “I really do not need this.”

Even before the session, I began to feel as though the entire event was engineered. Why ever did she invite me? She was busy with her therapy clients during the week (once a doctor, she now has a busy psychotherapeutic clientele), which left her husband to take me under his own wing. I began to see their intentions less as selfless gestures toward a woman on her own in a Parisian Covid hellscape than as a balm to relieve them of their own ennui. Conditions in their city weren’t nearly as bad as in Paris. Here, people were masked, but otherwise moving about normally. Still, the pandemic had affected everyone all over Europe.

As the week went on, the lingering effects of the drug session colored the time I spent at their household. I engaged in integration sessions with my host several mornings, where we sat at a table and she encouraged me to examine my feelings about a role-play I took part in during the session where her daughter played the part of my mother. But these seemed to be a kind of scrim over the dynamics of what was occurring in her household.

The husband surprised me one evening when I was emerging from the sauna in the basement. I was naked and about to shower. Suddenly there he was. Seeing him approach, I told him I’d just gotten out of the sauna and was about to shower. I pulled a towel off a hook and wrapped it around myself. He halted, stared at me unflinchingly for maybe thirty seconds, then turned and went back upstairs. This encounter engendered some longer-term fallout.

The couple’s own backstory is one of manifold boundary violations. After her first marriage ended following an affair from which she emerged devastated, my host, who was a doctor, began a Holotropic Breathwork training, among many other therapeutic modalities, to help her on her quest to confront her own issues and eventually use her knowledge to help others. Her present-day husband came to her as a client. He was also divorced. She taught him how to practice Holotropic Breathwork, and introduced him to MDMA.

The two fell in love. Her daughter (who was in our MDMA session) later left her own husband to marry another man (a former client of my host who was also in the session). This man’s former wife (also a one-time psychotherapy client of my host) outed them to the police over a decade before, blaming my host for the breakup of her marriage. Both my hosts, husband and wife, were arrested. They spent time in prison, and paid hefty fines. The husband gave up his license to practice law as a result.

Their casual air toward holding an MDMA session in their home, given their history of problems with the law, astonished me. (And why in the world would they include a woman they’d never met before?) Although nothing physical or aggressive occurred, the boundary violations took a significant toll. They brought up feelings from my childhood, of having been used as a pawn in my parents alcohol-infused folie a deux. My parents were both shrinks: my father a psychiatrist, my mother a psychologist. She was an alcoholic, he was a barbiturate and alcohol abuser, and a rage-addicted narcissist. The second of four, I’d been the family scapegoat. I was my mother’s personal whipping boy. I was often separated from my siblings. I felt, once again, that I was back at home in the worst possible way. I found myself revisiting the wished-for idea of home as a place of greater safety. At this couple’s house, just as with my parents, the reality was anything but. The experience was compounded when I learned, upon returning to Paris, that my father, from whom I’ve been estranged my entire adult life, died the day I was traveling to meet them. The coincidence was more than eerie. More complicated feelings followed.

I did not write about these occurrences, initially, for fear of harming my hosts. Once the Paris lockdown was over, I moved to Alsace to get my bearings, and to have the contents of my house delivered to me, finally, from storage, so I could sort through them prior to my now two year delayed move back to the US.

Living within a few hours of them, I suggested a visit to my hosts. Over the course of the year, I asked to see them a few times. I suggested to the husband we meet for coffee, as a way of clearing the air. Each time, I was rebuffed. For reasons I can only surmise, they no longer speak to me. I would have expected that psychedelic therapists — or any therapists — as experienced as they would be more self-aware about their own issues, and their own boundaries, and be able to face them. Not so.

Theirs was a very different response from the other psychedelic experience I had, as part of a clinical trial in 2012. My 2012 psilocybin experience left me with the sense I was part of a larger community. That feeling lingers to this day. I remain in touch with some of the researchers. Here, with the MDMA experience, I felt as though I was left high and dry. I was especially troubled by the husband: once I’d made my own boundaries clear, we spent what were for me pleasant hours together walking in the forest above the town with their dog and talking. I was able for the first time to speak candidly about my marriage, which ended in 2005. He was thoughtful and reflective. Knowing I used to ride, he’d taken me to the barn where he rides. He invited me to take a few lessons, if I liked, on his own horse, or on another horse in the barn. He invited me to a hotel he owns in the mountains for a night — an experience whose boundaries I made a point of defining and clarifying explicitly with him in advance of the excursion as non-intimate, and social only. He seemed fine with my candor — at least on the surface — protesting that he was able to have women friends, and had many, his riding instructor among them.

