“Legal in the books, short of electroshock therapy,” Lori, 40, says with a dark laugh. For more than 10 years, the russet-headed New Orleans–based mixologist, who asked to have her last name withheld, had tried to quell waves of depression, acute anxiety, and a raw fight-or-flight response. “I’d been on antidepressants and anti-anxiety medication. I’d seen psychiatrists, psychologists, social workers. I’ve seen internists, dietitians, endocrinologists.” She takes a breath. “I’d actually gone to see a witch doctor. I’d been to physical therapy, acupuncture, massage therapy. I had…a Rolfer. I became a certified yoga teacher. I went on meditation retreats.”
But nothing managed to bandage the lingering wounds of trauma. “I could flip out in a second,” she remembers, her nerves like a fuse on the bundle of lit dynamite tattooed on the inside of her left wrist. “People would make fun of me because they’d say, ‘Oh, Lori will jump out of her skin.’ ” The bottom would drop out on her mood for seemingly no reason, but she’d chalk it up to her personality. Sometimes, a certain touch or feeling would trigger her during sexual situations, and she’d literally scramble out of bed and flee the room. She’d race through her day, mixing up delicately balanced old-fashioneds at the Ace Hotel bar, all while battling her startle response with every clink of the glass. Back at home with her boyfriend and toddler son, she’d sit exhausted, depressed, numb. “I was just like, ‘This is who I am.’ ” And that’s the narrative she continued to accept.
In the fall of 2017, she was anxiously scrolling through Instagram one night and saw a post that mentioned a research trial recruiting participants who were experiencing some of her symptoms. The intervention incorporated an illicit method but also an incredibly revolutionary one: the psychedelic drug MDMA.
Conducted by MAPS, the Multidisciplinary Association for Psychedelic Studies, the study aimed to determine whether administering the hallucinogenic drug MDMA—what participants routinely call “medicine”—during psychotherapy could successfully relieve post-traumatic stress disorder and its attendant battery of symptoms. “I really didn’t equate it to my life,” Lori says she remembers thinking when she first considered PTSD as a possible cause of her difficulties. “I thought of it as something that soldiers had. My image was a shell-shocked veteran.”
With increasing numbers of Iraq and Afghanistan war vets struggling with the disorder, PTSD has become inextricably corded to that image and, inevitably, to men. But the inadvertent gendering can be misleading. In the general population, women are twice as likely as men to develop PTSD. Lori felt she couldn’t possibly have been suffering enough to qualify, especially in a place like New Orleans. “They’re gonna get thousands [of applicants],” she recalls thinking. “The air is PTSD.” Still, she emailed study researchers, describing some of her history.
Born in New Orleans, Lori saw her parents split before she hit high school. Her mom had bipolar disorder, so childhood felt “very unpredictable.” Her brother struggled too; the chronic lack of a calm home life left him battling a drug addiction. When she was 20, he fatally overdosed on pills in her home. Six years later, about a month before Hurricane Katrina made landfall, her mother murdered two people and then killed herself, a consequence of her mental health issues and a love triangle that spiraled out of control. “I was the one who discovered their bodies,” Lori ticks the detail off with a clean tone that seems to communicate, How else would you like me to describe the indescribable? It was, she continues, “horrific.”
Then the storm. “Here was a collective sense of grief and trauma,” Lori says of the 2005 hurricane. “It overshadowed my ability to deal with what had happened to me.” So the cumulative effects of these traumas went unaddressed. And in the chaos and disorientation that was reigning over New Orleans, Lori was raped by someone she considered a friend. During the attack, Lori says, “I remember I just froze. That’s the only response I had.” So an arduous decade elapsed, marked at turns by all of her attempts to find relief. In December 2017, MAPS clinicians administered a battery of psychometric tests, and she was diagnosed with PTSD. A month later, she joined the study.
MDMA—also known by its street names Molly, Ecstasy, or “E”—is a psychedelic drug first developed in 1912 as a potential drug to control bleeding. When that effort failed, the substance drifted out of awareness until it was rediscovered by the military and tested as an interrogation tool. When ingested, it can create intense sensory experiences—Technicolor landscapes, for instance, or a fish-eye lens perspective. Someone once saw visions of pretty girls with butterflies on their eyelashes. Another person kept seeing images of men with horse heads.
It’s also known to induce a deep sense of peace and well-being, creating, in particular, an openness to confronting painful memories and emotions because it reduces the intensity of fear. It’s a potential aid to breakthroughs in treating psychic injuries due to sexual assault, abuse, and other trauma. This therapeutic possibility caught the eye of psychologists and, by the 1970s, the idea that MDMA might assist psychotherapy began to filter through the culture. Some thought the combination could lead to a “neuro-consciousness revolution.” But the rise of raves in the 1980s—and ravers’ hunger for MDMA—gave the substance a “party drug” rep. Against the backdrop of the war on drugs, the Drug Enforcement Administration declared an emergency ban in 1985 and placed it on the list of Schedule I drugs, a group of substances deemed to carry a high potential for abuse with no accepted medical use. It cemented a taboo that has eased only in the past few years and cut off any potential for serious research until the late ’90s, when MAPS first began its work.
