Mayim Bialik's Breakdown - Rick Doblin: Overcome Trauma

Episode Date: March 16, 2021

Mayim explains the neurobiology of trauma and reveals her own experience working to overcome a traumatic event. Rick details the ground-breaking research his lab is doing using MDMA to treat PTSD. Rick and Mayim discuss everything from the ancient cultural origins of psychedelics and explore the "unified mystical experience of oneness" that is often brought on through the use of this medicine. Rick explains how MDMA can help free people who are stuck in a fight-or-flight response by calming their overactive amygdala while reconnecting them to disconnected memories. Jonathan volunteers Mayim for Rick's next study to get help with her on-going nightmares and Rick shares in real time the results of his most recent research which promises to change the laws and future of how we treat  PTSD. BialikBreakdown.com YouTube.com/mayimbialik Learn more about your ad choices. Visit megaphone.fm/adchoices

Okay, so one of the ways that we describe MDMA, and this is for your mother, is that it's a drug that you take and you can talk to your mother while you're on it. I think that might be the only way I'd like to talk to my mother. I'm Myambiolic, and welcome to My Breakdown. This is the place where we break down all of the things that make us break down. And today, we're breaking down post-traumatic stress disorder. It's Myambiolic's Breakdown. She's going to break it down for you Because you know she knows a thing or two

So now she's going to break down That's PTSD There's no acronym for this guy But we do call him JC Jonathan Cohen say hello Hello everyone, hello, my name Jonathan, if people are listening to this What should they do?

They should subscribe If people They should also leave a review And recommend it to a friend What if they didn't know that you can look at us while we're talking? They should go to the YouTube channel. My YouTube channel. My M-Bi-A-M-Bi-Lic YouTube channel.

Click the notification so you know when new episodes are there and subscribe. There has to be a website for this podcast. There is a website. It's biolik breakdown.com. B-I-A-L-K. Breakdown.com. You can ask my name anything there. You can submit a thing.

There's like a submission form to ask me anything. submit a video, a little piece of writing, a little poem about yourself. Jonathan, do you want to ask Myam anything today? I would like to ask you to explain PTSD. Okay. Ask Myom Anything is the entire episode. So like anxiety and depression, PTSD is one of those terms that a lot of people hadn't even heard of until a few years ago or so. But I know that so many of you, breakers, have found creative ways and not creative ways

to work PTSD into daily conversation somehow. This is not to say that you don't have PTSD if you are always saying you do. I don't know you. I don't know your life. I don't know your experience. But I hear these kinds of things a lot. That movie was so lame.

I think I have PTSD. That time my boyfriend stood me up on Valentine's Day gave me PTSD. I have PTSD from how bad my experience was at Starbucks. Now, here's the thing. I was once stood up on Valentine's Day. Did it give you PTSD? It did not.

I do still think about it. He was a famous person too, but we won't talk about that. I'm going to be a big downer right now. I'm going to do that thing that scientists do where we take away your right to use words and phrases that you like to because we're sticklers. We're just annoying scientists. I'm not trying to be annoying.

It just happens naturally. But specifically, when we are specific with our words, with our diagnoses, it makes us more refined thinkers and more refined feelers and more refined relators. And it legitimizes the challenges that people who have when they actually do have clinical diagnoses. And that actually expands everyone's understanding of mental health because if everybody goes around saying, I have PTSD, I have PTSD. When someone truly has PTSD and really needs help, they're more like, well, it's not that no one cares. People will be like, I know, me too. And it

dilutes our ability to get help to the people who need it. Another thing that annoys me, just because I'm annoying, is, you know, hyperbole. You know, that kind of hyperbole, like, OMG, I think I have PTSD. It also bolsters those grumpy old people who are like, these kids today, they're so weak. Anything happens, and they get PTSD. And again, there are people who absolutely have PTSD, but it is a very specific diagnosis that I'd like to talk about today. And that doesn't mean that things can't be traumatic.

it doesn't mean that things can't traumatize you. But when we talk about post-traumatic stress disorder, it's a very specific diagnosis, which means that a trauma has occurred, which has lasting effects, lasting neurobiological impact, and those effects are significant and interfere with our daily life. That's PTSD. Now, what's trauma? Not the same as PTSD, but it is a precursor. Correct. Well, and post-traumatic stress disorder is indicating that some trauma occurred. Trauma is a significant event which impacts us emotionally and physiologically and causes a lot of downstream things to happen in the brain and body. So downstream means, you know, there's an event that happens, but as your life goes on and as your experiences go on, it keeps finding its way like it's, you know, moving downstream.

The effects of trauma indeed can persist very long after the initial traumatic event and after what would be assumed to be the typical course of recovery from the event. The disorder part is where we get into that idea of how long has this been going on and how much does it impact your life and functioning. And those are the things we need to have an understanding of that clinical diagnosis. Traumatic events likely happen to most of us at one point or another in our lives. Has anyone ever been attacked by a dog? I have not, thankfully.

Oh, you love dogs. Maybe that's why. They like me quite a bit. Okay. I was, I don't want to say attacked. I did. I experienced a dog jumping up and scratching my eyelid when I was young. And for people who have been through more significant, you know, attacks, for example, by a dog, it can be a very, very violent and potentially very traumatic event. Sudden death of a loved one can be very traumatic. A natural disaster. Witnessing a violent crime.

witnessing or being involved in a significant car accident, these are things that many of us may experience in our lives. And when we experience these things, we're deeply affected. That's true, no matter what. Our sleep can be affected. Our eating habits might change. We might feel out of sorts.

We might feel disoriented. We might even like remember, like, you know, keep like playing back the accident. We may have an activated startle response. This is one of my favorites. That means that sounds. which are normally not upsetting may cause us literally to jump out of our skin. I have a very delicate startle response and I will cry if a sound is loud enough, even if it's not very loud at all.

And flashbacks of the incident are times when your consciousness is back in the incident. What about just being distracted a lot, feeling that you have to move a lot, feeling unable to settle? Yes, that can be a symptom of a lot of things. It could be agitated depression, could be anxiety. but yes, from PTSD, you will also get kind of a hypervigilance and a kind of a hyperactivation of your whole system. All those things I just said are those things PTSD? Probably not. Those are the body's normal response to an enormously significant traumatic event. All the things I just said, what did I say? Losing sleep, feeling affected, changes in eating, startle response. Those things are the body's normal reaction to a significant traumatic event. It's actually an adaptive

mechanism so that your brain knows, ooh, we didn't like that. We didn't like that at all. That's left over from like, I didn't like when that cheetah tried to kill me. I didn't like when that person came after me with a big club. When we're supposed to learn from that. Well, we do. Your brain is like, I got this. So what is PTSD? PTSD is distinguished by the effects of that trauma and those symptoms staying with you for a very long period of time with more intensity. and often more frequency, which means they go on for longer. They get worse and they get more often, meaning if you were having flashbacks once a month, they might come once a week. So what determines if someone experiences a trauma and gets PTSD or not? Three things. Saliency, that's a great word.

number two, genetic luck or lack of luck, and number three, previous experience with trauma. So three things determine. Saliency, genetics, and previous experience with trauma. Let's talk about saliency. Saliency is the fancy way of saying, how bad is it? How bad is it? How bad is it? How intense is it?

whether or not a traumatic event leads you to have PTSD depends first on how bad the thing is. How much can your brain handle? How much can it take in? So two people can experience completely similar events. One might get PTSD. One might not. There are not hard and fast rules because PTSD is not about the specifics of the event. It's about how that person experiences it and is able to either recover or not.

the more loud, the more violent, the more horrible in experiences, the more of your sensory systems that are involved, the bigger impression it makes on your brain, the more salient. Does that make sense? I heard you say two people can experience almost the same event and depending on our interpretation, how we experience that. Correct. It's not really interpretation, but the impact. The impact of that, which is our experience. Right. Everyone experiences things differently. Correct. And one person may get PTSD from that event and someone else won't.

And there is no objective measure. It's not like, oh, that dog attack wasn't violent enough for me to get PTSD and your dog attack was worse. Right. Which leads to point two, genetics. So what determines how much one person's individual brain can take in before it becomes PTSD? That's genetics.

Genetics is the part of the equation that will determine your susceptibility to a salient trauma or your predisposition to having long-lasting negative effects of a traumatic experience. So those are kind of related, but it has to be a salient experience. It can't be the lady didn't make your coffee right. I promise. It can't be that. What if no one has ever made anything right for you your entire life? And that one moment is your breaking point.

I'm going to go ahead and tell you that that still does not by. Traumatic classification from a science perspective still does not justify a traumatic event with the coffee lady. There could be other traumatic events. It's not like the straw that broke the camel's back was like everything was just teetering and I was holding it together just until that moment. Not so much. Okay. Every hipster in L.A. you've just been called out. So this goes back to the third thing and it is previous experience with trauma. This is essentially a fancy way of saying environment.

