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.

The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

Experience & Collaboration: A Practitioner's Approach To Teaching

Foundational Psychedelic-Assisted Therapy Training, Taught By Experts. 

Dr. Steve Thayer is a licensed clinical psychologist and psychotherapist. He started his career in the U.S. Air Force, overseeing a mental health clinic and managing programs for preventing and treating alcohol and drug abuse. Currently, he focuses on helping his clients through psychedelic-assisted psychotherapy, teaching counselling courses, and co-hosting a podcast on psychedelic therapy. Steve is facilitating the upcoming cohort of the Fundamentals of Psychedelic Assisted Therapy, and we asked him questions about the course and his teaching approach.

 

What experience do you bring to the Fundamentals of Psychedelic-Assisted Therapy course?

As a clinical psychologist specializing in psychedelic-assisted therapy, I have helped thousands of clients navigate their own healing journeys. I have been trained by MAPS in MDMA-assisted therapy, provide ketamine-assisted therapy in my practice, and serve as lead therapist on several psychedelic clinical trials. I also supervise clinicians providing psychedelic-assisted therapy and facilitate psychedelic medicine retreats abroad.

 

What can students learn from you?

Students can expect to learn the essential skills, qualities, and principles necessary to provide effective, compassionate, and ethic psychedelic-assisted therapy. I like to emphasize the importance of clinician self-knowledge, self-development, and self-care as a key component to doing this work well.

 

How do you approach teaching this course?

I take a collaborative approach to teaching. There is so much we can learn from each other! I try to draw out the collective wisdom of each group I teach so that we can elevate and support one another .

 

Why should people take this course?

This course will equip professionals with the foundational knowledge and skills to practice psychedelic-assisted therapy. I have extensive experience teaching, supervising, and mentoring therapists and I am committed to helping the rising generation of practitioners wield psychedelic tools safely, powerfully, and responsibly.

--

 

To learn more about the Fundamentals of Psychedelic-Assisted Therapy, click here. To listen to Steve on the Psychedelic Therapy Frontiers Podcast, visit Spotify, here.

Episode 39: Trauma-Informed Therapy with Atira Tan

 

“In human beings, there is a will and desire to heal. Part of that process is finding and holding onto what is wanting to emerge on that journey. It takes perseverance. It takes courage. It takes time.”

In this episode of the Numinus podcast, Dr. Joe speaks with Atira Tan. Atira is a somatic trauma specialist in sexual abuse recovery, educator, and activist. She has worked with survivors of child sex slavery, natural disaster survivors, victims of domestic violence, etc. And she has a very compelling TED Talk about these experiences. She is also an Expressive Art Therapist (MA), a senior yoga and meditation teacher, feminine leadership coach, and public speaker.

Atira teaches practitioners in trauma-informed plant medicine facilitation. She also works as a psychedelics facilitator at Aya Healing Retreats.

She is the Founder and Director of The Art2Healing Project, a non-profit that provides therapeutic support to women and children impacted by child sex slavery. She also provides trauma and psychological support to international NGOs for sex trafficking, abuse, and exploitation.

 

In this interview Dr. Joe and Atira explored:

  • Her professional history working with trauma survivors
  • The definition of trauma
  • What is trauma-sensitive therapy
  • The different between the responses to trauma for collectivist cultures compared to individualist cultures
  • What is involved in teaching trauma-informed plant medicine facilitation
  • What is involved in the preparation, duration, and integration of a trauma-informed psychedelic session
  • How to create a safe container to hold a psychedelic experience for a participant
  • What is missing from the modern day psychedelic field
  • The importance of practitioners and their own personal healing
  • How to build resilience

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Atira from the interview:

“Trauma healed can be a beautiful gift. It can help people tap back into what I call the essential blueprint that we’re born with.”

 

“With trauma comes the innate capacity of cultivating many different qualities that make us human such as courage, empathy, compassion, and aliveness.”

 

“Essentially trauma disrupts our ability to be in here and now.”

 

“Trauma recovery doesn’t happen alone.”

