On the drive to Charleston, South Carolina, to meet with the Mithoefers for the first time, Nigel admits his imagination went “really rampant.” The mental picture didn’t bode well. He had fantasies of walking into a hospital, where psychiatrists in white coats were doing clinical trials with psychedelics.
Fortunately, the reality didn’t match his fears. He arrived in the residential neighbourhood of Mount Pleasant, in Charleston. The office was located in a house on a tree-lined street. At first he wondered if he’d come to the right place.
Annie met him at the reception area. She was both “welcoming and kind.” Michael’s office was a cosy space downstairs. Nigel liked Michael right away. “He had a good energy about him,” he said.
Before going into psychiatry in 1991, Michael—now Senior Medical Director for Medical Affairs, Training and Supervision at MAPS Public Benefit Corporation—was an emergency medical physician. After he’d spent a decade treating patients in emergency rooms with physical trauma, he changed careers, and did a psychiatric residency. He treated patients with PTSD in an outpatient clinical practice, emphasizing experiential methods of psychotherapy. He is a Grof-certified Holotropic Breathwork Facilitator and is trained in EMDR (Eye Movement Desensitization and Reprocessing) and Internal Family Systems Therapy.
I asked why he changed careers.
“Part of it was scheduling,” he said. “The hours were much better, and I could get away.” The Mithoefer’s children were in their teens by then, and they liked to go on extended family trips. ER schedules didn’t permit much of that.
Partly, however, Michael changed careers because he could see that the problems he confronted in the ER began long before the gunshot wound, the drug overdose, or the attempted suicide.
“In the ER, I sensed I was getting the tail end of emotional problems: shootings, stabbings, heart attacks, people not taking care of themselves. Part of it was wondering what could be done further upstream.”
As a conventionally trained psychiatrist, Michael treated emotional trauma survivors for several years using the available therapy of the day–SSRIs plus psychotherapy plus an anxiolytic and often sleeping medication. All too often, the treatment regimen failed. Up to half of patients had no long-term improvement in their symptoms. In any other field of endeavour, this would be a poor showing. Many PTSD patients whose symptoms are severe enough to impair daily life, and warrant long-term treatment, experience dissociative disorder: the emotional equivalent of fleeing the scene so that the experience doesn’t hurt. Revisiting the scenario or series of events during conventional talk therapy causes many people with PTSD to feel retraumatized. PTSD sufferers are not able “just to talk” about what happened to them when they feel this way. They’re in a time warp wherein the experience recurs, along with all the accompanying fear, shock and horror.
There was another reason Michael was drawn to psychiatry: he was interested in states-of-consciousness research. As a student in the 1960s, he’d experimented with psychedelics. He knew even then the experience was not trivial. LSD introduced him to a different cognitive universe. He recognized—to paraphrase the words of psychiatrist Dr Stanislav Grof—the healing potential of non-ordinary states of consciousness.
Long before Michael did his psychiatry residency, he’d read about Grof and his LSD work.
Between 1967 and 1973, Grof, a Czech-born psychiatrist, was Chief of Psychiatric Research for the Spring Grove Experiment at the Spring Grove Clinic in Catonsville, Maryland. The experiment, sponsored by the National Institute of Mental Health, initially explored psychedelic drugs as potential treatment for schizophrenia. A few years on, the Spring Grove Clinic was rebuilt into the Maryland Psychiatric Research Center, where, along with Grof, clinicians Bill Richards and Walter Pahnke pioneered the use of LSD to treat patients suffering from alcoholism, heroin addiction, various neuroses, as well as the depression, anxiety and existential distress common among terminally ill cancer patients.
By the time Michael completed his psychiatric residency, LSD had been banned. Michael understood fully he was going to have to find another means of helping patients reach a broadened and deepened emotional state. He’d heard about Grof’s Holotropic Breathwork technique, which Grof developed once LSD was outlawed. The technique is based on the belief that many non-ordinary states of mind can be accessed without drugs using controlled breathing. There are several spiritual and yogic practices that use the breath to augment consciousness: Pranayama, in the practice of Iyengar yoga, to name one. Michael recognized from his years of working with PTSD patients that healing from trauma involves all parts of the brain as well as the body, from the rational mind down to the so-called lizard brain – the limbic system – the brain region associated with emotional response and the autonomic nervous system, which controls unconscious bodily functions such as heart rate, digestion and respiration.
When Michael announced he was going to California to do the Breathwork training, Annie, who by that time was working as a receptionist in the office, was very sceptical.
