FDA Acceptance and Priority Review: Lykos Therapeutics' MDMA-Assisted Therapy Breakthrough for PTSD

In a groundbreaking move, the U.S. Food and Drug Administration (FDA) has granted priority review to Lykos Therapeutics' (formerly MAPS PBC) MDMA-assisted therapy for individuals with post-traumatic stress disorder (PTSD). This development not only marks a significant leap in mental health treatment but also holds profound implications for companies like Numinus in the field of psychedelic-assisted therapy. 

Understanding the FDA Priority Review

The FDA's priority review is a special designation reserved for drugs that promise substantial improvements in safety or effectiveness compared to standard treatments. In the case of MDMA-assisted therapy, this acknowledgment underscores the urgent need for innovative approaches to address the complexities of PTSD. MDMA-assisted therapy was only submitted as a new drug application to the FDA by non-profit Multidisciplinary Association of Psychedelic Studies (MAPS) in December 2023.

A Glimpse into MDMA-Assisted Therapy

MDMA-assisted therapy, an important and promising venture in mental health treatment, involves the use of midomafetamine capsules (MDMA) in combination with intentional therapy before, during, and after each medicine session. Based on the data from two published Phase 3 studies completed by MAPS and numerous other trials, MDMA-assisted therapy is a real breakthrough in the treatment of PTSD. 

What This Means for Numinus and the Psychedelic Therapy Landscape

Validation of Psychedelic Therapies

The FDA's early acknowledgment of the potential benefits of MDMA-assisted therapy provides a significant boost to the legitimacy of psychedelic therapies. This is good news that we anticipate will pave the way for broader acceptance and integration of these treatments into mainstream mental healthcare.

Expanding Treatment Options

If (and when) approved, this therapy would represent a monumental shift in the available treatment options for PTSD. Companies like Numinus, already at the forefront of psychedelic therapy, may see expanded opportunities to offer innovative solutions for people suffering from post traumatic stress disorder. 

PTSD, a grave mental health condition stemming from traumatic events, grips approximately 13 million Americans each year. Military personnel have a greater prevalence of PTSD than the general population, however, it may not be as widely known that that the largest cause of PTSD is non-combat-related trauma (e.g., sexual violence, unexpected death of a loved one, life-threatening traumatic event or interpersonal violence). Women and marginalized groups bear a disproportionate burden, underscoring the urgency for inclusive and targeted treatment. With this treatment available, Numinus will be able to provide this option for relief that these people need and deserve across our network of clinics.

Heightened Focus on Safety and Efficacy

The FDA's priority review signals a keen focus on ensuring the safety and efficacy of psychedelic treatments. This emphasis aligns with Numinus's commitment to providing evidence-based and responsible psychedelic-assisted therapy.

Psychedelic-Assisted Therapy Training 

With increasing public awareness and acceptance of psychedelic medicine, our training program is pivotal in preparing professionals to meet the demand for responsible and safe MDMA-assisted therapy. As the therapeutic landscape expands, Numinus-trained and certified practitioners will be ready to integrate psychedelic assisted protocols into their practice. This transformative period presents opportunities for collaboration and cements the role of our training programs in moving this type of treatment forward. Learn more about our certification pathway here.

Looking Ahead

We are deeply invested in the transformative power of psychedelics and are thrilled to learn about the FDAs priority review of MDMA-assisted therapy. Our team wholeheartedly believes this development can and will change lives.

Honoring Veterans and Addressing PTSD

As Veterans Day arrives, it's not just a time for gratitude but also a moment to shine a light on the mental health challenges faced by those who have served in the military. On a recent episode of KSL’s Dave & Dujanovic, hosts Debbie Dujanovic and Dave Noriega delved into the topic of Veteran mental health, particularly post-traumatic stress disorder (PTSD), with Numinus therapist John Ellis.

The discussion opens with personal stories, including Dave's revelation about his grandfather's World War II experience, emphasizing the often unspoken struggles that veterans carry. John Ellis, a therapist with a background in the United States Air Force Reserves, shares insights into the importance of storytelling for veterans and the therapeutic value of sharing experiences.

"A lot of veterans do keep things inside. But they have stories to tell. And when they start to tell them, it does help." John says.

Fostering an environment of connection, empathy, and emotional understanding, the need for vets to share their experiences is paramount. Our collective society's attentive listening becomes pivotal in acknowledging the importance of veterans' narratives. So, what first steps can we take? 

Let’s start with compassion. Creating a safe and supportive environment to empower veterans to openly express their feelings will help them navigate the path towards healing.

But it isn’t all that simple to create this safe space. Veterans face challenges when opening up about the past, particularly the painful memories. These experiences don’t always flow from the memory into a story - they are sometimes haunting, and dig up old wounds. "We need to help them start telling their stories a little bit. And when they do, we need to listen. It does help them, and it's hard to tell them. Even the good ones." John continues to say. Many people feel sensitive about asking questions, fearful of saying something wrong or triggering. However, there is a balance, and approaching the conversation with delicacy, kindness, and respect can make a veteran feel appreciated. Think about starting by saying something like this: “I understand that talking about your experiences in combat can be challenging, but I want you to know that if you ever feel the need to share or discuss anything, I am here to listen without judgment. Your feelings and experiences are important, and if you choose to open up, this is a supportive space. I appreciate what you've done, and I'm here whenever you're ready.”

For veterans, the emotional connection formed through shared narratives can also be built through engagements such as individual therapy, group sessions, or community resources. "There's that emotion and empathy that can be formed in connection. I think that's really where it starts, whether it's in a therapeutic relationship, just one-on-one with a family member, or amongst veterans - combat or otherwise."  John explains. 