This is the environment. So the environment is everything about your upbringing and everything you've experienced. If you have experienced anything in your life, specifically in the most vulnerable time of your life, your infancy and your childhood, if you have experienced any trauma and abuse is trauma, physical abuse is trauma, sexual abuse is trauma. Neglect is trauma. that's emotional, you know, we call that emotional abuse. Those are all trauma. If you've experienced any of those, you are then more susceptible to re-traumatization and developing PTSD.

Is that clear, Jonathan? Someone at home might be thinking, I have all these experiences with trauma. Aren't I getting better at it? Your brain doesn't think so. It doesn't work like that. No, no. And that's because the brain is,

it makes me sad. It's because the brain is wired to help you survive and thrive. And what happens in abuse and in trauma is the brain says it's too much. It's too much. And that's when we get dissociation. That's when we get acting out, you know, what we call acting out. Those are ways to make it not as bad, you know. So let's go back to the examples that I gave. Jonathan, this is the quiz. Can you get PTSD from a lame movie? Likely not. Why not? It's not. Not traumatic enough. Good. It's not a strong enough stimulus. Can you get PTSD from being stood up? You say no. No, no. I say unlikely, but when might that happen?

If you created an entire narrative in your head that this moment was going to be the moment where everything was going to change for the positive for you. Think about your past. What if you've experienced Oh, if I've been... Abuse in a relationship. Correct. So then you have a template. So then you have being stood up. It feels bigger.

And it is bigger to your brain. You're not imagining it. And that's like a really important point. If you have PTSD, you're not imagining it. Your brain knows what's up. What about the coffee lady? The barista. We covered that.

That's a no. That's a hard no. Okay, got it. Let's talk about the violent dog attack. Let's talk about sudden death of a lot. loved one, natural disaster, witnessing a violent crime, being a victim of a violent crime, witnessing or being involved in a significant car accident. War? People go to war. People also go to war. Those are all very salient stimuli. Those are much

more likely to do it than the barista, the movie, or the celebrity who shall not be named. So add to a salient stimulus, any other issues that you might have, physical abuse, emotional abuse, sexual abuse, those make any of those other things potentially very, very overwhelming for your brain. And yes, you are then more likely to develop PTSD from those kinds of things. Then, though, we get to add in like, but what's your genetics, you know? And if you got a good dose of coping genes, you might not get PTSD. This is a fantastic example also of the mind-body connection, right? An event happens which impacts your safety or your mental state.

And what happens is you physiologically have changes that happen. PTSD is a physiological set of symptoms. I mean, it's things that are happening to your body. It's not just in your head. The process by which PTSD actually causes physical impact and physical changes in you, physiological changes, comes from a complicated, you know, combination of different brain structures and hormone systems. When we're stressed, we're going to release adrenaline

and we're going to release cortisol. And when we experience repeated abuse or repeated trauma, our ability to rebound can be depleted significantly. And we see that also in chronic depression, where the system can't even catch up. A little bit of that, you know, is part of the explanation, you know, for what we're seeing in PTSD. There's also a hyperactivation of a region of the brain called the amygdala.

The others. AMY G, G, D, A-L. A. And the amygdala is known as the fear center. We talk about it in anxiety. Many beautiful, loving animals have sacrificed their brains and their lives for us to understand that when you remove the amygdala, you lose fear and vigilance. And what happens to animals in the wild who don't have amygdalas is that they are killed because they don't have any fear. This is a great example of the need that we have for a very delicate balance between a reasonable amount of fear and the cognitive ability to understand when we should not be afraid of things. What happens in PTSD is that

the amygdala gets activated as if it's still happening. And that entire system does not know and does not distinguish between past trauma and current trauma. And everything is potentially an opportunity for retramatization. That's why people with PTSD have that startle response. Everything can be too much. I have a very very, very. interesting. I think it's interesting. I have an interesting story about my PTSD journey. Sounds weird to say it's a journey. But one of the things that I will say as I was in a significant car accident, for the acute period after that car accident, I all of a sudden was terrified of dogs. And yes, I never really loved dogs because Athena, this Doberman, scratched my eyelid when I was

eight. But I had no fear of dogs per se, you know, related to the car. car accident or at the time of the car accident. And what happened was my brain saw a dog. And the first thing that seemed to make sense was that that dog was going to attack me. And I would like run to the other side. I mean, I feel it like I would run to the other side of the street. And even if it was not a threatening dog, in my mind, it made complete sense that that may not look like a threatening dog, but it has the ability to hurt me tremendously. Was the amygdala, activation from the car accident, then bringing up the trauma from the dog that was unprocessed from when you were young? No, I don't think so. No, I think that was actually unrelated. Why was the focus on the

dog for you? Oh, because anything, I mean, this was very acute. This was in the acute phase, like, you know, the first couple weeks and month. What it was was that my entire system was still on high alert from that accident. It wasn't just dogs. I'm giving the example of dogs, but anything that had the potential for sudden motion, I mean, after my car accident, I didn't sit in a car for three months, like behind the driver's seat for three months. Not because I'm weak,

not because I'm a deficient human, not because I'm broken, because the physiological symptoms were not worth me negotiating. I did not have enough resources to negotiate what it physically felt like in my body to try and sit in that, that seat. And yes, that kind of trauma comes from previous trauma being activated, but it was not

poor Athena, the dog. I really do. We need to bring on Rick, who is a fascinating figure, fascinating figure in the field of PTSD, specifically for his work with MDMA. Let's welcome Rick. Thank you. My Ambialx breakdown is supported by Superpower. We all know the feeling of leaving a doctor's office and kind of feeling like we didn't get anything out of the experience that was useful. Maybe they're like, you're fine. Drink more water. There's no real data. There's no game plan. This has happened to me many, many times, especially on the perimenopause journey. That's why we're fascinated by what superpower is doing. They send a licensed professional to your home or you can visit a nearby lab. One simple blood draw with over 100 biomarkers. That's way

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My pleasure. You're the director, the executive director, and the founder of the Multidisciplinary Association for Psychedelic Studies. That's MAPS, correct? Yes, that's it. And I believe that you are the guy who introduced the use of psychedelics and MDMA as a potential treatment for PTSD. Is that correct? Sort of. I'm the one. So let me say this, that MDMA under the code name Adam was a therapy drug, quietly, secretly, from the middle to late 70s, around 76, 77 to the early 80s. And it was used for PTSD then. I didn't discover MDMA until 1982. I did work with a PTSD patient in 84. And so I knew that it worked, but other people had done that before. But MAPS is the first group to do a controlled scientific study with PTSD. Your doctorate is in public policy. Is that correct? Yeah,

my undergraduate degree is in psychology, but in the 80s when I graduated and wanted to get a clinical psych PhD, I wanted to do psychedelic psychotherapy outcome research, but nobody would let me in because psychedelic research had been shut down. So I wasn't sure what to do. So I went home and I spoke to joint and I thought I would think about my future. And during that moment, I had this realization that I have this pattern. I want too much too soon. And in this case, I wanted to do the science, but the politics was in the way. And so I realized I need to switch and study the politics. So that's where I got the master's in PhD from the Kennedy School. In general, your work has focused on really kind of peeling back the curtain of a lot of misperception and misrepresentation of

the use of a very specific kind of drug, which is therapeutic and has a tremendous amount of value, which we've known about for thousands and thousands and thousands of years, but which also does have a tremendous amount of political kind of heft around it. So I feel like I've already just started speaking to you and I feel like I could talk to you forever because I have so many questions. Okay. Well, let me surfer. One thing quickly, just was your comment about the thousands and thousands of years. Just to help people understand. Yes, that's what I was going to say. Like, frame this up for us. Okay. So, you know, so much of what we talk about is the psychedelic renaissance and we're trying to mainstream

psychedelics into Western culture. But it's really reintroducing into Western culture, the role of psychedelics. So from 1600 BC, which is a very, very long time ago, to 396 AD was the Ellucinian mysteries. And those were the largest mystery ceremonies in the world, the longest running that we know of. They were by the Greeks. And they had a psychedelic component where people had a potion that they drank called Kikian. They went to Elusis and they had this experience. It was very interesting in the sense that they let, of all people, they let women and slaves participate, not just men. I don't know how much difference there was between women and slaves at the time there. You beat me to it, Rick.

Yeah. But everybody that we think of, Plato, Aristotle, Pythagoras, the luminaries of the Greek world, they all had these psychedelic experiences. It was something that you couldn't say what happened under pain of death. So we don't know exactly what happened, but that it was a psychedelic experience and that it was about the death rebirth transition. And it was to spiritualize people. and that was the core of Western culture. And then it was wiped out in 396 by the Catholic Church.