“I was really afraid of him going to the training,” she said, “that he was going to California, it sounded pretty strange what he was going to be doing.” Annie herself was doing a lot of informal therapy work by then.
“I spoke to people a lot on the phone, patients if they called, if they needed to talk to someone,” she said.
“She thought I was getting kidnapped by a cult, basically,” quipped Michael. “Only later, she joined the cult.”
Annie herself is now a Certified Breathwork Facilitator. She and Michael ran groups together before they became involved in their MDMA work.
From what he was reading and hearing, MDMA appeared to be a breakthrough drug for therapeutic treatment of PTSD. Treating patients who were not getting any relief with existing therapy made Michael feel he had an obligation to enter the research world.
“I was increasingly dissatisfied. There were a lot of people we couldn’t help. I felt it was unethical to continue to practice psychiatry and not explore other treatments.” He added: “I was a clinician first. Research came later.” Michael claims he “fell into being a researcher inadvertently,” because he could not adequately treat PTSD patients using the limited tools available to him at the time.
In 2000, Michael began collaborating with MAPS on the first US Phase 2 clinical trial of MDMA-assisted psychotherapy. With the assistance of MDMA, it became possible for PTSD sufferers to revisit horrific memories without shutting down or dissociating or fleeing the room.
“In the therapeutic space, they revisit the trauma in a way that contradicts their sense of helplessness and powerlessness. It’s not just revisiting the traumatic experiences. It’s a process of affirming a different experience on all levels, including in the body,” Michael said.
Therapeutically, MDMA helps “create a situation of emotional flexibility,” said Michael. “Patients are able to get out of their emotional rut.”
The Mithoefers spent about an hour explaining the sessions and the treatment process to Nigel and let him know what to expect. The first order of business was a series of medical appointments, a neurologist then next, a cardiologist. Then lab work—essentially the same medical protocol I underwent before the psilocybin trial in Baltimore.
The next day, Nigel returned to the office to meet with the Mithoefers, who gave him the results of his medical screening. All was well, medically, and he was accepted into the study. They spent a few hours talking about his experiences, and about what in the end he wanted to achieve with MDMA therapy.
Although he felt a natural rapport with the Mithoefers, Nigel felt he was just going through the motions. For him, in some ways, it felt like a meaningless exercise. The conversations did give him the opportunity to recount what he was going through, but Nigel was highly doubtful the treatment would work.
“I was sceptical of everything. I was pretty paranoid,” he said. “I was suspicious about the motives of researchers. I didn’t trust anybody at all.” Nigel’s paranoia made it difficult for him to speak openly. “That was always the problem with therapy for me,” said Nigel. “My paranoia was always just under the surface. I could never open up deeply.” Mostly, he’d engage in only the most superficial and guarded dialog.
The Mithoefers seemed confident he would overcome the difficulties he described, even though Nigel was doubtful it would all work out.
Nigel spent the next few months weaning off the Bupropion. He drove to Charleston twice monthly to speak with the Mithoefers about his Iraq experiences. The study paid for his drive from Greenville to Charleston, as well his hotel and meals. He would not have been able to afford to participate had those costs had not been underwritten. A sense of the Mithoefer’s generosity and commitment helped him go through with it and set the tone for the talking therapy. Nigel felt the Mithoefers actually cared about his healing more than anyone he’d come across.
During sessions, they’d discuss how things were going. And each time, without exception, they’d asked: “Have you had thoughts of wanting to kill yourself or going to sleep and not wanting to wake up?” They worked on directing his focus toward what he wanted to achieve during the sessions and encouraged him to wrap his mind around the totality of the trauma his sessions would be addressing. They worked on focusing him so that the sessions would be optimal. He was encouraged to ask questions. He always wanted to know what to expect. In the end, there were no unknowns—other than what the experience itself was going to be like.
Nigel’s first MDMA session took place in May 2012—the same month I had my first psilocybin session, a few states and five hundred-plus miles to the north, in Baltimore, Maryland.
The study was designed as a placebo/low dose control study. Participants received a blinded dose either of a placebo or a low dose of MDMA (0 mg to 40 mg) or an active dose of MDMA (75 to 125 mg). The initial dose was followed after an hour with an optional supplemental dose equal to half the initial dose. The MDMA was administered during two to three eight-hour psychotherapy sessions spaced three to five weeks apart.
Fifty participants who received an active initial or second dose could go on to have a third session with a full dose. Control groups had the option of receiving two to three open-label sessions with an active dose of MDMA. Nigel received active but mid-range doses (75 mg) for both his first and second sessions (dosages were unblinded after the first two sessions). He was then able to have a third, full-dose (125 mg) session.