When discussing signs of PTSD,  common indicators include flashbacks, hypervigilance, night terrors, existential dread, and fear that can linger, making it difficult for veterans to feel safe. To begin working through these unwanted feelings, starting with the Veterans Affairs (VA) system is always a solid first step. 

The door is wide open at Numinus, where we provide therapy and utilize treatments like ketamine-assisted therapy, known for its effectiveness in reducing symptoms of PTSD and suicidal thoughts. Many Numinus therapists and staff are veterans themselves, and we always do our best to pair vets-to-vets for an added layer of empathy.

At Numinus, we strongly believe in the power of psychedelic therapy. Ongoing research favors ketamine and other psychedelic medicines, such as psilocybin and MDMA, in treating mental health conditions. Numinus is helping carry the torch for this work, alongside and partnered with long-standing companies like MAPS (Multidisciplinary Association for Psychedelic Studies). The promising results from recent studies show psychedelics, when coupled with talk therapy, have a highly positive impact in relief from depression, anxiety, PTSD, and more.   

We really have learned, from the 70s to now. There really is a lot of research and some real expertise – and there are people that really know how to help navigate your experience," John says. "We’re [Numinus] really helping people rewire their brain from that trauma - that medicinal kind of regeneration of neurons that happens during a psychedelic experience.

As we reflect on Veterans Day, let's carry forward a renewed commitment. Acknowledging the struggles of veterans and the importance of mental health, we extend our gratitude and encouragement. Together, let us foster a compassionate environment, embracing the healing potential of both shared narratives and therapeutic interventions. 

If you or someone you know is a veteran facing mental health challenges, remember, seeking support is a courageous and vital step. Your well-being matters, and the journey towards healing is a shared endeavor.

 

Episode 31: Dr. Gabor Maté on Trauma, Addiction, and Healing

 

“Addiction is not a disease. It’s an attempt to solve the problem of emotional pain.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Gabor Maté, retired physician, author, and world renowned educator. Dr. Maté has more than 20 years experience in family practice and palliative care. He has worked for more than a decade at the Portland Hotel in downtown East Side Vancouver with patients who suffer from mental illness and addiction.

He is a world renowned expert in trauma, addiction, child development, psychedelics, and the relationship between stress and illness. He is the best selling author of four books like When the Body Says No and The Realm of Hungry Ghosts, for which he won the Hubert Evans Non-Fiction Prize. And he is currently finishing his fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture due out in April 2022. His works have been translated into more than 25 languages. And he also offers online video courses including Wholehearted’s Healing Trauma and Addictions.

His work now centres around educating the public on the impact of trauma and human development and training therapists in Compassionate Inquiry. Compassionate Inquiry is a therapeutic method developed by Dr. Maté whose focus is on helping the patient to “recognize the unconscious dynamics that run their lives and how to liberate themselves from them.” He also just released The Wisdom of Trauma on June 8th, 2021, a movie about his life’s work.

Dr. Maté and Dr. Joe spoke about:

Connect with Dr. Maté on his siteFacebookTwitter, and YouTube.

Connect with Dr. Joe on FacebookTwitter,LinkedIn and Instagram

Follow Numinus on FacebookTwitter,LinkedIn and Instagram

 

Here is a transcription of their conversation:

Dr. Gabor Maté, welcome to The Numinus podcast.

My pleasure. Thank you.

Thanks for making the time to do this. Really appreciate it.

I’ll start by just asking you, how do you describe your professional identity and your activities?

I’m a retired physician. 32 years in family practice, palliative care, and addiction medicine. I’ve written four books, traveled internationally. My books have been published in close to 30 languages.

Now, these days, I’m a teacher, a speaker, and a writer. I’m writing a new book, a couple of new books. All on the subjects that enthused me or excited me as a physician from trauma, addiction, child development, human potential, stress, health and the relationship of the individual to the communal, familial, and social environment.

So really what I’m looking for is the unity of things and how the unity of everything shows up in health and illness.

I’ve listened to you talk on a number of podcasts, and I think what struck me probably the first time I heard you was just how open and honest you are about your own personal history with trauma. And I’m a little self-conscious that you’ve told your story many times. But if you don’t mind, could you tell us about your background? From what happened to you when you were a child.

Yeah, well, I do get a bit, what can I say, jaded, repeating it.

And also, I have to say that my particular history is a bit misleading only because it’s so dramatic that people, when they think of trauma, they think such things have to happen for us to cause something trauma. Where I think trauma is much more subtle than that.

And Clyde Hertzman, who’s a seminal researcher, who died way too young here in Canada, internationally known researcher into child development, said that it’s not the big things, but the daily misfortunes that affect children that have overall impact.

So with that introduction, my trauma is particularly dramatic because it happened in the last two years of the Second World War. Being born a Jewish infant two months before the German occupation of Hungary. My family then goes through the genocide. My grandparents, aunt taken to Auschwitz. My father taken to forced labor.

My mother and I survived the conditions of the allied bombing of Budapest, the ghettoization of Jews, the deportation of Jews. And I experienced hunger and dysentery and separation from my mother. And all of that within the first 12 months of my life.

All of which is a huge impact on the formulation of my personality and my emotional states and determining many aspects of my behaviour and emotional life later on.

So that’s what I can say in a nutshell. But again, I have to emphasize that you don’t need that drama or that degree of historical tragedy for people to be hurt

I definitely want to get into that. I have a question about that in a bit. You started to talk about how those experiences shaped your development. And my understanding is that those experiences and your research has taught you a lot about how trauma affects children, their development.