These occurrences have left me with the impression that I’d been used as a toy. My vulnerability and isolation, my very reasons for trusting them when I was literally at my worst, were my undoing.

I’m now convinced MDMA is not the right drug for female trauma survivors — especially when guided by practitioners who have boundary issues themselves. But how is one to know in advance? The inflated self-image many practitioners project, refined over many years, coupled with a sense of their own infallibility, often becomes mixed up with their own unacknowledged needs. They’re not likely to be doing much self-examination. Boundaries become even more porous under the influence of the drug because of the flood of oxytocin it causes and the feel-good messages it can elicit when participants take it together during the session.

For women survivors of sexual or physical trauma, MDMA should be used judiciously. Or maybe it shouldn’t be used at all.

MDMA for veterans is a different story entirely because of the nature of their experiences, and the nature of the population itself. Male veterans as subjects are coming to grips with guilt and shame over what they did to others during war in service to an outside authority. They must face the horror of their own actions — not what was done to them. They never lost or relinquished their own agency, even if they chose to submit to the demands of the service hierarchy. Autonomy and their own power never actually failed them, unless, for instance, they became prisoners of war.

By contrast, women dealing with sexual, physical and emotional trauma must come to grips with their internalized shame and fear because of what was done to them when they were powerless. Victimized women had no agency, and no capacity to make decisions in and around their abuse. The physical and emotional violations were enacted upon them. They are the victims of the actions of others. MDMA compounds their vulnerability. Under MDMA, women relinquish personal agency, as they were forced to do when they were abused. Under the drug, they are entirely powerless. Guides or therapists who are willfully unaware of their own boundaries endanger them.

Having tried several therapeutic modalities — conventional psychotherapy when I was younger and more recently, psychedelic therapy — I’m convinced the classic psychedelics, such as psilocybin and ayahuasca, when used with the right guides in the right settings, are far more suitable for women dealing with trauma. MDMA should probably be avoided altogether.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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Erica Rex
Erica Rex writes about science, environment, mental health, climate, and the forces shaping all of them. She’s written for The New York Times, Scientific American, The Times (UK) among many other publications, and is the recipient of a National Magazine Award. She was a subject in one of the first clinical trials using psilocybin to treat cancer related depression in 2012. Her book-in-progress traces the story of psychedelics through the lens of her quest to heal from childhood trauma. Ms. Rex’s unique perspective shows how psychedelic medicine can provide a pathway out of trauma, a light at the end of a very long tunnel, but it is not without risks.

19 COMMENTS

  1. This board has been plagued by people promoting street drugs. I guess it is being rationalized as the alternative to prescription drugs. But in both cases the drug does not solve any real problem.

    And then I guess that California Institute of Integral Studies in San Francisco seems to encouraged this.

    Joshua

  2. Thank you for this thoughtful and honest article. I have had similar experiences.

    The piece that I think sums up the essence of the problem is “what can occur in the psychedelic space when practitioners whose own drug use, and persistent adulation by their clients and disciples, leads them to believe they are larger than life. Normal rules of conduct do not apply.” It can happen even without all that much adulation, and the suggestibility that emerges for those seeking help–both because of the drug’s effects and because they (we) are often so longing for relief–is what makes it, in the worst possible way, a perfect match. I have seen it happen numerous times with people who have the highest and most impeccable credentials in other realms and sometimes specifically in the psychedelic realm, which of course adds to the seductiveness, as well as the doubts that come in the wake of these experiences.

    I’m also with you on nonetheless recognizes the value of psychedelics when used appropriately and carefully. But the train is moving too fast and without sufficient care.

    Thank you again!

  3. I notice that these enthusiasts don’t seem to believe in screening their “patients” for perceptual distortions prior to giving them psychedelics- a must for determining whether said patients are decent candidates for psychedelic therapy. Maybe these pseudo shrinks should try to find a copy of Hoffer and Osmond’s book *The Hallucinogens*, which describes psychedelic therapy in detail (long out of print, alas).

  4. I agree with the overall point of this piece, I think that the boundaries, emotional maturity, and self-awareness of individuals who consider themselves as offering help to vulnerable others play an important role in whether that help will actually be helpful or harmful. Individuals with trauma need to be respected as autonomous agents whose boundaries and wishes should be respected.

