Part 1 of my conference notes took us up to Saturday afternoon, when I had the very great pleasure of hearing Friederike Meckel-Fisher speaking about her therapeutic work. Friederike presented an approach that differs significantly from the therapy protocols developed and used by MAPS and the team at Imperial College; her approach is highly personalised, more physical/interventional, and involves pharmaceutical assistance for both the client and the therapist.
I found this last aspect of Friederike’s approach very interesting; it was something I’d asked Ben Sessa about the previous day, and also discussed with another therapist who had worked on clinical trials with MDMA. I’m interested in theorising the ‘informal’ therapeutic relationships that exist between friends or partners, particularly where they use psychedelics together in a mindful, developmental way, to support either an equal, mutual exchange or something more unidirectional. In either case, it makes sense to me that the process could benefit from both parties having increased empathy, openness, positivity, etc..
Thinking about therapeutic relationships in these terms – for me – brings into sharp relief questions of ethics and professionalism and humanity itself. To be a professional means to aim for the highest of standards in one’s practice; to commit fully to the principle of ‘do no harm’. It requires constant, rigorous reflection. A psychiatrist has to be a professional in every respect; the patient trusts them to provide the highest possible standard of care. In comparison, the ethics of friendship, parenting and other personal relationships are somewhat less well-defined. Again, Alexander Nehamas comes to mind with his refreshingly nuanced view of friendship, and many will be familiar with Philip Larkin’s This Be The Verse:
They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.
Most of us, I’m sure, have at some point got ourselves into a relationship where we feel like we’ve bitten off more than we can chew; one where we wanted to help – we thought we could – but we start to worry that we don’t have the right skill set, or that our own crap is getting in the way, and we may actually be making things worse. I have friends in this situation who’ve given an ultimatum as a form of referral (or last resort), saying they won’t continue to see the other person socially unless/until they seek professional help. I don’t know what it feels like to be on the end of an ultimatum like that. I think if it comes to that point then something must have gone wrong earlier on, either in terms of underestimating the issues, or overestimating one’s capacity to help. We could say that all personal relationships are, in a sense, therapeutic if they are to have any real meaning for us. Entering into any deep relationship is inherently risky, with or without the use of psychedelics. Perhaps the more powerful the substance – and the closer the relationship – the greater the risk. But perhaps, also, this is where the most profound gains can be made?
In any case, I feel like I got something of great value from Friederike; an understanding that if someone who is dealing with past trauma ‘freaks out’ or ‘shuts down’ (goes immobile, starts to shake or show other signs of life-threat, dissociation, etc.) then they may be re-living that trauma. Whether it is to do with being alone, neglected, or hurt, what the dissociated person needs is physical, empathetic, loving contact.
One of the first sessions I saw on Sunday had David Nichols presenting his findings on DMT and the pineal gland. David had taken it upon himself to kill off the romantic notion that naturally-produced DMT is responsible for the visions, euphoria and analgesia that accompany near-death experience (NDE) and life-threatening injury, and he did so with aplomb, sensitivity and academic rigour. While DMT may be present naturally in the brain, it is not found in effective concentrations and there is no evidence it can accumulate. David showed how the phenomenology of NDE could be explained by other systems, such as the robust and sustained surge of adrenaline, serotonin and dopamine seen in cases of asphyxia (suffocation). The rise in glutamate levels during asphyxia is notably similar to that achieved with ketamine. I didn’t personally think David killed the romance; he just added another layer of explanation. We know that during an NDE there is a large increase in the amount of neural signalling at gamma frequency (between 25 and 100 Hertz). The brain’s activity becomes highly synchronised; it is pulling out all the stops in order to maximise chances of survival. This increase in gamma power is also seen when people take DMT. So, there is still a physiological commonality between a DMT trip and an NDE, it’s just that the common causal factor is more likely to be something like gamma power, rather than DMT itself.
The penultimate session (after being persuaded into buying a raffle ticket from David Luke – what is going on? I never buy raffle tickets) was Ben Sessa in conversation with Julie Holland. I really enjoyed this. I like the way they did it and I especially liked the discussion about ‘hippies’ and whether we’re doing something wrong in the way we get the message out beyond this ‘microcosm of intense understanding’ about psychedelics. I’d been thinking about getting Julie’s book, Moody Bitches, but after spending a weekend connecting with some of the nicest people on the planet, I’m not sure I need to. The book’s central message is that our natural moods comprise a finely-tuned feedback system that should be paid attention to rather than medicated away. ‘Nuff said. The Ritalin’s gone back in the drawer. I’ve switched to decaf and am cutting down on the sleep aids. I feel really good. I googled ‘anti-inflammatory diet’ but it turns out I’m already doing it.
Finally, we had Rick Doblin’s update on the latest developments from MAPS. This was immense. I knew they are currently in between Phase 2 and 3 trials for MDMA-assisted psychotherapy, and that Phase 2 went so well they were able to apply for Breakthrough Therapy status, but it was great to hear about the process in more detail – and what we can do to help (donate!). I thought there are a couple of things MAPS are doing that are pure genius. One is the recruitment of a range of participants – from war veterans and fire fighters to victims of sexual abuse – that ensures bi-partisan media support. Another is the utilisation of couples therapy – where one partner has PTSD – to promote empathy and strengthen relationships, boosting the support patients receive at home and increasing the likelihood of a successful outcome. Currently the US spends 17 billion dollars annually on disability benefit for war veterans, and the Phase 2 MDMA trial had a 66% rate of success, compared to 23% for 40 hours of non-assisted therapy. These are compelling results. I felt such a rush of optimism during and after Rick’s talk. This work really does have the potential to change the world for the better.
I should also mention that one of the nicest things about the whole conference was bumping into one of my colleagues from UAL on the first day and finding out that he had been one of the subjects in Robin Carhart-Harris’s clinical trial of psilocybin for treatment-resistant depression. When I first met him as a participant on the PG Cert he was at rock bottom, and I think he even associated me with that very rough point in his life, so I was one of the last people he expected to see at Breaking Convention. Like most of the participants, he responded really well to the therapy and is no longer depressed. We got to hang out quite a bit and went to a lot of the sessions together, which was awesome.
Funnily enough, I was back at Greenwich today at another conference; this one was about the future of higher education (from a digital-technological perspective rather than a psychopharmacological one). I was googling things as I was going along (I like to check certain things as I write), and some of what I wanted to look at was getting blocked. I spent a while sending applications through for various pages to be reclassified under the topic ‘health’ rather than the forbidden category ‘illegal drugs’ – I wrote a little rationale which I copied and pasted – and just got an email through now to say that the pages had been reclassified. Small steps!
The feeling of immense love I got from Breaking Convention is still lingering. I feel the need to mention that personally the only psychoactive tools I used all weekend were a couple of iced coffees, three glasses of white wine and a few deep breaths. The conference was, in itself, a truly psychedelic experience.