I wonder if you can just speak to that. How do children adapt and get through these experiences? How does it affect them as they grow up into adults?

Well, let’s just begin by saying that life affects human development. So whatever happens in life will have an effect on human development and whether those things are good, whether those things are harmful. All that will have an effect because we’re creatures of the environment and we’re born with certain biological needs and psychological needs.

In fact, you can’t separate the two because the emotional needs not being met has direct and definable and defined physiological effect on the brain and on the body, and this begins in utero.

So already stresses on a pregnant woman will have an impact on the physiological stress reactivity of the infant. In fact, a study recently within the last two weeks showed that stress on the mother in pregnancy shows documentable effects on the infant’s stress responsivity up to age forty five. And there are some gender differences in how prenatal stress affects the females and males. So it begins in uterus.

So the more stressed women are, the more inflammation that might be in the child’s body, the more the stress regulation mechanisms of the brain might be disturbed. Metabolism is affected and so on. And then this thing goes on to childhood infancy. And so you have a combination of physical effects.

But also if you look at how the human brain develops, the most important determining influence on the actual development of the brain is the quality of emotional relationships between the child and the parenting environment.

I’ll quote you from an article from Harvard Center on the Developing Child published in the Journal of Pediatrics in 2012 that says, “the architecture of the brain is constructed to an ongoing process that begins before birth, continues into adulthood, and establishes either a sturdy or a fragile foundation for all the health, learning, and behaviour that follow.” Not some of the health, learning, and behaviour, all of the health, learning and behaviour that follow.

And a second sentence, “the interactions of genes and experiences literally shapes the circuitry of the developing brain and is critically influenced by the mutual responsiveness of adult-child relationships, particularly in the early childhood years.”

So under the circumstances of my own first year when my mother was concerned with sheer survival, grieving the death of a parent, agonized over the absence and unknown fate of her husband. She could not provide me with those playful, relaxed, stress free interactions that I required for my healthy development.

But you don’t need that degree of stress in modern society. A lot of parents are stressed in such a way that they can’t be responsive to their child’s needs. Not because they don’t love the child, but just because they’re too stressed, too depressed. Having looked at their own traumas, too distracted. So that, again, I’m just emphasizing that you don’t need the drama to create the trauma.

Right. I’ve heard you talk about how children adapt to these highly stressful environments. And that adaptability can sometimes be quite remarkable and actually produce some quite incredible skills or sensitivities later in life, obviously comes at a cost.

Can you articulate how that adaptation happens and how some people end up with these sort of exceptional skills in some ways?

Well, so let me quote you again from the same article that I just cited. This is again from Harvard Center on the Developing Child, 2012. “Growing scientific evidence demonstrates that social and physical environments that threaten human development because of scarcity, stress, or instability can lead to short term physiological and psychological adjustments that are necessary for immediate survival and adaptation. But which may come at a significant cost to long term outcomes in learning, behaviour, health, and longevity.”

So they’re saying that the adaptations are necessary in the first place and they help the child endure the immediate stress, but they become a source of problems later on. And that’s largely how I see it.

So it’s not the adaptations that result in these skills, but in working through them later on that result in certain skills. Let’s take an adaptation: tuning out absent-mindedness is an observation, dissociation is an adaptation. When the stress is too much and one can’t change the situation or escape from it, then one dissociates.

Well, that’s not a good thing, but it’s a good thing in the short term because otherwise a child’s brain just couldn’t endure the stress. That same dissociation then results later on in any set of mental health conditions from ADHD where tuning out is the hallmark of it. That’s what I’ve been diagnosed with. Or at the extreme end of the scale, psychosis or dissociative disorders. Now, working them through results in a lot of insight.

Or take an adaptation like–Given my first year of life, I get the message that I’m not wanted, which is certainly the message that the world gave me. Well, then I might work very hard later on to make myself wanted. So that makes me a really good physician. I work hard. I’m available to my clients, more than available day or night. I work hard to ensure that. They do well, all those are good things.

But driving it, to a certain degree, to a significant degree, is this desperation to be wanted and to be validated and to justify my existence. Which the world denied my right to when I was first in this universe.

So that may seem like a good thing. Now being a dedicated physician or whatever professional or pursuit that you have, that’s a good thing. But if it’s driven by an unconscious need, it’s not a good thing.

Now we can learn to work through those things. And I’ve gained a lot of insight and empathy and I daresay compassion through working through my own material. But it wasn’t that the adaptation itself made me compassionate.

It’s true from a very early age on, I was aware of pain in the world, and I was very aware that people have felt pain and were hurt. Who in no way deserved it. And the question, why are people hurting people has always agitated me like this. How could this have happened? What made human beings behave the way they did? And what makes them behave today the way they do? So those experiences certainly can excite those questions in someone’s mind.

As far as sensitivity is concerned, which you mentioned. By and large, I think that’s the one thing that’s genetic here. This is a big mistake that a lot of researchers make. They think people inherit mental diseases. No, they don’t. There’s no gene that codes for any mental illness. There’s no set of genes that code for any mental illness. There’s no set of genes without which you can’t have a mental illness. There are a set of genes which if you have them, you’re more likely to have any number of mental health illnesses, non-specifically.

But with the same genes given good circumstances lead to increased creativity, leadership, spontaneity, aliveness. So what are the genes for? The genes are for sensitivity. And the more sensitive people are, sincere, meaning the Latin word sincere to feel, the more they feel. That means when bad stuff happens, they feel that more and their adaptations become more rigid. At the same time when good things happen, it has a more positive effect on the sensitive person. So sensitivity itself is a neutral quality given the right environment, it’s highly beneficial. Given the negative environment, it leads to more pain and more suffering. But it always makes for a more possibility of insight and empathy.