They ruin all our good times. They are, you know, well, orthodoxy of all kinds. Let me just say the Orthodox Jews are a little bit. There are Orthodox ayahuasca circles, which we will get to in a little bit. Go ahead. Oh, okay. Yeah. Well, I don't know if you know this, but we also have a project, Israelis and Palestinians,

doing ayahuasca and MDMA together. Love it. For our psychedelic reconciliation. So we've got a three-year project looking to that. But the point about the thousands of years is just that psychedelics have been part of human evolution for a very long time, part of Western culture. And then it's been lost by groups that want to be the powerful and intermediary between people and spirituality. And now I think humanity has reached a point where we really need to democratize it. And when you talked about your podcast and stuff on mental health, MAPS's main mission is mass mental health, which means on the one hand,

medicalization through FDA, through drug development research, but on the other hand, drug policy reform to make it so that people's fundamental human rights to explore consciousness. What I try and do as a human, which I'm bringing to this podcast, is I tend to be a very middle of the road person. And one of the really neat things about, you know, being me and exploring the internet is that I have a large portion of my audience that's conservative, and I don't mean politically, but I just mean kind of socially conservative. And then I have a large portion of my audience that is quite liberal. And I've never hidden the fact that I'm a liberal. I'm a, I'm a, I'm a, the child of civil rights activist, first generation Americans. Oh, nice. Yeah,

I'm like, I'm very, very old school. However, I like to find, you know, the rational and logical and scientific basis for what I often know to be true, either in my soul or in my experience. What I think a lot of people feel is problematic about the kind of work that you do and even the kind of conversation that we're having is a very, and I don't mean to sound judgmental, is a very puritanical perspective that we should not, you know, we should not try and reach the sun. Do not construct, you know, wings to try and fly to the sun. We're here to have, you know, an experience based in controlling based desires. And this is, it's a very puritanical kind of perspective that many people do subscribe to. And you're right, many religious people in particular continue this.

But I recently watched Fantastic Fungi, the documentary. Oh, great. Yeah, which, you know, was, and we're going to link to that on my website. But what was really beautiful about the way, you know, he spoke about this kind of consciousness is that people are not saying that the solution is for everyone to be stoned all the time. The solution to our existence is not that everyone needs to have psychedelic transformative experience. the notion is a very scientific one that we have the capability as human beings to access things that are beyond the realm of our daily understanding. Those things are not sinful. They are potentially dangerous, if not monitored and regulated and understood. But the access

to other realms of our consciousness is absolutely a critical. part of mental health and of our wellness on this planet. And that's not, that's not hippie-dippy, you know, nourish kite, as my parents would say. That's not, that's not nonsense. And this is not paranoia. The reason that there have been so many restrictions around this kind of research and around this kind of use is that people who have no fear and have been liberated, indeed are difficult to control because they have tasted their own power. And I'd like you to talk a little bit about sort of the political conflict surrounding this kind of research in a way that we can guarantee to all of the conservative people who might be

listening, this is not hippie-dippy paranoia. I'm not stoned right now. I can't speak for you or Jonathan. No, I am not. I am not stone. I know. But talk a little bit about, you know, the fear of the Timothy Leary. and the fear of the Hunter S. Thompson and what it really means to do what you do from an academic and legitimately beautiful, you know, perspective. Okay. Well, first off, we know the myth of Icarus, you know, flying too close to the sun. But what my Aunt Miriam used to say and still says the whole time is that you need to give your children wings and roots. So I think this idea of stay away from the sun, stay away from

spirituality, stay away from states that go beyond the ego, these unit of mystical states, that that's fundamentally wrong. We need to experience the full range of consciousness, but we need to do it in a way where we ground it into practicality. So what we're doing with psychedelic assisted psychotherapy is trying to help people have these remarkable therapeutic, sometimes mystical experiences in a few short-term experiences wrapped in psychotherapy and then help them integrate it so that they don't need drugs anymore. And it's fundamentally different than classic pharmaceutical approaches, particularly for mental illnesses, where you're supposed to be given drugs on a daily basis for

controlling symptoms. What we're trying to do with psychedelics is to help people get to the root, the core of the problem, work through it, and then integrate it and then not need drugs before. Yeah. Now, I'll just combine two things for a second. One of the most important studies that was ever done with psychedelics that Timothy Leary did in 1962 was called the Good Friday experiment. And it was an effort to try to see if psychedelics could catalyze a mystical experience. And so they took 20 divinity students into church on Good Friday. The minister was Reverend Howard Thurman. And he was this incredible dynamic African-Americans. American minister, and he had studied with Gandhi, and Martin Luther King was his mentee. He was the mentor for Martin Luther King. Martin Luther King got a PhD at Boston University. And so I did a 25-year follow-up to the Good Friday experiment. And so I spent a fair amount of time at the Marsh Chapel on Boston University, where it took place. And in front of it is a statue for Martin Luther King. And it has a quote from him on the side. And what it says, and I'll paraphrase it, I'll paraphrase it.

I don't think he'll get it exactly right, but it says that for someone who thinks that a law is unjust and willingly violates it and will accept the punishment in order to be an example to others about the unjust nature of the law, actually has the highest respect for the law. So it was Martin Luther King trying to reframe civil disobedience into patriotism and into respect for the rule of law. And I think people need to keep that in mind that if you're willing to suffer the consequences and have yourself be an example of the unjust nature of the law. So I think that there is, though, something about the 60s and something about what Timothy Leary was doing that points to how psychedelics can inspire people for certain kinds of political action. And I think the core element of it is this sense of this unit of mystical experience. Yeah, can you talk for someone who doesn't know that expression? What is that? Well, you just feel like everything is connected.

So we know that maybe you could explain more than I can about quantum physics, but it's this idea that at a certain level of analysis, it's just all energy and it's all in one big system. And so, you know, the separate objects and things like that are true at a certain level as well. It's like light is a wave and a particle, you know, how you look at it. But there's a way in which we're all connected. And I would say something that would be easier for people to understand is during the 60s, when we had the efforts to go to the moon, that the pictures of the Earth from space, of the earth as a, you know, a blue marble, you know, floating in space, that that caused a lot of

the astronauts to actually become more spiritual and to really see the earth without political boundaries, without countries, without fences. You know, you can see the Great Wall of China from the space, but this idea that at one level of analysis, that it's all one system, I think that that's this mystical experience. And there is other elements to it. It's a certain transcendence of time and space. We know, again, from Einstein, that time is not fixed the way we think it is, that there is a certain loss of time, you could say, in black holes and other kind of cosmic phenomena that in the theory of relativity time changes. So that there's a sense that we're all part of this enormous system together.

One of my favorite albums is by Rita Marley, who is Bob Marley's wife. And the title of it is, Who Feels It, Knows It. So we can say these words, but it took the astronauts seeing the Earth from space. It takes experience, who feels it, knows it. So it's different to have that experience. And once you feel that connection with everything, that you're part of this, everything, then when you come back to normal consciousness and you try to integrate it, What it suggests to us is that the differences that people have in their skin color or in their religious orientation or in their nationality are minor compared to the commonalities that we have.

And so once you have that sense of connection with everybody, then that for me, I think, can be the antidote to genocide, to racism, to environmental destruction. You know, it's not just the environment is somewhere thing out there that we can trash. part of us. So I think that in the 60s, a lot of people look back on it and think that the backlash for the 60s was psychedelics gone wrong. And I actually think there was a lot of psychedelics going wrong. That's true. But I think there's also the core thing, I think, was psychedelics going right and people having this sense of connection. And then also part of it, when you have this transcendence of time and space, you see this whole sweep of evolution, there's a certain loss. of fear of death as well.

So, okay, you just said like 8,000 things that could each be 8,000 hours. I want to, I mean, I also love that you literally just spoke. I don't even know how long that was. You just bent, I think, time and space. But you literally went from quantum mechanics to, you know, the entirety of our collective experience. That's the way I live and think.

And for me, it's because, I mean, for me, it's two things. It's because I'm a scientist. and it's because I'm a person of faith. And this is something that freaks a lot of people out, that I am a scientist and also a person of faith. But what you specifically described happens to sit extremely well with my religion of origin. I'm a Jewish person and I'm ethnically Jewish and it's my religion of choice, as it were. You know, the entire notion of the spiritual practice of Judaism is oneness.

And the notion that whatever you call God, whatever you call God, whatever you call, your experience. Those are the names that humans put on structures and buildings and people and things. But the notion of oneness is that that essence that transcends all religion and all agnosticism and all atheism. There is one source in this universe that is essentially its gravity, it's everything. It is the world of physics as we know it. It's microbiology. It's biochemistry. It's all of those things. And as humans, we get to come up with words for it. And we make buildings that we go and sit in to talk about it. But the core of it is exactly what you said. It's the smallest thing you can imagine, which is also the largest thing you can imagine. And that's sort of that oneness.