 

“The goal of a trauma-informed plant medicine facilitator is to support participants to build their own resiliency, establish a greater sense of self-regulation, and to support the trauma resolution which is unfolding in the session.”

 

“​​We’re really creating that container to prevent re-traumatization from happening. It’s really more about what we can do as facilitators to create that container for the person to feel really met.”

 

“When that relationship has been made, as practitioners, we can understand their needs. If the trauma imprints did arise, we are more equipped to provide the antidote, rather than to amplify the rupture.”

 

“We can’t really understand what it means to find and hold a safe space for other people, if we haven’t felt that felt sense of safety in ourselves as therapists.”

 

Here are some highlights from their conversation:

 

I wonder if you could give just some highlights or kind of reflections on how the trauma informed approach or this trauma sensitivity might show up in the different phases of the psychedelic healing. As I think you said that the trainings you’re doing are sort of structured around that. How might we think about trauma sensitivity in like prep, during the actual medicine sessions, and then in integration? 

How I kind of understand working in the psychedelic and plant medicine space is that the medicine actually starts to kind of work with us when we kind of said yes. So it doesn’t just start when we enter a session, it actually starts way before with the intention, when an individual says, ‘Yes, I’m going in for this experience.’ I believe that there is a kind of portal or connection with the medicine or with the intention of the participant.

And what I kind of understand is that people come into the space of plant medicines and psychedelics for many different reasons. But for me as a somatic trauma specialist, I work specifically with people that come in who are wanting to heal trauma imprints. Something is not happening in their lives. They feel disconnected. They feel stuck. They have been suffering from mental health issues for a while and they want to be free from some of these imprints.

So from the get go, my sense is that in order to create that safer space for people, there needs to be a dialog around the intention of people wanting to come in, what the categories of trauma are, what the symptoms they are experiencing in their lives, and also the intention for having the session. And if that can kind of be met with the same kind of attunement and care and empathy, which is kind of needed for this work, then as a result, a person will probably feel more regulated, more safe as they enter the session, and also kind of more prepared.

As you know, this field of plant medicine and psychedelics as we entered is an altered state of consciousness space. It is a mystery. And this can create high arousal and high activation in the nervous system. So as we create the container of safety and prepare–help to regulate and discuss resources, but also understand the individuals entering the session with us as practitioners, we can really understand their needs in this session in a bigger way. And when that relationship has been made, people can feel more comfortable with us as practitioners in order to, number one, have choice and agency around the session. As a practitioner, we can also understand their needs if the trauma imprints did arise and we are more equipped to, as I mentioned, provide an antidote and to repair rather than to amplify the rupture, so to speak. So I hope that I’ve answered your question.

 

So in talking about trauma, I also want to make sure that we talk a little bit about resilience because prevention is often the best medicine. And so I’m curious how you think about cultivating resilience, especially in the context of how ‘life is suffering.’ We’re always just one step away from being confronted with some really challenging experience. 

If I think about how I’ve been thinking about resilience over the years before really appreciating the trauma informed lens, I would think, for example, of this very classic Viktor Frankl quote that circulates a lot in the mindfulness world, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom to choose.”

I think the core message there is that there’s always choice. And it’s how we choose to respond to things. And that’s been a powerful principle for me personally and in working with my clients to help people develop a sense of self-efficacy and a sense of resilience against stress. And again, there may be this piece where it’s not trauma informed as a way of approaching it. I’m just curious how you think about resilience in this context. 

I think it’s very interesting what you’ve kind of brought up around the subject of choice and agency and trauma. So as I’ve kind of mentioned in the definition of trauma, there are certain times that happen in our lives where we didn’t have choice. Whether we were children or if something happened way too fast. For example, if we were perhaps in a high velocity motorcycle accident and we were unable to protect ourselves.

And I think that it’s important to acknowledge that for people that have felt that in certain circumstances in their lives, where they have felt that there has been a lack of agency. And I think that for these people, from a trauma perspective, part of the antidote is to renegotiate the trauma so that the body can experience what it’s like to have choice again. And what it’s like to have agency. And perhaps what it was like if we could replay or renegotiate that certain event, what it was like to have choice and the body to experience that.