“I’ve always been, on some level, a high-functioning person,” says Karen Diamond, 62, a brunette with kind green eyes and a no-nonsense delivery. She lives outside of Boulder, Colorado, where MAPS conducted another, earlier trial. “But there are so many things I’ve lost out on because of how PTSD and repeated traumas have held me back.” Raised in a small Connecticut town by a drug-addicted single mother, Karen spent her early childhood looking for connection that remained elusive.
She remembers her mother nodding off in a chair in their apartment, high on a cocktail of heroin and LSD, oblivious while 5-year-old Karen was repeatedly molested by upstairs neighbors. By the time she was 12, she’d lost both her parents to suicide. She was shuffled from one foster home to another, where more sexual trauma occurred. Ultimately, she dropped out of high school and fled to Virginia Beach to live with a friend and her mother. “I always did have this feeling that basic things that people take for granted—waking up, brushing your teeth, making your bed—I had to really fight to, like, keep all that together,” Karen says. She underwent decades of therapy, trying different antidepressants, but never really found a solution.
When Karen started the trial in 2015, she received three sessions of MDMA-assisted psychotherapy over the course of three months. The MDMA used in the study is 100 percent pure—unlike street versions—and participants tend to stay fairly present in their bodies and retain their sense of self. For her first session, Karen chose to lie down on a couch with blankets. Some trial participants prefer an eye mask and headphones with a combination of tribal and classical music playing. Participants take one dose of MDMA at the beginning of the six to eight hours they spend with therapists, and there’s an option to take another half dose after several hours. Then, you can “go in,” as they say.
Karen wrote a letter to her friends and family, documenting how she felt after her first experience.
What they say about the process is all true. It’s like doing years of therapy in one day. It’s not scary, I never felt out of control, and I didn’t feel high.… I did have these metaphorical visions in my mind and I’ve decided I like calling them “self-metaphors.”… If I started to see something I did not want to look at, I could and did easily move away from it. For me, that was the sexual abuse and I will be revisiting that for sure. The great thing is I was able to take the principles that I’ve intellectually known after decades of therapy and make a huge guttural connection.… Fucking amazing. The core of that for me, my main story, is that I’ve felt broken and unworthy. But I now know I’m whole and worthy.… A beautiful bud on a strong stem, some outer leaves crushed and bruised, but still able to bloom.
The following day, participants have an intense 90-minute therapy session in which they integrate the experience. “When you have an experience in an altered state, it can remain just as that. It’s not a part of [the participant’s] everyday life,” says Marcela Ot’alora, the study’s principal investigator in Boulder. “When they say, ‘These are the insights I got, these are the feelings I had in the session,’ and you allow that to really sit in the body, and you start exploring what that really feels like and how that relates to their life now, a change begins to happen. Finally, acceptance.” Ot’alora describes that session as a kind edge that demarcates the experiences of the past from “the possibility of what can be.” Participants remain in close contact with therapists in the weeks between sessions as they continue to process their experience.
When Karen finished the program, her PTSD score was a 3, down from 99 (participants need a minimum score of 50 to meet inclusion criteria). After a prolonged physical illness—coupled with the current political climate—she recently experienced a setback in her progress and began ketamine-assisted psychotherapy with Ot’alora, who serves as her private therapist now. Ketamine, a gentle anesthetic commonly used on children that has been shown to produce psychedelic effects, is an approved drug prescribed off-label to treat depression. In the absence of access to MDMA, the psychedelic-curious have turned to ketamine clinics and physicians willing to prescribe the drug for their symptoms.
A year and a half after her participation, Lori sums up the trajectory of her work in therapy as such: “Before, it would be my therapist saying, ‘Let’s just keep you alive.’ Now it’s like, ‘Let’s talk about your career.’ ” As the co–executive director of the Psychedelic Society New Orleans, Lori raises awareness around the use of psychedelics as well as their possible legalization, which could arrive in the not-too-distant future. In August 2017, MDMA received “breakthrough therapy designation” from the FDA, a signal that the agency acknowledges the treatment may have a meaningful advantage over available medications for PTSD, which could speed up the approval process. As the final phase of MAPS trials enrolls participants across 14 sites, the potential for legalization grows. If approved, the drug could be available by 2021.
This marks a cultural shift between the past and the possibility of what will be. “I think right now, with the political climate we’re in, a lot of women have suffered sexual assault. But now all of that’s coming to the forefront,” Lori says with an air of hope. “We’re starting to talk about and recognize our trauma and how it affected us…and I think these types of therapies are radical.”