But what you describe or what these astronauts, you know, described, what you're describing, it is a divinely mystical, spiritual, and in some cases, religious experience. And there have been very, very moments, you know, in most of our lives where we feel that, you know, witnessing the birth of a child is one that a lot of people talk about, you know, falling in love. As a scientist, I'm a little bit shaky on that because it really is just a lot of chemicals. But there's a very special feeling of mystical connection that we get very, very few opportunities. But what my religious tradition allows me to do is to keep that going and to find that in all of the things that we do and all the things that we experience. So the reason I bring that up is because I think a lot of the people

who dismiss what you say and sort of what you experience and help others experience is like, that's hippie stuff. That's crazy. That's like, why do that? That's nuts. But the fact is, for all of, you know, structured human history, it's what we're all chasing. And, you know, the notion, at least in the Jewish tradition, Moses went up to a mountain and had a mystical experience, but he brought it back down because those experiences that you have when you are in touch with something that is bigger than you that is mystically, you know, fantastic, it is not about what that experience is. It's about what you do with it after. I don't really like to hear about people's crazy tripping stories. I really don't. It's not my thing. And almost everyone that I

interact with has done lots of drugs, which is just how it is. But I'm more interested in how How does it transform you? How does it change you? How does it give you more compassion, more love, more goodness? How does it make you make the lives of other people better? But maybe you can describe a little bit about what this actual therapeutic protocol is, because I know you are deep into it because it's your research. What does this actually look like?

Are you standing on a street corner handing out bags of mushrooms? Is that what you're doing? It's in a van, right? Are you in a van? You're blasting Grateful Dead. What happens? First off, this idea of bringing it back down to ground is therapy. Therapy is the reality check for all of these experiences. Can we use them to help people actually enjoy their lives more to heal? So that, I think, is the reality check. Before I describe that, I just want to say two things. You talked about love being all chemicals. One of the chemicals is oxytocin. Yes. that's connected to nursing mothers, to falling in love. All right. So MDMA stimulates oxytocin.

That's one of the main things that MDMA does. And there was neuroscientists at Johns Hopkins, School Dolan, who published a paper in nature in mice that showed that MDMA stimulated oxytocin in mice, and not only that, that it promoted neurotogenesis, meaning new neural connections between new synaptic connections. So that what you're doing is you are rewerewis. your brain when you are on the influence of MDMA or also psilocybin does this, other psychedelics can do it. So just for those of you watching from home, oxytocin is the hormone that is associated with nursing. You need oxytocin to have a milk let down, which this is not about breast is best.

This is about the mammalian body is programmed to release milk, to create the ability for your offspring to survive because that's what milk is for. But it is also the chemical that is needed to create a bonding experience with your mammalian offspring so that as you teach your baby to exist, you teach them how to exist. Oxytocin is also what happens when you have an orgasm. The same contractions that allow, sorry people, this is what I do. The same contractions that allow milk to be let down also allow contractions of the parts of the body that allow us to have an orgasm, that's what oxytocin is for. It's for releasing the things that make us alive and make us feel alive. But oxytocin is what allows you not only to release a child from your body, but to feel

an emotional connection with the process so that you'll do it again and pass your jeans on again. So oxytocin, when we, and this is, you know, a lot of people talk about Molly and a lot of people talk about ecstasy if you're as old as I am. That feeling, which yes, can be artificially stimulated and they do it in mice all the time, but that is a powerful feeling that absolutely allows your brain to say, I can do this. I can connect and I can have access to that. That doesn't mean you spend your whole weekend doing drugs. What it means is the process of bringing it down the mountain working with a licensed and skilled and trained therapist and guide is to help you take those feelings and find the ways that your body naturally can create that and thrive in that environment.

So I just wanted to clarify how happy oxytocin makes me that you just mentioned it. Okay. And let me say that there's a German psychiatrist, Torsten Passy, who's published a paper that says that one of the ways to understand what MDMA does, it's like the post-orgasmic state. Correct. And I think for people to think about that, you're satiated, you're not striving, you're there, you're feeling connected. That's what MDMA feels like, the post-orgasmic state, and because in part of oxytocin release. Correct. The other thing, just before I start explaining what the therapy is, is that I just want to talk about in some ways the tragedy of fundamentalism and that my Israeli relatives who are Orthodox are some of the most racist, anti-Arab people that

I have encountered. I'm going to go ahead and say same and maybe we're related, but I'm sure there's more than just one family. Yeah. So what that means to me is that, and it gets back to what Rita Marley, who feels it, knows it. When you become the people of the book, you become overly rational and you become overly insulated. You have lost the core message of oneness. And you end up, it's oneness of your own tribe, your own community. But the other is somehow or other denigrated and lesser than. The Old Testament is also full of hallucinations, visions, the tradition of prophecy from the Old Testament.

It is some of the trippiest stuff you will read is the things that our prophets saw in their visions and in their sleep. And yes, there also is absolutely evidence of the use of hallucinogens at that time in history, but also the vividness and the openness of that society has been lost, really from the destruction of the Second Temple, which I'm happy to talk about another time. But moving into what we identify as the rabbinic period of Judaism has been one of politicization of the religion and in many cases a loss of many aspects of that, which is why there is a Jewish movement of which I am a part of, which is post-denominational and emphasizes a lot of really

more of the core, you know, spiritual and religious, you know, traditions isolated from that. So I just want to, I want to give a nod to that. And I love my family dearly, but the culture that many religious people of all varieties are raised in really misses out on the fundamental concept of oneness, which again is the foundation in particular of Judeo-Christianity. The fundamentalists have lost a lot of that experience. They get it more in cognitive, rational ways. And so this kind of emergence of psychedelics is something that can be of great.

great benefit to fundamentalists. And what happens is that you don't leave your religion, you don't leave your traditions, but you just look at them in a more metaphorical way and a less literal way. And then you, you aren't so threatened by other people's metaphors. The best example for that, for me, is language. You know, we have different languages. You know, Hebrew is not better than English. English is not better than French. French is not better than German. There are different ways that we've learned to communicate. They all have their different subtle flavors, and they are different from each other, but just because I speak English doesn't mean that it's better, and everybody who speaks French is worse than me. So I think if we can eventually see

religions in that way, they all have their different flavors, but underneath it is this core of unity and similarity. And what we see is that the mystics of the different religions have more in common with each other than they do with the fundamental. of their own religion. So I think what we're trying to say is that we can bring these technologies of the sacred to the fundamentalists and that they won't be left driftless

and with nothing. They will actually reinvigorate their traditions and that they can celebrate them in different ways so that there's a lot of threat that fundamentalists feel to this, but that really deeper down it can be beneficial to them. For sure. Okay, now you tell us how it actually works.

Okay, so what we have done is we have developed a treatment that is around three and a half months long. This is for chronic, on average, severe, most treatment resistant but not required PTSD. That's what we're doing, but it applies to other conditions, other things. But what we're doing is a three and a half month treatment. And we call it MDMA assisted psychotherapy. So what that means is it's psychotherapy is the core of it. And the MDMA assists the psychotherapy. So the treatment is not the drug.

The drug is just a tool. And I think you can think of psychedelics like a knife. You know, a robber or a murderer can use it to kill you. A surgeon can use it to save your life. It's more of a neutral tool. And it's the relationship that we have with it that makes the difference. And that's the fundamental problem with our drug war and prohibition is it's imparted qualities of goodness or badness in certain drugs. This is a bad drug and it's illegal and we've lost the sense that it's just a neutral tool.

It's the relationship we have with it. I want to also just add before I get in more detail to the therapy is that Benny Shannon was the head of a cognitive psychology at Hebrew University in Jerusalem. And he wrote a paper that was very interesting. and he talked about Moses going up to the mountain and seeing the visions. And he speculated that the manna had potentially some psychedelic aspect to it. And when I shared it with my father, who is very Jewish, but very liberal, I said, look at this. My whole life has vindicated. Now look at this paper, you know, and it was reported on in the New York Times and elsewhere.

This paper about Moses was high when he saw the burning bush and stuff. And so my father said, well, in order for me to believe that, first off, I'd have to believe in Moses. Because when you actually look at it, there's no archaeological evidence of the Jews going through the Sinai Desert or building the pyramids. So it's metaphorical, most likely. And we should see this as metaphors. Okay. So the three and a half months is a short-term intervention. there's only three days that people get MDMA, one roughly three to five weeks apart, roughly one month apart, embedded in 12 non-drug 90-minute psychotherapy sessions.

So hold on, 12 90-minute sessions. It's a lot of therapy. Well, this is. This is a labor-intensive initial. Think of it as psychic surgery or, you know, some kind of deep intervention that is meant, to have long-term impact. Now, if it doesn't have long-term impact, then it's not cost-effective. Now, we have just published a paper in a plus one, which is the Public Library of Science,

PLOS, 1. It's an open access journal. There's a cost-effectiveness study, the first one ever done of psychedelic psychotherapy that just got published about two weeks ago. Well, and the fact that you even have to also enter into that is only because I think of the extreme skepticism and conservatism of our field, because the notion is this is a potentially unbelievably significant transformative opportunity for people. But the next thing after people say, it's for hippies and you're going to play Grateful Dead, the next thing they'll say is, well, it's too expensive. I mean, this is just, this is bureaucracy. So anyway. Well, well, the key factor for us now we're thinking about is how do we get insurance coverage? From an equity point of view, when you think about it,

those people that are the most traumatized are often the ones that have the, the least financial resources. You know, the PTSD in a substantial way, it impacts people's ability to function in the world, the ability to work. And, you know, a lot of times people are disabled from violence and a lot at an early age. So we need to get insurance coverage. So that's a big part of it. If we just get approval by the FDA and it's only for self-pay people, we've not accomplished what we really want to accomplish. No, then it becomes like the rest of the mental health system, which is just for the elite, because that's who needs it most. Okay, but that's also why we work on drug policy reform. So we people think that people should have access to these

drugs without having to claim religious freedom or medicalization. They should be able to access and they can do self-healing. We are training people to do psychedelic harm reduction, to do peer support. So it's a three and a half month process. There are three 90-minute sessions before the first MDMA session and then three 90-minute sessions after each MDMA session for integration, preparation, then the dosing session, then the integration sessions. The actual dosing session is eight hours long. So I'm going to ask a question as if I'm my mom. How do you take it? You drink it, you smoke it, you inject it, you snort it. You take a capsule or a cap. A little pill like the government tells us to take in every commercial we see on television.