So part of this work in trauma resolution and healing is around cultivating resilience. And we can cultivate resilience in many, many ways. And I agree with you that exploring choice and perhaps giving people who haven’t had choice in past experiences the chance and opportunity to renegotiate that can be something that can be very, very empowering for a person.

But there are also other things, other elements that can add to our cultivation of resilience. And two things that I will name, which I find very important. Number one is to understand and to track what’s happening in our inner worlds, in our nervous system all the time, and to understand how we can settle and self-regulate ourselves. Especially when we’re feeling perhaps more activated in the sympathetic nervous system, for instance.

And part of that is being able to self-regulate or co-regulate is really a conversation around our resources and how we use our resources. Because all of us have inner resources and outer resources, too. For most people, we are unaware of our resources and how to tap into that resource vortex in a way, a healing vortex in a way.

And part of this work around trauma is not all about focusing on the trauma and focusing on the suffering. More often than not with clients it is really about amplifying what is resourceful for them or what is life affirming or what’s life giving. And because they are living in such a place of neuroception where they feel danger constantly, they are unable to even drink in or receive the resources, the inner and outer resources which are available in the here and now at all times. So those are certain things that I think could be helpful for folks out there to cultivate resilience.

 

Connect with Atira on her websiteFacebook and Instagram.

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Episode 38: David Treleaven on COVID Trauma

 

"To move through trauma often means going back to what was too much. Often we need to be with someone who is with us saying ‘I’m here. You’re safe. It’s okay to feel it now.’”

In this episode of the Numinus podcast, Dr. Joe speaks with David Treleaven. David is a trauma professional, mindfulness teacher, and educator. He is also the author of Trauma-Sensitive Mindfulness: Practices for Safe Healing. After struggling through symptoms of secondary trauma on a meditation retreat, he developed the Trauma-Sensitive Mindfulness (TSM) approach.TSM helps trauma survivors avoid the risks they face when practicing meditation. TSM has been taught to veterans, prisoners, healthcare professionals, first responders, and many others.

Through workshops and online courses, David teaches mindfulness providers the tools of TSM, so that they can meet the needs of people struggling with trauma. More information on his online training can be found here.

David has worked with organizations like Search Inside Yourself Leadership Institute (developed by Google) and the University of Massachusetts Medical School by bringing them the tools and techniques of TSM to their staff and programs. He is also a visiting scholar at Brown University.

He is the host of The Trauma-Sensitive Mindfulness Podcast. He has had guests on like Sharon SalzbergRick Hanson, and recently Dr. Joe Flanders!

 

In this interview Joe and David explore:

  • Challenges with the definition of the word trauma
  • Is there such a thing as COVID trauma?
  • Why some people are more resilient in the face of difficult experiences
  • Neurobiological models of Post Traumatic Stress (PTS)
  • Diagnosing PTS
  • Approaches to treating PTS
  • The implications of collective trauma from COVID-19

 

Here is more information on subjects mentioned in this episode:

 

More quotes from David from the interview:

“Post-traumatic stress can be the impact of two different impulses acting at the same time.”

 

“Sometimes I think of trauma as us living through impossibility, and then the costs of that.”

 

“The further away I get from academia, I find myself less interested if we count a hundred people and we talk about all of their stories, whether or not we’re going to qualify their experience for being traumatic or not. What I’m most interested in is what, in a very practical way, are going to be the interventions that are going to support this person to have less pain and suffering in their life.”

 

“To move through trauma often means going back to what was too much. Often we need to be with someone who is with us saying ‘I’m here. You’re safe. It’s okay to feel it now.’”

 

“In my experience with people when they’ve really moved through or integrated that trauma is that they’re on the other side of a pretty big emotion or discharge through the body, they say, ‘Oh, it’s finally over. It’s been trapped inside of me for a long time. And now I’m integrating it in a different way.'”