So you’ve got this film coming out, I believe, at the time we’re recording this, next week. The title of it, The Wisdom of Trauma, speaks to what you just said. This thing about working through, getting insight.

Can you just explain the title? So what is the idea behind the wisdom here?

The wisdom is on two levels. One is the adaptation itself has a certain wisdom in it. So trauma is not what happens to you. Like we often think of trauma as a tsunami or as genocide or as child abuse. Those are traumatic, but they’re not trauma. The trauma comes from the Greek word for wound. So trauma is the wound. But it’s just saying that it’s not what happened to you, it’s what happened inside you.

There’s a wisdom in it. For example, let’s say you have a two year old child and they throw a temper tantrum. And you follow Jordan Peterson’s advice, which is to say that an angry child should be made to sit by themselves. So you give the message that your anger is not acceptable. Now, what will a two year old do if they continually get the message that their anger is not acceptable? What will they do with that anger?

They’ll stuff it down as far as it can go.

Exactly. They will depress it. That’s a wise adaptation. Because to express the anger is to threaten their relationship with the people that they rely on. So there’s a wisdom in that adaptation. So that’s the first wisdom or my tuning out. Believe me, there was a lot of wisdom in my tuning out in my first year of life. I could not have enjoyed life if I hadn’t tuned out a lot, I’m sure. So there’s a wisdom in that. There’s a wisdom in all these manifestations. So that’s the first wisdom of trauma

The second wisdom of trauma is the one we’ve touched upon, which is that when you work it through, you learn so much. I don’t recommend it as a way of learning.

It just so happens that I’m writing about it in a book I’m writing. I’m writing about disease as a teacher. A lot of people even with terminal disease have told me that they wouldn’t switch their disease for non disease because of what they’ve learned. And I don’t recommend that way of learning. I’m just telling you what people have told me. So there’s a lot of wisdom and learning from our traumas. There’s a lot of wisdom in multiple ways.

The wisdom in the adaptations is something that I’ve come to appreciate in some of the more recent trainings I’m getting as a psychotherapist. And it’s this sort of understanding of like sort of de-pathologizing of what clients or patients go through.

And I’ve heard you talk about how we should consider the intelligence or the wisdom in the addiction. That there’s something right about the addiction, even though we tend to focus on everything that’s wrong with it.

Can you talk about the link to addiction here and why this de-pathologizing framing is valuable and important?

Well, it’s a question of whether we want to hold on to a certain model or whether we want to really understand what’s going on. The medical model has addiction as a disease largely inherited, which is genetic nonsense. As I said earlier, there are no genes that code for addiction. Nor are there genes that if you don’t have them, you can’t get addicted.

So while there might be certain sensitivities, which had to do with certain genetic predispositions to do with sensitivities. As I mentioned before, a predisposition is not the same as a predetermination. So to really understand what’s going on in addiction, let’s look at let’s look at what an addiction is.

So I define addiction as–well obviously it’s a complex, psychophysiological process–but it’s manifested in any behaviour that a person finds temporary pleasure or relief in and therefore craves. But suffers negative consequences as a result of and has trouble giving up despite the negative consequences. So short term. Relief, pleasure, craving. Long term. Harm, inability to give it up.

So by that definition then we clearly get that addictions could be to substances and they often are from alcohol to cigarettes, to the illicit substances like opiates and stimulants and so on. But they could also be to shopping, to eating, to work, to gambling, to sex, to pornography, to internet gaming, to the internet itself, to extreme sports, and so on, to any number of activities.

And the issue is not the activities so much as the internal relationship to it. If it’s characterized by craving, pleasure, short term relief of some kind. Negative consequences and difficulty giving up, you got an addiction. I don’t care what the activity is. So now, depending on how we’re going to play this game or not, I could ask you according to our definition and without asking you to be specific in any way, have you, yes or no, at any kind of an addictive pattern in your life?

Of course.

If the answer is yes, then without asking you what it was and what to do. Let me just ask you this. What did it do for you in the short term that you liked about?

It’s funny that you’re using the past tense, you’re assuming I’m well-adjusted and addiction free, which is not necessarily the case.

I’m very kind of sensitive to these things, like I watch my behaviour very closely for whatever reason. And I just see tons of things that I wish I wasn’t doing. Probably the easiest one is just like Twitter and how much I reach for my phone. And to answer your question, it’s because it provides a temporary vacation from the noise in my head.

Okay, so you’re looking for some rest, some mental rest.

Yeah, exactly.

So is that in itself a good thing or a bad thing?

It’s a good thing. The need for the rest is a very real and valid thing, as far as I could tell.

Absolutely. In other words, the addiction is not your primary problem. It’s not a disease. It’s an attempt to solve a problem. And in broad terms, addiction is always an attempt to solve the problem of emotional pain, however, that emotional pain shows up, for example, mental noise.

So my mantra on addiction is not why the addiction, why the pain? Now, if I look at why the pain, I’d have to really look at your life and my life and everybody’s life. Something happened to create that mental noise. And we live in a culture, of course, that delivers and instigates a lot of mental noise. But again, it still has to do with child development. And that mental noise is not an automatic attribute of a human being.

Rather than seeing the addiction as the primary problem, we can look at the issue of the mental noise as a primary problem and and what maybe can be done to quiet it in ways that don’t have negative consequences.

So addiction all of a sudden goes from the disease model to a response to a human experience model. Which means that treating it needs to take into account human experience and the trauma, the traumatic imprint that human experience carries.