Yes, yes. Got it. So you take a pill. Yeah. And so we've actually made some fake commercials just for fun. You know, ask your doctor if MDMA is right for you. Can we post those on the website? I would love to put, I'd love to make our own. Jonathan and I would do an amazing series for you. Yeah. I would love to see things that you could create. Oh my gosh. Putting it on the list, Rick. Add it to the list, Jonathan. So they take a pill and they do it in the office or you do like, how long does it take? Okay. Okay. It's only in the office. It's only in the office. It's, only under direct super, again, because it's therapy aided by MDMA, it's not a take-home pill. So for those people that are worried about- That's not like, I'll handle this at home, doctor. I got this. Yeah, not like that. If those people that are worried about drug diversion, like the D.A, it's easy to control. It's fundamentally different than medical marijuana. Medical marijuana is something you would minister to yourself.

Yes. And you take home a month supply and who knows who you give it to it. It's gone in a week, isn't it, Rick? Well, I think most patients use it, you know, for medical purposes. But it's easy to control. And because it's psychotherapy, it's only going to be prescribed by people that have been trained in the psychotherapy specific to our method for working with MDMA. Got it. Now, the other big thing to say is that most of us get traumatized at some point in our lives in some ways.

But most people are resilient. You suffer from the trauma, but most people don't get PTSD. Correct. Those people that get PTSD, and this isn't true for everybody, but for many of them, they have a history of trauma that, goes back often to childhood. And also because MDMA is stigmatized, psychedelics are stigmatized, what we felt we needed to do in our studies was to maximize therapeutic outcomes. And, you know, luckily we found that it's cost effective. But still, the goal was maximize therapeutic outcome. So what we have is a two-therapist team. It's not one therapist when you're

going to the MDMA assistance, like at least for now. I mean, we may be experimenting to try to make it less expensive or different ways. But we feel that it's best to have a two-person team. And in general, in general, it's a male female or male-identified female identified. I appreciate that, yes. We have had two female teams, two male teams, but the model is generally male-female. And that is because when you often work with people, they do talk about childhood traumas. and to have a well-functioning kind of parental vibe there, which they may not have had when they were growing up, can be restorative.

Sure. Now, we also, it's optional again, but in most cases, we want people to spend the night at the treatment center. So you go to the clinic, you have an eight-hour session. We start at 10 in the morning. It goes till 6 at night. The therapist leave. We have a night attendant come in who doesn't do therapy, but he helps or she helps bring dinner. These are usually students or interns or wanting to learn about MDMA.

People spend the night in the treatment center. And then the next morning... Do you serve them breakfast, Rick? We serve them breakfast. We serve them dinner. But the therapists come back, and that's where you do the integrative psychology. Got it. Got it.

Okay, wait, but take it back a step. Yes. Because, like, everybody who's never done drugs or hasn't done a lot of drugs, like, what happens when you take the pill? Is it like the matrix? Like, what happens? And I'm not asking for gory details. I'm saying that, like, just for people who have...

zero idea what's happening in those eight hours. You take the pill to walk us through it. Okay. Well, let me first make a distinction between the classic psychedelics, which are like LSD and psilocybin, ayahuasca, you know, mescalines in peyote, iboga, ibogaine, the classic psychedelics, and then you can discuss this more than I can, but they have an impact on what's called the default mode network in the brain, which is identified more or less as our self. It's our functioning for how we assess the environment for our priorities. You could even go back to Abraham Maslow, a nice Jewish psychologist for the hierarchy of needs. Yep. So your default mode network is kind of scanning the environment for your hierarchy of needs. And the classic psychedelics dissolve

your sense of themselves. They take a coffee stirer and they do this to that part of you is what they do. Yeah, and we see in brain scans that that portion of your brain becomes less active. And so that's where people have this kind of more likely they have this unit of mystical experience. Your brain is Aldous Huxley even talked about. Your brain is like a reducing valve according to this default mode network and your hierarchy of needs. There's so much stimulation that you're getting, but you focus on what's most important. With the classic psychedelics, your focus is diffused. you're not so egocentric.

You feel and hear a lot of different things. And for many people, that's scary. Like you're losing control. Sometimes we so identify with our ego, with our sense of self, that people confuse this ego dissolution with physical death. A lot of times people think that they're dying.

They sometimes go to the hospital. They do. So now, that's the classic psychedelics. In a safe, controlled environment with people properly prepared, it can be enormously therapeutic. The reason that MDMA is in phase three and no other psychedelic is in phase three is because of a strategic decision that we made 34 years ago, that we would focus on MDMA,

that it's the most gentle of all the psychedelics. So it does not dissolve the ego in the same way. So when people think about psychedelics, that's what they think about LSD and you're seeing hallucinations, you're seeing visions. MDMA doesn't cause that same degree of hallucinations or visions, doesn't really interfere that much with your optical perception. My mother's voice, though, is saying, that's just what you're saying, it's all the same.

But this is an important distinction that you're making. This is not an all or nothing system, and that's just true scientifically. This is not an emotional or a, like, groovy perspective. there are different chemical processes by which every drug works or doesn't work. And this is one that specifically does different things. And that's just science. This is not you trying to will it to be so so that you can make everybody feel great all the time.

This is an actual fact. I just want, like, my mother's voice is constantly like, no, now, now. But I'm with you here. Okay. So one of the ways that we describe MDMA, and this is for your mother, is that, that it's a drug that you take and you can talk to your mother while you're on it. I think that might be the only way I'd like to talk to my mother. It certainly helps.

Surprise, Ma. I actually was doing MDMA one day and my mother called and I actually did talk to her one day when I was on MDMA. So what that means is you can carry on a rational conversation. You can be listening to people. You know who you are. But what it does is that MDMA may. you a better listener. It makes you less defensive. MDMA and through the oxytocin and other properties that it has. It releases serotonin, dopamine, nor epinephrine. It shifts the balance of

activity in your brain. It reduces activity in the amygdala, your fear processing part of the brain. We've talked about that here. Okay. It increases activity in the prefrontal cortex where you think more logically. Correct. And it increases connectivity between the amygdala and the hippocampus, which is where we put memories into long-term storage. So the thing about PTSD is the trauma is always right about to happen or still happening. It's not been processed and put into long-term storage. So what MDMA does is basically what the opposite of PTSD does. So brain scans have been done with people with PTSD,

and you have a hyperactive amygdala, and you have reduced activity in your prefrontal cortex and reduced connectivity between your amygdala and your hippocampus. so that these memories don't get stored into the past. It's not also it's not just that they don't get stored into the past. Your brain can't tell the difference. That's really what it is. For people who don't understand trauma and PTSD,

and I try and explain it in the introduction to what we're talking about, the physical state that you are placed in when you experience a flashback or any of the, it is as if you are still there because your brain doesn't know the difference. So yes. Yeah. And in part that's because of the reduction of activity in the prefrontal cortex.

So that let's say that you were in a war and you heard, you know, bombs. And now you hear a lot of noise. You don't have that as much capacity as we normally have to separate out. That noise doesn't mean a bomb right now. It's, you know, a car backfire or who knows what it is. So what MDMA does is it promotes a sense of self-acceptance. and self-love. There's a way in which you can accept yourself for who you are. You're not as defensive. So that's why you're a better listener. You want to hear what people really think of you.

You're more open is the sort of colloquial way to explain it, right? You're more open. Yeah. Yeah. You're more open. You're less defensive because therefore you can be more open because you're not defending yourself in those same ways. You have this sense of self-acceptance. And of the eight hours now, of the therapy session, what happens is that we have music and we give people eye shades. The essence of what we're trying to do is to help people get in touch with their own inner memories, their own emotions, and we don't want to, the music without words kind of facilitates emotional release. One of the things we talked about briefly is that, you know, there is this project we have with Israelis and Palestinians doing ayahuasca and MDMA together as kind of a psychosovoys.