Nigel arrived at the office in Charleston feeling strange about not knowing how much MDMA he would be taking, and what his response would be. There were other things that felt wonky. He’d been so worried about being late to his session, he was speeding on the way down. He was pulled over and ticketed. The traffic stop rattled him. That day, he recalled, he was still very guarded and paranoid, and still feeling hopeless. But he was willing to try it and see what would happen.
Nigel was given the medication at 9:30 in the morning. He lay down on the sofa with earphones and the eye mask. Both Michael and Annie Mithoefer were there.
About 45 minutes into the session, Michael nudged him and asked him to talk about what was going on. Was he was feeling the medication? What was going on inside. He sat up, feeling a little wobbly at first. He had some visual distortions. The air looked watery. He felt relaxed but awake and alert. He could tell he’d received an active dosage.
He put the eye mask back on. The music blended into the background. There was a jazzy track with a bass. Something about the song bothered him—or rather something the song was bringing up bothered him. He described the feeling as “scarring.” He told the Mithoefer’s the music was awful and asked them to shut it off. They suggested he breathe into it and see where he could go with it. Wherever that was, he found it extremely uncomfortable.
Unlike my experience with psilocybin, Nigel does not have a distinct, narrative memory of his MDMA sessions. He remembers them clearly as waves of feelings, moving from one to another. As-good-as-real progressions of occurrences—like my psilocybin journey—were not part of it. There were a few images connected to the feelings and to the music. Nigel remained connected to what Roland Griffiths refers to as “consensual reality” throughout. My psilocybin sessions gave me something else entirely: I was carried down someone else’s river, in a dugout canoe of someone else’s fashioning. I didn’t get to choose. I had to trust the current, and ride along.
During that first session, Nigel had one a profound realization. He described having spent years feeling as though his life was a tangled web of frustration. His mind was folding in on itself. He was frustrated and angry all the time. He could not explain what was going on, other than a gnarly internal conflict. He described “little tendrils all tied up together, each one an aspect of what he was struggling with that created its own problems and its own interferences.” He meditated on it. He began to visualize it: “a tangled web of neuroses tied together.” He’d been caught in them for years and years. In the state of consciousness aided by the MDMA, he found himself up in the air looking down on the tendrils. He could see the entire terrain for once, the “forest for the trees.” The most significant change for him was moving from an internal personal, gnarled mass of feelings to an awareness which allowed him to become more detached. “I moved from inside to outside,” he said. He became liberated from the knot. Something shifted. “I had an overarching awareness of what PTSD was. It was not inside me, a desert of mental illness without map, without a compass.”
He thought about one part of his service where he felt at peace.
After his return from Iraq, Nigel’s unit was sent to Twentynine Palms, California for three weeks to train for desert warfare. Although by then, he was awaiting discharge, his commanding officers decided there was no reason to keep him from training.
“I guess they figured if I kept on as though I were still part of the unit, training to go back to Iraq, they’d force me to redeploy to Iraq,” he said.
He’d been reassigned to a machine gun unit—a kind of demotion, a step down from leading a mortar section.
Nigel was assigned to fireguard duty at an outpost in the middle of the desert. He’d begun to meditate there. He enjoyed having an hour or two of peace, with the empty beauty of the California desert in front of him.
He recalled how he felt in the fireguard hut during his MDMA session. He began to be able to recall who he was before he went to Iraq.
“I saw who my core personality was. I wanted it back.”
Since Iraq, he’d lost any sense of compassion for himself. His greatest hurdle was the death of two little girls.
He’d struggled with self-hatred for years because of that event. He viewed himself as a monster. Rationally, in soldier’s terms, he knew he’d done what any soldier would have done: he’d protected himself and the platoon from what he perceived as an imminent threat.
Being able to experience the feelings safely helped change his perspective. It also allowed him to begin to have compassion for himself in way he hadn’t in years. Over the course of that first session, he was able to forgive himself for what had happened to those girls. A weight lifted.
The session ended at about 4:30. He felt drained, “but I felt a kind of lightness as well.” He ate dinner, and then fell asleep at about 7. It was, he said, the best he’d he slept in years. The sleep problems he’d suffered from for years vanished.