    However, I think the point about treating different traumas involving different relationships with violence and powerlessness could be made while acknowledging the complexity of trauma. I am a male survivor of sexual abuse, and I have also experienced powerlessness, and as a result been harmed by therapists who had poor boundaries. I think that the range of different traumas for which poor boundaries could be harmful is broader than only women who have experienced abuse, and could include anyone who has been abused, and other situations that induce powerlessness.

  5. What you went through was horrendous and I wish I could express the sorrow I feel that your trust had been shattered and in a state of such vulnerability it was shattered again.

    Psychedelic therapy is like where the ‘rubber hits the road’ for the trustworthiness empathy and emotional maturity of therapists. And the repeated reports of nightmares of untrustworthiness need to tell us something that can be less clear in more mundane settings. Where trauma is concerned it’s like the first rule of fight club. But for therapy it is ‘be trustworthy’. Second rule is ‘be trustworthy’ and so on.

    To be a therapist and to not even know what trustworthiness is and therefore, how to create necessary safety, in relationship. To be so lacking in true empathy and in maturity….. These failings in a therapist are a recipe for causing further harm, yet without even the empathy and maturity to know it.

    To me this is the message. It saddens me that you feel that psychedelic therapy should not be used to help those whose trust in other people has been badly broken because therapists can’t be trusted with the basics. This is tragedy.

    This is not rocket surgery, but the basics: trustworthiness, being safe and creating a safe space for another. These qualities are also the bedrock for creating any authentic relationship in any context. These non-healers failed at the entry-level.

    This is not an argument about psychedelics, for me that is a separate issue. What you are describing about their behaviour says a great deal about the dangerousness of psychotherapy in the wrong hands. These reports of untrustworthiness where such exquisite vulnerability is concerned need to be a lesson about character and trustworthiness in members of the ‘healing professions’ more generally.

    We keep seeking fault in the injured when ‘help’ doesn’t help while ignoring the humanity-health of the ‘helpers’. Trauma and psychological pain are about being human, so helping is intrinsically bound up in the quality of being human in response.

    This is like seeking medical treatment for a broken leg and the so-called professionals jumping on the injury.

    I’m so sorry.

  6. First, I am so sorry this happened to you and I could feel the powerless part . I honestly could not read with normal tension after the husband told you “You are beautiful”. Yikes!

    But I want to also just make an observation that you stated the woman is a doctor so many times, I wonder if your own value of hierarchy and profession is skewed and affected your own intuition and instincts? The idealization of your parents may be something they picked on like vulture.
    They included you in their weird cultish event because you were the perfect victim – a transition person leaving the country shortly.

    To know in advance for this type of people is quite simple. Not doing this type of work with family group (you were outnumbered). Having contracts to sign so you have a list of things to do and not do – no contract no regulation not doing it. To do it with others who are not related to the therapist. And not to do it in countries where one does not have much of rights or time to live in there long term.

    I do not know how others may do it but for me…perhaps having a person I know and trust who is not doing the drug may have helped.

    I think unfortunately your trusting nature met with a exploiters who took full advantage of your stressful time (selling house in foreign land and pandemic)….they are predators! You probably avoided a serious grooming to trap others for them. It seems they were recruiting.

  7. I am truly sorry to read of your experience. You have surfaced one of the risks inherent in the medicalization of psychedelics. For that reason, I wish your piece had been titled “Psychedelic THERAPISTS Will Not Save Us,” because that seems closer to the truth in this and other cases. Your takeaways about MDMA say more about setting and therapist than they do about the drug itself. As a counter-example: MDMA was absolutely crucial to my journey of recovery from years of sexual assault as a boy. I discovered the drug in 1985 (just after it was banned) and took it many times with my new girlfriend (now my wife) in settings that we devised by means of our own emerging wisdom and mutual trust. No power handed over to strangers. There’s no question those sessions began releasing me from the death-grip of trauma and opened me to a life-long bond with my partner. Other hallucinogens, also self-administered, played different roles in the healing. No doubt this approach is not for everyone—or even advised. I’m just passing it on. If you’re so inclined (especially given your work in progress), you can read more in my recently published memoir: https://www.amazon.com/Chosen-Memoir-Boyhood-Stephen-Mills/dp/1250823218
    Thank you for sharing your story here, and I look forward to reading more…

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