Reconciliation. And one of the comments there from one of the Israelis was that whenever he heard Arabic called to prayer or Arabic music, it frightened him because that was the enemy. That was the other. But under the influence of ayahuasca, when he heard this Arabic music, he could see the beauty in it. And he didn't react in such a fearful, programmed way from before. And for people with trauma, everything potentially is the music. of the enemy, meaning it will trigger all of that experience of fear and panic and terror and abuse, that you're really trying to reset the soundtrack, as it were. Yeah. Yeah. All right. So in this eight hours, roughly half the time people's eyes are closed,

they're listening to music, and they're having this inner flow of imagery and metaphor, and they're thinking about their lives, they're thinking about their trauma, they're feeling it, They have a lot of bodily sensations. There's a psychiatrist we work with called Bessel van der Koke, who has written a tremendous book on trauma called The Body Keeps the Score. So a lot of trauma is stored in the body. You know, we have kind of a brain-centric view of things, but trauma can be stored in the body. And particularly when we're not capable, because it's too frightening, of processing it in a

conscious way, a lot of times it shows up in the body. We talk about this a lot. It's something Jonathan and I personally talk about a lot. And it's something we do talk about here. Fasha is going to be the word of the day soon. But I've done trauma work and Jonathan also has a healing background. And so we both are very familiar. You're speaking to the choir here, but we're hoping really to share what you're saying with more people. So also just everything's blowing my mind right now. It's awesome. All right. So let me give an example. This is years ago when MDMA was still legal. I was working with a German psychiatrist, a German doctor. It wasn't a psychiatrist. German doctor. And under the influence of MDMA, his arm became paralyzed. So this is an example of this sort of somatic situation. And he was scared. And he was like, my arm is paralyzed. Let's go to the hospital.

It wasn't paralyzed because of the MDMA. I just want to clarify. Well, that's what we tell them. Yeah. This is something psychosomatic going on. That we don't need to, you know, MDMA is not hurting your nerves. You're not really paralyzed. Yeah, let's figure out what's going on.

So over the course of several hours, He told a story. And the story, as it evolved, was that he and his mother and his siblings were in the hospital, and their father was being kept alive by machines. And he wasn't really even conscious. And they had to decide whether to stop the life support or not. They all decided to stop the life support. And since he was the doctor, he had to sort of right disorder.

He said the complication was he hated his life support. father. And so this unconscious conflict was, did I kill my father? Did I do this because I hated him? And over time, as he spoke about it, he said, no, my mother was there. She thought that that's what he wanted. My siblings were there. They thought that that's what he wanted. I did really think that that's what he wanted. And as he worked out this conflict that he didn't kill his father, this deep-seated hatred, the feeling came back to his arm. And by the end of the session, he was fine, his arm was fine, their paralysis was gone. So during an MDMA session, we respect the fact that sometimes the memories are so difficult for people. They're so sort of unconscious or

subconscious that they can't grapple with them directly and it will come in the body. So of this eight-hour session, roughly four hours or roughly half of it is people with this inner experience. And then the other is them talking to the therapist. With the classic psychedelics, like psilocybin or LSD, it's more like 90% of the time. It's people having an inner experience. A lot of times they can't even talk. You are unable to verbalize. It's what's called ineffable.

You know, you can't put it into words. You're processing. I call Jonathan ineffable all the time, but for different reasons. Oh, yeah. Well, it's a beautiful, beautiful word. And it does explain a lot of what's going on. So the thing is with the eight hours, what we have. is a fundamental belief that there is this inner healing intelligence.

Now, we all know that's true for our body. You know, our body gets hurt. It will try to heal itself. There's certain limits to that. You know, we don't regrow legs if they're amputated, but, you know, we can not yet heal ourselves. Yeah, maybe we can figure that out. But we know that there's this sort of energy to restore the sort of.

structural integrity of the body, that the body does below level of consciousness. We believe that there's something similar to that. And Stan Groff, who's sort of the world's leading LSD researcher, therapist, he's 89 years old now. He's helped start transpersonal psychology. What he has talked about, he's described LSD as a non-specific amplifier of the unconscious. And so things emerge, but you don't know what is going to emerge. and you don't know the order.

Now, the therapies that have been developed for PTSD, cognitive behavioral therapy, cognitive processing therapy, prolonged exposure, they're very scripted. Here's your lessons. Here's what you need to do. This is the first session. You need to learn this. The second session, we need to talk about this.

It's very scripted. So we do the opposite, though. There's no script. There's no order. We call it interdirected therapy. And for those that want to learn our treatment, method, the treatment manual is posted for free up on our website. So you go to the MDMA page at the bottom, you get the treatment manual.

So what we're doing is we're supporting people in whatever is emerging. And we don't necessarily try to steer it to the trauma. It's whatever is coming up. Sometimes it's a beautiful memories of their childhood before, you know, their parent died or whatever. And then you go through the beautiful method, the memories. and that sometimes they're building strength to do the more difficult stuff.

Sometimes they go directly to the trauma. The mind has its own, you know, it has its own map. And that's the entire purpose of the kind of work that you're doing is that there are things that are not evident. If you break an arm, we can x-ray it. We know how to do with that.

If you have eczema, we know, okay, there's that and here's what we can do. But the kind of things that we're talking about, especially with trauma in particular and with PTSD, it is all invisible. And what this work does is it makes that visible so that it can then start to be healed.

And this could take 20 years in classical psychotherapy. I mean, it could take forever, really. Well, forever, I'll say that we worked with somebody also in Israel that had PTSD from the Young Cooper War from the early 70s. And this was now, you know, 40 years later. And he still was able to heal. So these patterns are very deep. They affect everything in your mind and your emotions, how you process them.

But I think the message I'd like to get across to people is they're not necessarily permanent. You are not doomed to having PTSD your whole life necessarily, even if psychotherapies have failed, even if the pharmacology that you get from your psychiatrist to control the symptoms hasn't worked for you. There's still opportunities for healing. Stories are how we tell ourselves what the world is like. I mean, that's also religion and mythology and these stories. So people are rewriting their story under the influence of psychedelics in this MDMA-assisted psychotherapy. We used to think that memory is like a book. You find the book on the shelf, you pull the book out and you read the book and then you stick the book back on the shelf.

That's what a memory is. But it turns out that that's not really what a memory is. memory is put together from different parts of your brain. There's the episodic memory, the emotional memory. But when you have this memory, you actually, in a sense, have to reprint the book. The memory reconsolidation is you're putting the book, a new book, and that explains how our memories change over time, you know, that we have to be suspicious of our memories because sometimes we- Jonathan rewrites history all the time. Yeah, yeah, you do that. And so we have to be careful.

of, you know, how much we attribute to our memories. But what's happening is that in trauma, that we have the episodic memory, the memory of what actually happened linked with the emotional memory, which is fear, terror, you're not sure you're going to survive. And then every time you remember it when you're still not healed from this, you remember it, it's connected to this memory of fear. And also, that's evolutionarily advantageous because the reason, you know, I talk about about the brain being redundant all the time. The reason that exists is because if as an animal in

nature, which we are all animals in a state of nature, but picture yourself, I say, like, wherever you want to picture your animal self, are you in a jungle, are you a Serengeti, wherever you are, if something significantly traumatic happens to you as an animal, it's extremely important to remember, do not go there again, run from that creature, Don't eat that. And the only way that that information gets appropriately coded is the strongest way possible. And that's when it's a tremendous emotional content. So that's why we talk about like why many people drink tequila only once.

I'm one of those people. Because the extreme reaction that you can have from something that really doesn't sit well with you, it is so profound that it can cause changes in your behavior. But what happens is in the complex primate that we are, Those experiences are much more difficult to classify as yes or no. And this is where this comes in. The other thing that I wanted to say is that the people you're describing, these are not people that you're selecting because they know themselves so well

and can have these experiences and are touchy-feely. These are people who have experienced things and this process is teaching them how to start tapping into this. So what you're doing is you're not taking people who are like, I get this. I'm going to have an amazing experience. These are people who, you know, one of the, unfortunately, one of the examples that we have is people who have been traumatized by war, soldiers. You're not saying, who's the most hippie-dippy among you who likes to be in touch with

your feelings? You're saying who's the person that needs this treatment and how can we teach them to have this vocabulary so that they can start healing? Yeah, most of these people have not done psychedelics before, and they're coming to us out of desperation and out of pain. So yeah, it's the full range of people. It isn't hippies. Not to take the wrong with hippies. Some of my best friends are hippies. I'm a hippie. I consider myself hippie as well. But it's definitely a wide range of people. That's why we're talking about the mainstreaming of psychedelics. And people come out of need rather than, oh, yeah,

I'm just happy to do a psychedelic. But to finish on the memory reconsolidation, what happens is with MDMA, because it reduces the emotional fear related to the memory, that under the influence of MDMA, people's memory for the trauma is enhanced. You can recover memories. One of the best examples is a firefighter who was involved in a fire where the roof collapsed and about eight of his firefighter peers were killed. He managed to survive and he had trauma, PTSD from that. And under the influence of MDMA, he shared that he thought that he had remembered the entire story of what happened during this fire. But under the influence of MDMA, he realized that there had been whole chunks of it that he had completely put out of his memory, that he was able to

recover the memory of while he was under the influence of MDMA, because the emotions had been so painful attached to those portions of it, that it was just too difficult. It was too much. He literally said enough, that's enough. Yeah. And it pushed, but when it's subconscious or unconscious like that, it has an enormous power over you because you don't even know why you're influenced in such a way because you've submerged it to consciousness so that people's memory is enhanced. Now, also what MDMA does is gives you the sense of self-acceptance, this sense of peace. You're able to put the memory in the past. So when you re-consolidate the memory, what you're doing is you're swapping out the emotion of fear and terror and anxiety and it's always happening now with a different emotion. I've processed that. This is in the past.