A few months later, during Nigel’s third MDMA session when he received the full 125 mg dose, a real emotional breakthrough occurred. Although he’d been cooperative in sessions, and to the extent he was able, shared his thoughts and feelings with the Mithoefers, he still reflexively guarded his words. In therapy, this created a huge stumbling block. With the stronger dose, he was able to let go a bit more.
During that session, music played a role.
“Music played huge part during the deployment. It was how the guys connected with home, their culture, their past. Everyone had a music collection.” They’d listen to music out on patrols. Most of the collections had a lot of heavy, aggressive metal music, with a lot of anger and intensity. “Lets-go-out-and-start-some-shit music.”
The sound track for the MDMA sessions was all “positive and encouraging,” varied but kind of sweet. During the high-dose session, Nigel asked the Mithoefers to play a track from the industrial metal band “Ministry.” It was unlike any of the music tracks they used for sessions.
“Michael and Annie couldn’t figure it out,” said Nigel. But he insisted.
The Ministry tracks reminded Nigel of the brutal harshness of the Iraq war. “It was symbolic for what was going on inside,” he said.
Nigel listened to a few Ministry tracks. It didn’t take long. After a few minutes, he knew he’d arrived where he needed to be emotionally. The feelings emerged:
“Hatred towards people I was with, hatred toward people in Iraq. Hatred I’d had for myself, hating having to feel good about it.” He couldn’t stand when people thanked him for doing service when he felt like “a piece of shit.”
For twenty minutes, he focussed on his feelings, breathing into them, paying attention to what was happening inside.
Within a few minutes, the hatred dissipated. He stopped running from his Iraq experiences. He just embraced whatever was going on. He thought about the guys he’d served with who got killed, and how senseless their death was. He really couldn’t stand what had happened. The Mithoefers encouraged him to focus on the pain, letting him know they were there for support. They asked him to consider how all the people who had died would feel now, and what they would want him to be doing. How would they want him to be living in the world? Would they want him to be overcome with grief, or or enjoying life as much as he could?
“I realized then I should be focused on living versus dying,” said Nigel. “I think I’d been dying. I felt guilty about living because they couldn’t. I understood that not dealing with the situation was not making anybody happy. I wasn’t doing what the people who had been killed would want me to be doing. And I think that was sort of left off,” he said. “The relationship with the guys who were killed was put to rest, on some level.”
Now, he said, years on, he feels righteous anger rather than hatred. I asked what kind of music he liked to listen to nowadays.
“I’m not stuck on listening to angry music anymore. I’d still always listened to metal and angry music up til that point. It seemed like a way of maintaining a connection to Iraq.” After that session, Nigel said, he had “no desire to listen to it anymore.” Now he listens to “everything, really. Jazz. Classic rock.” He likes Emancipator, a violinist and DJ based in Portland, where Nigel himself now lives. Nigel said he listens to music less, and plays more. He learned to play the violin at the age of four using the Suzuki method. He switched to the guitar at 13. Now he’s enjoying playing his own music. He improvises and he makes up songs on the fly. He’s found since the MDMA sessions he’s more creative. Music, he said, serves “no purpose other than it just feels really good getting it out,”—a way to express feelings and emotions that don’t take verbal form.
The year following Nigel’s MDMA therapy was difficult. He had just started grad school at Firman University. He was managing biochemistry lab. His supervising professor expected a lot of him. Lots of emotions came up for him during that time. “Really intense feelings, out of nowhere.”
“I couldn’t control the process. I had to be patient with it. I was very busy, but I got good at allowing myself a few hours to let the emotions come up.” Nigel said he can’t recall any period of his life when he cried more than he did that year. Lots of emotional events he’d been unable to process because he’d been too “walled up” began to surface, feelings not just from the Marines, but situations before and since the war. Most importantly, he’d begun to be able to untangle different kinds of emotions. This experience is universal among PTSD sufferers: the profoundly difficult task of discerning—emotionally, on the feelings level—the difference between present and past. Now, following the MDMA sessions, Nigel knew the difference between feelings and events that had happened then, and what was happening now. What had happened in Iraq no longer defined him.
There was another facet of his experience he felt was important, something he’d spoken about with the Mithoefers: the spiritual side of warfare.
Shortly before he took part in the MDMA study, Nigel read a book by Edward Tick, War and the Soul, which described what takes place spiritually when a soldier goes to war and returns. “Ancient cultures brought soldiers back with rituals. They had a way for soldiers to process the experience. The US has none of this.”
Nigel read the book right before he went to see the Mithoefers for the first time. They’d just spoken to Edward Tick themselves. Nigel viewed this as a good a sign, of “everything resonating, coming together.”