 

Here are some highlights from their conversation:

 

COVID might refer to a specific viral entity, but it means so many other things. And I guess there’s a diversity of experiences that people have had. And I don’t know, you tell me, do we want to talk about–what was your distinction there, like traumatic experiences people have had in the pandemic era or or just like some kind of collective trauma that we’ve all experienced living through this? 

Well, there’s so much to say here. I’ll talk about how I’ll define trauma here which would be a response to actual or threatened death, serious injury or threat to physical integrity. And I think it’s important to at least start here and see if we’re on the same page because trauma as it’s become more of a popular mainstream term has become slightly diffuse.

And I’d say the definition has been watered down and there’s been some concept creep in the humanities more generally around trauma, which yes, again, there’s a double edged sword here. Where it’s great that people are talking about trauma and unhelpful in some ways to just generalize.

So I’d like to talk about trauma as an input or a situation that is a threat to life and limb where our survival and our fundamental safety is on the line. And COVID cuts both ways here, where definitely it has been a significant threat and it has been an actual material threat to family. I mean, people, families, communities or people are literally dying or their well-being has been threatened. And then there’s been a whole range of more generalized threat that people could say has been traumatic.

But I’d actually challenge that where I think it’s actually just been more a challenge in adversity and where it got murky and it was confusing about, ‘Is my life in danger here, even though I’ve been triple vaxxed,’ for example. So there’s a whole other place where trauma has happened. And then I think there’s been a massive period of adversity collectively that we’re trying to sort out and maybe we’ll be talking about it here in the conversation.

 

Let’s come back to that very evocative story about the child that gets pulled out of the way of an oncoming car. That seems like a pretty good example of a threat to the child’s life, their safety and that child’s nervous system probably goes into some kind of fight or flight reactivity. And then if I’m extrapolating a little bit, the mother is basically communicating through her reaction, ‘shut that emotion down.’ And the child is basically saying to themselves, if I want to stay connected to mom here, which feels really important right now because I’m kind of freaked out, I have to put that emotion away, inhibit it in some way.’ That sounds to me like an example or a mechanism around how things get stuck. 

I wonder if you can say more about why would that be in evolution that certain really intense experiences get trapped? And even what the hell does that mean for something to get trapped in our nervous system? Can I know exactly what that means experientially and sort of working with clients?

The metaphor that’s worked for me I learned from Babette Rothschild, who’s a trauma writer. She wrote a book called The Body Remembers. Yeah, all the best trauma books are like, ‘The Body Keeps Score of the Body.’ But she’s great. She’s awesome. When she’s training people around trauma and is trying to capture what you’re saying, what’s the essence of it? Why does that stuckness happen? Like, what’s the stuckness?

She’ll bring a bottle of soda up on stage and she’ll start shaking it up, and she’ll basically be talking about how the stuckness is the cap. And her metaphor is saying, ‘now what would happen if we just open this soda right now?’ And of course, it would fly. It’s too much for someone. So in Babette’s work, it’s been a lot about–and in a lot of trauma work, it’s about kind of cracking that soda top and allowing some of the pressurized gas.

But let’s back that up even further, because I think it answers your question. The reason I think that metaphor works is that when it comes to trauma, like with that child, there is some kind of activation. I said factory loaded some kind of deep survival response, often referred to as fight flight. So the sympathetic nervous system and the autonomic nervous system just hit the accelerator. We have the survival response. We don’t have to think about it. It just happens automatically. Flood of adrenaline pupils dilate to try to protect us. And then that’s the moment that I think you’re pointing to. That gets very interesting.

Why the cap? There’s lots of stories about different mammals who are able to shake and discharge that activation. You know, a classic example is the deer who shakes it off. It gets really frozen and then shakes it off, moves on like nothing happened. But what’s happening for humans?

You gave the example around attachment. I’d say, ‘yes, I’m faced with the choice of either being disconnected from my caregiver, which is fundamentally threatening. So let me basically cap that energy through locking my jaw so I can stay connected.; And then in other situations, there’s a legitimate freeze, the intense parasympathetic arousal sometimes known as tonic immobility. Which will come and cap or trap that activation of fight flight in the nervous system that can’t discharge over time.