I can look at that from a peaceful perspective so that after the therapy, and this is what we do during the integration process, when you end up remembering it again, you have now got a different. emotional tone to the memory and it's more processed in the past. Why are we not all on this all the time every day? Well, first off, you function in a different way. It's not what we don't want to be on it all the way, but all the time. But we do want to be more loving, more open. And so there are a lot of things that we want to bring back from our MDMA or psychedelic experiences into our everyday life. But when you're under the influence of MDMA, you know, it's not as good for certain kind of things. Let's say you need to do a podcast. You need to write an essay, you know, or something, or you need to do certain kinds of work. It's a different way of processing. Another way to look at is

the rainbow. You know, there's different colors of the rainbow. We don't want to be stuck in one color. It's the whole rainbow. We don't want to be stuck in one state of consciousness. We certainly don't want to be stuck in the ordinary state of consciousness only, but we also don't want to be stuck in the sort of unit of mystical experience. Rick, I want to be stuck in this podcast interview for the rest of my life. Well, this is an important question. Rick, if a podcast host that we may or may not know has nightmares often, how would an MDMA session potentially help her and maybe him or her, I don't know, I'm not making any assumptions. Yeah. Well, my, okay, hold on. With all due respect, my nightmares are not an isolated symptom. I do have trauma.

So that we're going to cover in the opening. The way, the way scientific research works, though. And Rick has some unbelievable, statistically significant, very, very important research results that he has recently gotten, which is very exciting. But the way that you get those results in early studies is to, choose very specifically patients who have the least amount of variability possible in terms of their profile. The kind of patients that you're talking about and that you use for these kinds of studies are people who are resistant to other forms typically of treatment. So just like, you know, electroconvulsive therapy, which they still do, that we reserve for people who are completely, like really resistant to every single class of medication and treatment possible, you don't like throw me in there as a give me pig. I think that this would help me tremendously but you want people who have been not treated other ways and who have a very specific profile.

Well, I would say your whole discussion here has been a defensive maneuver. You're right that we don't want a lot of variability, but we work with complex PTSD that's severe. That's me. I'm your best friend right now. All right. Now, also, one of the symptoms of PTSD is nightmares. Yeah. So what we find, though, is that as people are in the therapy, their nightmares get reduced and sometimes go away. Because the emotions that generate the nightmares, you address them. I'll say that a lot of the people in our studies have said, I don't know why they call this ecstasy.

It's not like you take MDMA, which people have heard about, is ecstasy, and your problems go away and you're filled with love and everything's easy. It's not that way at all. There is a lot of difficult release of emotions and processing. It is work. For people who are living with trauma and for people who are living in this nightmare, which really the daytime feels like a nightmare also many times, there is help and there is hope many ways besides what you're talking about.

But trauma work specifically is very, very, very difficult. It's exhausting. It's not a day in the park. it's not like clubbing on ecstasy. So I think that that's, you know, the beauty of the work that you do is you really are. You're not just transforming these people's lives. The reason I wanted to talk to you,

the reason I'm so honored to get to speak to you, is you really are. You're transforming the landscape that we even place this in. And my father died five years ago, bless his memory. Like, I wish he was alive to hear this because he always had this sense that there was more to a moment.

our consciousness and our capability, but growing up the way he did, he couldn't, you know, access it. Like, this is something that I really wish so many people could understand, not just like you should take MDMA, which I plan to, in a therapeutic environment, but the idea that you are not destined to live in your trauma, whatever that is. And having an open mind about whatever might open that up is the way to that freedom, that universal feeling like that oneness. Give us a sense of how much research is going into this to make it, for lack of a better word, mainstream.

Or legitimized. Legitimized where we're getting it to a point where people can actually access it. You don't need a special pass. You don't need necessarily to be a part of a study with, you know, like, where are we in from where you started? So when can we get it at CVS? Maps was started in 1986. I started 34 years ago.

In the history of maths, we have raised now over $100 million in donations, which have gone to the research or to struggling to get permission for the research. We have done research with cannabis. We've done research with Ibogaine. We do Harmonic. So not all of us has gone roughly $70 million or so is going to the MDMA research. It's a lot more expensive for Big Pharma to do things because we're non-profit pharma.

We have loads of people volunteering their time or working below market. We like to say we have refugees from Big Pharma. What has happened from 1986 to 1992, five products, six protocols were all rejected by the FDA. We finally got permission in 1992 for a phase one dose response safety study. That was done actually at Harbor UCLA with Charlie Grope, as the, uh, principal investigator. That took us through much of the 90s. In 1999 is when we started to work with PTSD. And so we had what's called an end of phase two meeting with FDA. Phase one is your, well, first off, you do preclinical studies, you get a basic sense of toxicity, safety,

then you do phase one, which is generally in healthy normals. You get a sense of what the drug does at different doses. You learn of the effects of it. Then phase two is where you're starting to work with patient populations. And these are small pilot studies where you're trying to refine your methods to see who it works with, who it doesn't work with, what's your treatment approach, what's your doses, who do you exclude, who do you include? What are your measurements or the measurements sensitive to the changes that are happening? So we did basically... And then what's phase three just to finish this out? Well, phase three is the large scale, multi-site, double-blind, placebo-controlled studies that you have to prove safety and efficacy. There's also a phase four. So,

Phase four is after you've been given approval, if you've been given approval for prescription use, phase four are certain requirements that the FDA puts on you. For example, we've been required to do studies in adolescents who are traumatized, 12 to 17-year-olds, but only if it works in adults. So you have to show it works in adults. We're also in phase four are supposed to be looking more at how do we separate out, who are the responders, who are the non-responders, and then also looking at relapse, who relapses, and under what conditions and what he'd do for the relapsers. So we did roughly 16 years of phase two

studies in the U.S., Israel, Switzerland, and Canada. And we went to the FDA, November 29th, 2016 for what's called an end of phase two meeting. The data that we presented basically showed that those people in the control group that had the therapy without active MDMA, again, the hardest cases, treatment resistant, chronic, on average, severe, that 23% of them no longer had PTSD in the people that got therapy without active MDMA. When we add active MDMA, 56% no longer have PTSD, more than double, which is great. The more important, I'd say, is the 12-month follow-up. Well, because also PTSD doesn't, it doesn't disappear overnight, but in terms of the measures that you're taking, it's not detectable to the same level. So after 12,

months, go ahead. Well, after 12 months, two-thirds no longer have PTSD. Right. That's a lot. And of the one-third that still has PTSD, almost all of them have had clinically significant reductions in PTSD symptoms. If we could have given them a fourth session, maybe they wouldn't have PTSD either. So, okay, so tell us about the study, though, that you just, right, go ahead. All right. All right. So then we negotiated with the FDA. They said, yes, you can go to phase three. Not only that, we will negotiate, we have to do two, 100-person phase three studies. And after we negotiated that and what's called a special protocol assessment process, the FDA said it's a breakthrough therapy. They gave us breakthrough therapy designation, which is for the most important drugs, the most promising drugs, two-thirds of applications

from pharma for breakthrough are rejected. And just this morning, I got the results of our first phase three study. And what we learned is first off, it was statistically significant. Which for those of you watching from home, really the only thing that matters when you do an experiment is a statistically significant, which means the possibility that it is chance has been ruled out by so many statisticians and so many things have been controlled for. It's what you want most. And the level of statistical significance that you reached, I don't think I've ever heard of that level because it literally is. It's either a 0.05. It's a 0.01. It's a In order to satisfy the FDA that you have a statistically significant study, and we had a great safety profile, I just add that to, it's 0.05, which means one in 20 chance that it's due to chance. Correct. And that's kind of the lowest level of safety that you can move forward with your research with. Yeah. If you get statistical significance at the 0.05 level, then it counts as a successful study when you compare it to your safety. safety profile. It's great. Now, the FDA has another level, which they call robust. If you have a robust study, it's 0.001, which means it's 1 and 1,000 that it was due to chance. And so once you have a

0.001 robust study, we will engage in some discussions with FDA. I mean, we'll probably still have to do the second phase three study as it is, but maybe we can say instead of half the people that get the placebo and half get MDMA, maybe we can have one third get the placebo and two thirds get the MDMA, whatever. But what we found is that we had point zero zero zero one. It's unbelievable. Yeah. So that means you have a relatively small variability. And you have dramatic results in changes. Congratulations. It's enormous. It's just, it's astonishing. And coupled with the safety profile, again, unlike many studies with PTSD, because we need to work with the hardest people, we include people that have previously attempted suicide. A lot of times PTSD studies exclude those people. We had only one person attempt suicide, and it turns out they were in the placebo group. Now, the other thing that's very important is that there are people that are called the dissociative subtype. And so one of the common strategy, when you are traumatized is to separate out, to dissociate.