So you’ve got this book that you’ve been working on coming out next year, I believe, The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. I have a feeling where we’re getting some little previews from the content of that book.

I just wanted to talk about, you know, that you’ve been quite critical, on record and even in our conversation about mainstream medicine’s approach to trauma and addiction. And then, the title of the book just going so far as to just name the craziness of our own–like the way we live, at least here in the West.

Maybe you can speak to what your main concerns are about the way we think and talk about trauma and addiction and what you’re advocating for and where we should be going with all of this.

So, first of all. Trauma goes way beyond addiction. Actually, what I’m actually saying based on voluminous scientific evidence, let alone human insight, is that most chronic illness, whether physical, so-called or mental so-called, is rooted in trauma.

The British psychologist, Richard Bentall, writes that the evidence relating psychosis, for example, to childhood adversity is stronger or is about as strong, at least as the evidence linking cigarettes and lung cancer or lung disease. So it’s not like we lack the evidence.

That only comes to say mental illness, but all mental illness is a response, in my view, an adaptive response is in some sense–at least to begin that way–to childhood adversity and trauma, as are most chronic illnesses as I show in my book When the Body Says No.

So a Canadian study, men who are sexually abused–I’m trying to remember the study– does they have a 50 percent more chance or double the risk of cancer as adults? Something like that, but certainly elevated risk of cancer. This is regardless of lifestyle factors, by the way, smoking or drinking.

A study out of Harvard, two years ago, women with post-traumatic stress disorder, severe post-traumatic stress disorder doubled the risk of ovarian cancer.

Now, if that was the only study ever done, and it isn’t, and it’s already been shown in animal models, that stress and trauma increased the risk of ovarian cancer. But if that was the only ever study ever done, that should send every physician running to figure out what’s the connection between emotions and malignancies.

This information has been coming in for decades and decades and decades. So whether you’re talking about autoimmune disease or you’re talking about malignancy, that is a huge traumatic imprint every time.

Now Western medicine separates the mind from the body–oh, by the way, the ovarian cancer study, the milder the symptoms of PTSD, the less the likelihood of cancer. Which means that if we help people deal with their traumas, we could potentially prevent malignancy. Now, there are all kinds of physiological reasons for that. The physiological pathways have actually been worked out and none of this is a mystery.

But for all that science, the average medical student never hears this stuff. At least until recently, it’s changing a little bit. The average student does not get a single lecture on trauma. You should get a whole year long course on trauma. They don’t get a single lecture. Except physical trauma, like, you know, broken bones and so on.

So Western medicine separates the mind from the body, the emotions from the physiology, which scientifically is non tenable. In real life, it doesn’t exist. Let me induce any emotion in you and see if he doesn’t have a physiological correlate in your body right away. Whether you’re happy, relaxed or terrified or angry. They all have physiological imprints. They all involve your nervous system, your cardiovascular system, your gut, your immune system, your hormonal apparatus, it’s all one system. Western medicine does not take that unity into account. Either in its understanding of the etiology of illness, the causation of illness and certainly when it comes to the treatment of it.

Number one, Western medicine separates the individual from the environment. So, for example, addiction is seen as an individual problem. It’s not. It’s a multigenerational family problem. It’s also a social problem if you look at today with the hollowing out of the industrial economy in the United States under neoliberalism. The fraying of the social net. You’ve got massive dislocation, massive despair, and you’ve got massive increases in addiction. You can’t separate the individual from the environment.

That ovarian cancer PTSD study. Nobody develops PTSD on their own. That happens in an environment. So that the cancer showing up in the individual female body is a manifestation of a social process. And so that’s not understood.

What’s also not understood by Western medicine is the body’s and the psyche’s own healing capacity. So we’re all about cure, if it’s possible, or symptom suppression in, for example, chronic mental health conditions and chronic autoimmune conditions. All we do is we suppress symptoms. But that the psyche or the Soma, the soul or the body is an innate healing capacity that can be encouraged and invited and supported, that’s not considered in Western medical training or the Western medical ideology.

So those are significant gaps which really limit the–I mean, as amazing as Western medicine can be. And I mean, one is gasps at the miracles that they can perform, but at the same time, it’s so much more limited than it could be. And the miracles are largely in the realm of acute conditions, which are really quite illiterate when it comes to the long term chronic conditions of mind in the body.

Let’s talk for a second about a new development in Western medicine that is getting a lot of attention and has a lot of potential, particularly in the area of trauma and addiction. Something that you’ve been involved with over the last few years. And that’s the psychedelic renaissance.

I understand that you are involved in holding space and doing integration work around ayahuasca ceremonies. Where do you think psychedelics fit into this whole story? And what are your thoughts on how to most skillfully reintegrate these compounds back into our society, given their checkered history?

So, yes, I’ve been involved with ayahuasca work for about 12 years now. Even to the point where at some point I got a warning from Health Canada to cease and desist. Thank you Health Canada. Which is interesting because by the time they sent me that notice, they had already acknowledged that ayahuasca was neither addictive nor harmful. And in fact, they had allowed it for religious purposes, just not for healing purposes. So we could talk about the illogicality of that.

The way you framed the question, Joe, is that this has happened in Western medicine. It hasn’t happened in Western medicine. It has happened largely outside Western medicine. So the renaissance of psychedelic research and interest has not been mainstream by any means.

Precisely because of the failures of Western medicine that I’ve been mentioning, and especially in the mental health field, there’s been real interest in what else is out there. Yeah, we have the resurgence of research, particularly the very detailed and extensive research now on the use of MDMA in the treatment of post-traumatic stress disorder. I mean, if somebody told you five years ago, ‘you know, MDMA could prevent ovarian cancer’, you think they’d be nuts, right? But in fact, this makes perfect sense because if it can help heal PTSD, it can help you heal all kinds of diseases or prevent all kinds of diseases.