So it has deep evolutionary roots about why we had that freeze, for example, playing dead like the possum. If you’re a gazelle, you’re dragged to a cave, you might freeze. The predator thinks that you’re dead and won’t actually attack you. There are many different inherited reasons that we have that–but it can create tremendous amounts of suffering in an ongoing way for people because we can’t uncap that freeze and it gets really frustrating.

PTSD or post-traumatic stress can be the impact of two different impulses happening at the same time. So for example, the impulse to run and the impulse to freeze, they’re both happening. They’re both legitimate survival strategies. And that combination of the two creates that charge. And you could say that stuckness.

And I wanted to link it here to what’s happened to a lot of health care workers or even family members. Where I heard stories of people saying I was on one impulse was to hold the line around safety in hospitals around who could come in and out of a ward, for example. And then there’s an equal impulse to, of course, let a family member come and be with someone, that loved one or a family member. And so it creates these impossible situations.

And so sometimes I think about trauma as us living through impossibility. And then the costs of that.

 

I think that I probably learned this vocabulary from you, but maybe I can just ask you, describe it, this notion of like pendulum motion. And there’s another term that I find really useful, like titration. 

Titration?

Exactly. I think these are great tools for people to know. Can you describe those? 

Yes, it doesn’t come from me, but Peter Levine. It comes from Somatic Experiencing, which is a really popular psychotherapeutic approach to trauma or healing. And I don’t receive any money for that. I just trained in it a long time ago and the core principle–this actually gets right back to the soda bottle or the pop bottle.

So imagine that bottle of carbonated water being shaken up, and you could think of that as a traumatized system that there’s a tremendous amount of sympathetic activation fight flight in the container. So the accelerator slammed the ground. But there’s also tonic immobility. So it’s capped and that if you imagine the feeling of the accelerator and the brakes slammed down, that’s often what trauma can feel like or post-traumatic stress. It’s really painful, uncomfortable, and dysregulating.

So the idea behind pendulation and titration in this work around trauma–the idea is you’re going to pendulate your attention, so basically go back and forth between areas of where you feel more trauma and areas where you feel more resourced. And in doing so, you’re doing what’s known as titrating. Which is actually an old concept in chemistry where you’re opening the soda bottle, but only to the degree that a little bit of the carbonation is released and then you’re turning it back.

If you opened it all at once, that’s not titration. It’ll cause an explosion. Someone gets flooded. It’s too much. And we all know this. I think intuitively that we can take only so much until we need to take a break because our systems can’t tolerate it all at once. So the essence of a lot of trauma work is to go back and forth in order to titrate and not have it over, not have trauma overwhelm.

 

I wonder if you’d agree with this statement that at least this might be just one among many qualities. But this is the quality or the expertise of a trauma therapist that might be sensitive to the pace and to not go at it full speed right away because one has to work very carefully with that limit. And if you went to a therapist that doesn’t have that training, they might not know how to work with that. Is that a fair statement? 

That is the essence to me of trauma training. That is why one would train to know how to work with a combustible process. It’s because more is not going to be better when it comes to working with trauma.

Let me give an example of that. So I was trained as a somatic therapist where the main question I had was, ‘Where do you feel that in your body? It’s all I had. I was like, ‘Well, where do you feel that?’ And if you just keep driving someone towards intensity to your point, that actually can be too much for them. Now that can be confusing because when you’re working in any kind of mental health work, I think when you see emotion, you think you’re doing a good job. Someone’s crying. I’m like, ‘I must be doing something right.’ And then I’m trying to amplify it because I think we’ll go deeper. ‘That’ll be great.’ And sometimes that’s true.

But when it comes to trauma, right to your point, it’s not. It’s that you need to have a more nuanced approach and you’re learning to track someone’s mind and body in a really nuanced moment to moment way.

 

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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:

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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?