You're not really there. It's happening to somebody else or something like that. The problem with that strategy is it bleeds over into your daily life. The extreme of that is called dissociative identity disorder. Which used to be called multiple personality disorder. Yeah, where you're so dissociated. So we exclude people with a formal diagnosis of dissociative identity disorder. Because they're their own category.

Yeah, not because they can't be helped, but because they might need more support and more sessions. But we do have people that fall into what's called the dissociative subtype. They score higher on the dissociative tests that we give them. And so what we showed, to our surprise, I would say, is that the people who had dissociative subtype actually showed a greater increase in therapeutic effectiveness than the standard group. so that what we're showing is that it works in the hardest cases. Well, and the neuroscientist and me wants to know so badly, can we replicate that with 200 people so that we can figure out what is the mechanism by which there may be a propensity in those with these dissociative features that is behaving better

and happier with the way MDMA is acting. It's tremendous. I mean, the FDA requires you to prove safety and efficacy, but you don't have to figure out mechanism of action. I know, but I'm just excited about it. Yeah, yeah, yeah. I'm just saying, but that's, that's like an endless thing. The brain is so complicated, you know, so if you had to prove how something works. Oh, and for me, it's just, well, it's very, but it's important. It's because maybe, and this is something I'm not persuaded of, but, but there's a, it's called translational neuroscience. How much of neuroscience actually translates to improving outcomes?

And it's not clear to me that there is any translational neuroscience in this case because we know the therapeutic approach. We have our methods and we still don't really know exactly how it works. So whether neuroscience will help us optimize outcomes, we hope so. But that remains to be seen. Thank you so much. Thank you so, so much. Thank you for having me. Thank you for having me.

That was something. Hold on. Let me get out from under the bus that you threw me under. I was just trying to get you some help. That's what this podcast is about. Practical solutions to myam's problems. I so miss being around that kind of scientist. They just like every stats in their head, every anecdote, every, just he's got it all there.

He's a very impressive storyteller, and we should have him back on. I do want to actually mention something that came up a lot in this interview that I do want to clarify. So he works very closely with several research. in Israel and mentioned a lot about Israeli researchers and Israeli studies. Why Israel? It's a very kind of strange reason, but it's sociologically important. Israel, while it was not created because of the Holocaust, has a tremendously large population and had a tremendously large population of people who experienced a genocide, many of whom moved to a very, very, very small country. So you have a country essentially the size of an extended family filled with people who had

experienced tremendous crisis and trauma. Many people who survived the Holocaust witnessed things that are really unfathomable by most accounts. And so many researchers were the children of that generation. And many researchers and students grew up in a culture intensely touched not only by the Holocaust, but by the trauma to the rest of the populations of Israel that make up the population, as well as the Palestinian population, which also experienced a tremendous amount of trauma and continues to. In addition, Israel has been under attack by several times in 1967 and 1973 were the wars that most people think about. So after people left the Holocaust, many of them then became soldiers in significant wars,

where Israel was attacked by six Arab countries. So you now have a population with compounded trauma. And I hate to sound like a scientist, but what that provides is an opportunity for a population of individuals who have provided a tremendous amount of not only sacrifice, but ability for us to understand trauma. And the attacks and the threats of bombings

and the first intifada, which I lived through in Israel for part of it, where you could be walking down the street and your favorite pizza place would blow up in front of your face. That happened. Buses were frequently bombed. You had an entire culture really living on the edge. Again, this is not a political conversation,

but that was the truth for that population. My family all serves in the army there. I have had family members on the front lines in Janine. The entire region, everyone is... The entire region, everyone is either in the military, close to the military, who has witnessed someone die or be killed. And people on the other side, everyone is on edge all the time.

Everyone's on edge all the time. And in addition, what I thought was really beautiful about, what he talked about, was trying to get resources to the Palestinian population, which is an underserved population, especially in the medical and psychiatric branches. So that's why he talked about that so much. But I really, while the kind of treatment that he talked about may not be for everyone, his work highlights some of the most critical aspects of what we try and talk about on Miami-Bialx breakdown, which is understanding that. the need for support and being open to seeing the places in our lives where mental health is hiding in plain sight and doing things to try and heal. That's what he's talking about. It's a process of healing. When Rick was talking about unified mystical experiences where people have that sense of oneness. He's talking about obviously the profound experience of seeing the earth from space, But people have that sometimes in nature, sometimes in other experiences without having to leave the earth. Is it just a flood of oxytocin that gets us there? What is going on in the brain that makes us feel the interconnectedness of all life, which Rick was explaining to us, is one of the fundamental ways that people experience.

I mean, there's a little bit the million dollar question because. Is there a button and can I push it? that kind of experience is not a solitary place in the brain. It's not one chemical. It's a combination of your experience and a circumstance and an availability, meaning being receptive. While people do sometimes have mystical experiences of like, I was walking in the desert and all of a sudden, you know, that usually I think does not happen. I think that more often there's an environment and a sense of preparation for being receptive. to that. One of the reasons that, you know, I always say that you have to talk to, I call it God, but you can call whatever you want. One of the reasons I say that you have to talk to God, even when things are going well, is so that when things are not going well, you already have a line of communication open. You know the language that you use with which to contact that power greater than yourself. So that's really what this is about. It's about being a vessel for then

having this experience, but it doesn't just happen. I'm certain, and I'm happy to research it after. I mean, off the time, sometimes I don't know things. This is one of those where, you know, if you put someone in an MRI scanner, you can try and recreate some of these experiences, but keep in mind, we're then recreating these experiences with someone in an MRI scanner. I've heard that's not the most comfortable place. It's not the most comfortable place. And anyone who tends towards claustrophobia or panic, they have to be ruled out from that study. So like, I would love for you to be able to see what's going on in my brain when I am having a religious experience that is profound and divine, but you likely will never get to see it because the way that we

observe those phenomena is by trying to measure them. This is the Heisenberg uncertainty principle that you cannot know both the location and the speed of any particle. You can know one or the other. So you can't really know, but we can try and get close. I know the chemicals that are involved, But for me, when I've had mystical experiences, it's because I've done preparation for the place that I'm going to be at to receive that. I've tried to remove impediments to having that experience. And then I facilitate it to the best of my ability. And then what happens is something that I don't know if there's an explanation beyond a divine confluence of circumstance and hormone and spirit. And, you know, this is, I'd love to talk to Sam Harris about this.

like, I don't know, seems pretty much evidence for that this isn't all there is, but I could be wrong. Let's sum up you might need help if regarding PTSD. Because although we talked about so many things with Rick, this episode really is about trauma and about one of the, we will do many episodes, God willing, we'll do many episodes on PTSD. This was one about psychotherapy and MDMA and PTSD. and the symptoms of PTSD very widely. Obviously, one of them is nightmares. Thank you, Jonathan. You're welcome.

You might need help if you have experienced a significant trauma from which you can't seem to get over it. That's sort of the layperson's terms. We talked a bit in the intro about significant trauma and what that is. If you've experienced any significant trauma, chances are there's some residual stuff that you probably will want to process and work on,

but in particular if people comment that you don't seem to get over it, you don't seem to be the same, you might need help. You might need help if you have physiological symptoms such as nightmares, flashbacks, a delicate startle reflex, anxiety attacks, panic attacks, or an inability to stop reliving the event. You might need help if you have no specific memory of a traumatic experience, but you have a lot of these features. And this does not mean that you need to go to therapy so that we can uncover this trauma and ruin your life.

Many people never specifically pinpoint their trauma, but still can get a tremendous amount of relief in their lives by doing some of this work. In addition, you may not have experienced trauma if you show all of these things, but it is absolutely necessary to get help to even pinpoint if there's more to be done. There are many, many things that you can do to recover from trauma. Talk therapy, cognitive behavioral therapy can be part of the answer. Focusing on any way to lower overall anxiety helps PTSD symptoms. Things like meditation, learning to breathe, increasing exercise, and general ways of improving self-care can be very helpful. Processing trauma is best done with a professional. I'm just going to say it. You can sit in meditation all you want. You can. feel like you've thought about it and you're okay all you want when we're dealing with trauma i'm

saying this as a human and as a scientist this is something that needs the assistance of a professional we're going to put some some books that that rick mentioned and that jonathan and i um have have have uh have worked from on the website what a spectacular episode from my breakdown to the one that i hope you never have i'll see you next time it's my and be allicks breakdown she's gonna break it down for you she's got a neurosephi PhD or two One, fix you more than that she's gonna bring