So the studies have been with MDMA. Studies with mushrooms now and end of life anxiety. But there’s nothing specific about end of life anxiety. They just allowed studies because those people were dying anyway. But mushrooms, I know, can help anxiety. They can potentially help stimulant addictions. They’ve been studying for that. I’ve seen ayahuasca people go through ayahuasca ceremonies and heal from addictions, from depressions, from anxiety, from compulsions even from severe autoimmune disease.

And none of that is miraculous if you actually get that, you can’t separate the mind from the body, the psyche from the soma, the unconscious emotional dynamics from our physiology. When you get the unity of it all, then you can understand that anything that can powerfully work with the mind, can have powerful impacts on people’s mental states and people’s physiological states. So that’s what’s happening now. Now it’s being documented more and more and again because of the desperation with the failures of the mainstream model.

Having said that, I’m not a psychedelic evangelist. I don’t think they are the answer for a whole lot of reasons. One of them being is that most people will never have access to it. I mean, under the best conditions, I can’t imagine how large numbers of people will be able to be trained enough to pursue these practices or many people who can afford them.

And at the same time, I also think that the sources of these problems are social and economic and political. So that any treatment process only deals with the outcomes, not with sources in a certain sense.

Having said that, given the limitations that we’ve been talking about, psychedelics are a potentially beautiful modality. Sigmund Freud said that dreams are the royal road to the unconscious. Which is true because the dreams really reveal the unconscious, if one knows how to interpret them and integrate one’s interpretation. The problem is dreams are really hard to interpret. Freud I think was terrible interpreting dreams. And some of his interpretations are hair-raisingly arbitrary, I think. But he was certainly looking in the right direction of the how do we get at the unconscious.

Well the psychedelics are a very immediate way of consciously getting at the unconscious, because in the psychedelic experience, people are both conscious and they’re having their unconscious run riot and reveal all its contents. What an amazing modality in the right hands.

You know, I’ve been meaning to ask you this for a long time, it just comes up whenever I hear you speak or I read your stuff and it came up actually right away in our conversation. Your comment that you don’t need drama to have experienced trauma. Is everyone traumatized? Is being born traumatic?

Well birth can be traumatic. And in this society, we actually make sure that a lot of birth is traumatic because of the heavy, unnecessary medical interference with birth. Which would be lifesaving in some cases. But it’s way beyond that right now, and that actually interferes with the natural physiological hormonal processes of birth. So birth need not be traumatic. I mean, unless one says that life is traumatic because, you know, there’s no way to live without being born.

So in writing this new book I looked at, what are basic human needs? And there’s two ways you can hurt people. Now, I can hurt you by never touching you, by never hitting you, by never assaulting you in any way at all. I could hurt you by depriving you from your needs. Not giving enough oxygen to breathe. Not giving enough food or water. I could hurt you like that. I could wound you like that. I could make you sick like that.

Now, we were born with certain needs. And given that our biggest need is that mutually responsive relationship with a nurturing environment, deprived of that, who doesn’t get wounded? And in our society, very few people really get that optimal, nurturing, interactive, responsive environment because their parents are too stressed. Because the community is no longer there to support the parents, as it was throughout our evolution. Because parents are themselves traumatized. Because society creates a lot of strain and puts a lot of burden on people.

So there are very few who are not wounded in this culture. Very few. So if you understand the meaning of the word trauma as coming from wound, then yes, there are very few who are not traumatized to some degree or another. Now, there are, of course, ranges and a whole spectrum of trauma, but hardly anybody escapes it completely.

One thing I learned about you when we met the first time a few weeks ago. I’ll just actually tell the story briefly to kind of give some context. We met at a meeting for the Numinus clinical advisory board that you’re a member on and I work with Numinus.

And I was excited to meet the board. I hadn’t met before. I hadn’t met you. And I was sort of enthusiastic and excited to kind of present to the group that I had that I’m now joining the team. And the facilitator says, ‘so does anyone have any questions for Joe?’ And you sort of looked up and you said, ‘I have a question for Joe.’ I was like, ‘oh, cool. What’s Gabor Maté going to ask me?

You said. ‘Mindfulness, like, what the hell, there’s nothing about trauma in mindfulness. Do you know anything about trauma?’ You just head straight, straight into that. Which I understand very well, why you did. I’d be curious to unpack that a little bit.

But my question here is like you’re tough and you’re critical of, you know, a lot of the sort of systemic and structural things in our society and how medicine operates and all of this kind of stuff. What are you optimistic about? What are you excited about?

Critical is already a formulation. What is a critique? Used properly. What does that word mean?

Like when I say you’re critical, I don’t mean that in a judgmental way. Just that you’re calling out certain flaws or gaps in our understanding of human experience and health and wellness.

I know what you meant, and I need neither find it offensive, nor am I finding anything to defend. But I’m just going to put the word critical into a larger context. A critique is an evaluation.

Yes.

So when I talk about Western medicine, I acknowledge its brilliant achievements. And I say here are its limitations. So I’m not critical. I’m just making a critique. I’m saying, here’s how it is. Here’s what it can do and here’s what can I do and here’s why it cannot do it.

So what am I optimistic about? Life. The possibility of people seeing the truth. I mean, I would not be doing a lot of speaking and writing and advocating if I didn’t think that there was a huge need for people to know the truth, but also a huge capacity which is driving people to know the truth. Not that I have some kind of a special line on the truth, but I do seek and speak the truth to the degree that I’m capable of.

I’m completely optimistic about the human capacity to receive and to grow with reality. And this despite all kinds of social forces against it. In a society that largely denies human reality and not only denies it, it assaults it.

So my optimism has to do with what I believe about human beings. In the diary of Anne Frank, a few months before she was taken Bergen-Belsen to die. She wrote basically that no matter what she says, I believe that people are good at heart. She was one of these really sensitive souls. So in the middle of the greatest crime, arguably, that human beings have ever committed against one another. She said, ‘I believe that people are basically good at heart.

And you believe that?

Oh yeah, I totally believe that. I believe that when the goodness doesn’t show up is because it’s being squelched. Whether you’re talking about Donald Trump or a Hitler of Stalin or to a lesser degree, any number of political leaders from George Bush to Stephen Harper to Justin Trudeau. I don’t care. You’re dealing with degrees of suppression of pain, which results in lack of empathy, in the extreme cases, tremendous cruelty, like monstrous creatures like Stalin or Göring or Hitler.

In the chapter, I just finished writing, I report the conversation I had with the grand niece of Hermann Göring, Betina, who herself is a healer. And she’s one of these empaths. Göring was an opiate addict, you know? The Reichsmarschall was an opiate addict and a food addict.

And Bettina talks about a healing experience where being an empath, she entered into the psyche of her great uncle. She said it was monstrous and black. Well, of course it was, he was a highly traumatized man. And I think if he hadn’t been traumatized, he could have been a good man. That’s what I believe about any of them.

So, Gábor, it’s very important to me that you continue doing this work and that you sustain your energies, and I know that this afternoon that involves you getting into the pool for a swim.

So we’re at a time here, and I want to make sure that you have that space for self care. And just, again, super grateful that you’ve taken the time to do this. I really enjoyed our conversation. And please keep doing all the good work and we’ll make sure to promote all this cool stuff coming up, your book and the film and all these online courses that you’re doing.

So thanks again.

Episode 4: Trauma-Sensitive Mindfulness with David Treleaven

I am really excited to share the conversation I had with David Treleaven on the podcast today. David is quickly becoming an important figure in the mindfulness community, especially since the release of his book Trauma Sensitive Mindfulness, which we will discuss at length. He offers some fascinating insights on the intersection of mindfulness and trauma, two topics that seem to be on everyone’s mind these days.

For those you that haven’t heard of David, he is a writer, educator, and trauma professional living in the Bar area, whose work focuses on the intersection of mindfulness, trauma, and social justice. He received his master’s in counseling psychology at the University of British Columbia, and a doctorate in East-West psychology from the California Institute of Integral Studies. He is currently a senior teacher with Strozzi Institute, which helps leaders embody skillful action, and with generative somatics, an organization that integrates personal and social transformation. He is busy gearing up for a series of workshops on trauma-sensitive mindfulness, including at the Center for Mindfulness in Medicine, Health Care, and Society at UMass Medical School and of course at MindfulnessMTL.

We had our conversation about a month before he is set to arrive in Montreal for the event. It’s called Mindfulness Growing Pains and features a public lecture about research on “Meditation-Related Challenges” and a 2-day training for mindfulness and meditation teachers on “Working Skillfully with Meditation-Related Changes.” David is one of 3 presenters and MGP. I spoke to the other 2, WB & JL in episode 2 of the podcast which can be found on MS website. mMTL is a not-for-profit community initiative I co-founded in 2015 to bring together mindfulness practitioners, teachers, health-care professionals in Montreal. All the information is available at mindflunessMTL website and Facebook page.

You can find David online on his website and Facebook page. You can find updates from me on Facebook and Twitter.

David is deeply passionate about the work he is doing and it comes across clearly in the discussion. He is also incredibly knowledgeable and generous provide lots of interesting information, stories, and practical recommendations.

We talked about:

The basics about trauma and how mindfulness can help with trauma recovery. We also talked about some of the risks involved in using mindfulness unskillfully with trauma survivors. The was a fairly long discussion of clinical issues in the trauma mindfulness intersection, including an analysis of a recent clinical experience of my own. And we spent some time unpacking David’s claims that trauma is inherently political and that mindfulness teachers ought to develop greater sensitivity to the social and political context of trauma.

 

Here are some highlights:

5:57

DT: The story of how I got here is… It’s a long one and I’ll give you the headline version. I grew up in Toronto, I was a meditator there and I had a pretty long practice. I really took myself pretty seriously in my early 20s, really got into it.

I had an experience on a retreat. I was in a longer-term retreat, and I had an experience of really dissociating from my body at the time. I was deep in practice, I had a day or so of not being able to really feel my feet on the ground. I went to the teachers at the time and received mostly what was a basic instruction of trust that, and take it back to the cushion. That’s what I did, I was a really earnest meditator. Took it back, but then when I was at the other side of a retreat, I realized the retreat had really ended up being dysregulated for me. I started talking to people about what had happened on retreat and it actually led to this intersection of mindfulness and trauma. Which was surprising to me, I didn’t feel like I had necessarily a history of trauma in my past, but for reasons I get into in the book, it actually made a lot of sense. I ended up doing a dissertation on the topic of, really what’s the intersection of mindfulness and trauma. The dissertation defense got recorded and the video went “viral”. I put that in air quotes because as much as a dissertation on meditation and trauma could go viral… A couple thousand people saw it, including Willoughby Britton from Brown University who you had on the show and on the podcast. Her and I started to get into a collaboration and a conversation.

11:58

DT: What came out of this work was actually realizing — and I get going on this more in the book — is that the years of work I had done working with sex offenders and being exposed, over and over again, to some really traumatic stories, was creating some tertiary or secondary trauma. I was having some symptoms of having nightmares and actually some uncontrollable sensations and that’s what was popping up on retreat for me. So this work really helped me see “Oh my gosh, okay well, trauma actually holds some relevance for me.” That’s what was showing up on retreat for me.

16:53

JF: I wonder if we can kind of backup a step and kind of start with the basics. There may be many people are familiar with somatic experiencing or trauma in general, but want to make sure we’re all on the same page and we can kind of set the foundations with some basic stuff.

For example, what is trauma? What are you referring to when you use that word? It’s so widely used, I think there’s an increasing sensitivity to it and an increasing interest in understanding more about it. What exactly do you mean and what are we talking about?

DT: So trauma is an extreme form of stress. It’s a term that we tend to reserve for the worst things that can happen to us, as humans…

You know, I actually was just on a plane and watching Van Jones on CNN. I was just browsing through the news and Oprah was on CNN. So here are these two, you know, pretty big celebrities at this point, who are really in the news and they were both talking about trauma. I thought “Wow this is this is really starting to come to the fore.”

I’d say in part the reason that’s happening is because of all the organizing happening these last four years: Black Lives Matter, the #MeToo movement… I think trauma is just baked into these movements. I’m glad it’s coming to the fore and I think it’s such an important conversation.

This other part is, I really appreciate you saying, “Well what are we talking about?”, because trauma can also… We don’t want to water it down.

I want to say to your listeners right upfront, trauma is not just a negative emotion. It’s not just a really really bad feeling. It’s actually this very particular intersection of a lot of different psychological, neurological mechanisms happening.

I do want to define it right now and say, as I understand trauma, it’s any event, or a series events, that’s stressful enough to leave us feeling helpless, frightened, overwhelmed, and profoundly unsafe. That’s the terrain we’re in with trauma. This could be witnessing or experiencing violence, or in a serious accident, being targeted by oppression… Research says, you know, 90% of us will be exposed, or will experience traumatic event in our lifetime.

22:10

JF: What is your take on how mindfulness is currently being used to help support trauma recovery?

DT: This was one of the primary motivations of writing the book. It was to support, well really to challenge the idea, that mindfulness based interventions or mindfulness practices, are necessarily a panacea to all problems.

My experience early on in the research was, there was a number of people who were making a jump — and this happened, you know, in your interview with Willoughby and Jared. People were making a leap and saying, well, mindfulness is being empirically shown to reduce stress, so then, it would hold that, when it comes to traumatic stress, mindfulness interventions would be helpful.

In my research and experience, that wasn’t actually the case. It was for some people, and others not. That was the frame of the book, it was to say, mindfulness can both help or hinder trauma survivors.

And to your point, really I think the most important thing for any of us that are offering mindfulness instruction, or interventions, is just to be cognizant of the fact that it’s not a panacea, and that we don’t necessarily know best.

To me that’s where there has been, at times… It’s to really try to push against — I don’t know if I’d call it “arrogance” — the sense of like, “we can do no wrong”. I think that’s the first to your points. That’s just the first, laying the groundwork of saying, if we can go into the conversation about how mindfulness is being used with survivors — in a complex way that’s nuanced — then, we’re already ahead of the game, because I think, it’s deeply subjective.

What has been happening in the research is, this notion that mindfulness can enhance self-regulation. That can be actually profoundly beneficial for people who are experiencing post-traumatic stress, and who are actually dysregulated in their bodies and their minds.

When we talk about self-regulation, we’re talking about the ability to regulate one’s attention, regulate emotions, and also be a tune with one’s body, this is all so helpful.

26:51

JF: Right. So, what’s missing here… Why do we need to improve our sensitivity? What’s the danger?

DT: That’s also a great question. The basic argument that I’m making — and I want to know what you think of this, or your experience is, working with clients and students — is that: Imagine for a moment, that you’re someone who’s experiencing symptoms of post-traumatic stress. That could be flashbacks, that could be… At any point, you could be flooded by sensations that are profoundly disregulating. Imagine that’s your way of being, that’s it, that’s how you’re moving through the world.

And then you come into a contemplative environment, and you’re asked to pay close and sustained attention to your present moment experience. Now that can be… Again, that’s a huge shift for a lot of people to make. And I think it can be very very helpful and often is for a lot of people.

But there’s this potential pitfall, where if someone is attending to what’s predominant in their field of awareness, and what that is is a flashback, or the feeling of one’s got clenching, or legs tensing, you know, of symptoms of trauma.

That can actually end up exacerbating the symptoms and have someone left kind of worse for wear. What’s challenging inside of a contemplative environment is, you don’t always know, as the teacher, how everyone’s doing. You can’t always see… You can’t check in with necessarily everyone at the end of the class. So people can end up falling through the cracks.

30:32

JF: How do we process this very fine line between, when it’s okay to turn toward and be with, and when we need to go seek safety and stability and grounding? How would you recommend people work with that, walk that line?

DT: Joe, that’s the million-dollar question right? It really is. That is the question.

My recommendation, when we’re in this territory, in this particular issue, is for people to stay in that question. I really think that’s the path. A willingness to really stay awake.

Again, speaking to folks who are offering mindfulness interventions inside of their clinical work, or as mindfulness teachers, or for those listeners who are practicing, but especially for those who are in a position of power and authority.

To me there’s a responsibility in that, to stay very live, and very current, and very subjective, with the people that we’re working with, to be in that question you’re asking. When does leaning in to practice actually support and alleviate suffering? I’ll put it that way. And when is it exacerbating symptoms?