You could say that my marriage was on its last legs by the time I sent the article to my husband, but that gives the image of something somewhat upright. More accurate might be to say that it was on its knees or perhaps curled up in a tight ball, arms tightly held to its chest with snot dripping from its nose.
Whatever the metaphor, we were in bad shape. We had already said out loud the thing we had never said before in our marriage – that we believed it was over. We had gotten an apartment nearby to birdnest while we made the arrangements for a life apart, but every few days one of us would find ourselves wondering if there was still something out there that could help.
He had most recently posed trying yet another couples therapist, but I felt like we had exhausted the local circuit, especially since I knew many of them from my own professional work. I had been researching out-of-state options online and had found a New York-based therapist who offered “relationship coaching” over Zoom. She’d written a book that I loved, and so my hope was starting to percolate when I saw the $450 per hour price tag and defeatedly closed my browser.
I went to my notes app where I’d saved the link for the New York Times article I’d read a few days before. I copied it into a text message and said, “I know this might seem crazy, but what if we tried this? Maybe it’s worth a shot?”
The article was called “Can MDMA Save a Marriage?” and it described couples who were turning to the notorious drug popularly known as Molly or Ecstasy as a last resort in their relationships. The couples profiled in the article, all anonymous given the drug’s illegality, talked about the profound opening and softening effect it had for them. “It feels like everything that you’ve ever cared about or held onto that was getting stuck in your throat or making you anxious, just melts,” one husband had said. MDMA had given them a bridge out of their entrenched patterns, a way to talk about things with an empathy and understanding they hadn’t been able to find otherwise.
A psychedelic novice, I had been hearing whisperings about MDMA as a potential treatment for PTSD for a few years, though hadn’t yet dove into the research. I had also had patients with eating disorders who had turned to ketamine and psilocybin trials in recent years, traveling across the country to access universities and clinicians who were experimenting with these medicines. They had seemed like options of last resort, Hail Marys after years and sometimes decades of treatment that hadn’t touched the core of their suffering.
It seemed to me that my husband and I were in need of our own last resort, if we were to save our 13-year marriage. Our conversations had been following painful and predictable loops for years now, each ending with us feeling that the gulf between us had widened another inch. I was constantly wondering how two people who wanted so desperately to connect with one another kept getting stuck behind their own armor. I wasn’t convinced it would be a miracle drug, by any means, but if something could help us loosen the grip of the pattern, I was all in.
“I don’t think so,” he wrote back. I could hear his voice through the text bubble on screen and through the filter I’d constructed, it felt cold and emotionless. I felt like my outstretched hand had been batted away for the last time.
–
Nearly a year and half later, I was sitting in a spacious classroom in Fitchburg, Wisconsin, just a few miles outside of Madison. I pulled my notebook and a pen from my bag as I looked around at my classmates. We had come from all over the United States, as well as from Canada and the Caribbean, to the Usona Institute, a facility that had just opened weeks before as a premier research center for novel therapies. Novel therapies meant, in this case, psychedelics, and I learned that Usona was leading the investigation on psilocybin as a treatment for depression.
I noticed the interesting shape of the lights overhead, and the gray-bearded man sitting next to me could tell I was pondering them. “It’s the molecule for psilocybin,” he said, gesturing upwards.
“Oh, wow,” I remarked, genuinely impressed. He smiled broadly and introduced himself. He was a psychiatrist from northern California, he told me, in private practice mostly, but he also spent time teaching at the nearby medical school.
“It’s pretty wild to be here,” he said. “I didn’t think it would happen.”
“Yeah,” I responded with a nod. “Was your flight delayed too?”
“Oh, no!” he said with a hearty laugh. “Well, yeah, actually, it was. But I meant here as in seeing this renaissance happening. I’m one of the old-timers around here. I remember the first heyday of psychedelics, and then the crackdown. It’s crazy, really, to think it’s taken this long for this field to rediscover what a lot of us knew.”
By this point in my journey, I knew some of the history. I had learned about the early studies with psychedelics, reaching all the way back to the 1950s when the famed novelist Adolus Huxley drank mescaline he had dissolved in water in the presence of psychiatrist Humphrey Osmond. Osmond is credited with coining the term psychedelic, a word that combines the Greek for mind and manifesting. Osmond and his colleagues had become fascinated by LSD, a substance that they believed could help people with alcoholism stop drinking. Their research trials seemed to prove just that, though many of the studies lacked scientific rigor. But by 1965, over 40,000 patients had been prescribed LSD therapy and the results of over 1000 research papers seemed to show enormous promise.
As the scientific community was gaining excitement about LSD, so too was the recreational community. The 1960s saw a surge in recreational use, and the drug became associated with much of the anti-war and anti-government student activity around the U.S. By 1968, the federal government had made it illegal, and clinicians and researchers were forced to end their investigations.
MDMA, I learned, had seen a similar fate. While it was first developed back in 1912, it wasn’t until the 1960s that its psychoactive effects were noted. Users of the molecule and the clinical community observed that taking it produced heightened feelings of empathy, connection, and openness, and they started to consider how these experiences might be translated to long-lasting positive effects. The 1970s and early 1980s saw clinicians and researchers experimenting with MDMA to help patients resolve long-standing psychological burdens, as well as awaken pathways to spiritual connection. But as had happened with its psychedelic cousins, MDMA began being known more for its use in clubs than therapy rooms, and by 1985 it was classified as a Schedule One substance by the U.S. government, effectively outlawing it.
Now sitting in a gorgeous research institute almost forty years later, I could understand my new colleague’s wonderment. The world had seemed to reawaken to the potential for psychedelics in recent years, even while major regulatory hurdles remained.
We settled into our seats as our trainers, therapist-researchers from the MAPS, the Multidisciplinary Association for Psychedelic Studies, began to lecture. “What you are going to see and learn over the next few days is going to change how you look at healing for a long time,” one of them told us. It was a bold statement, and there was a part of me that did an internal eye-roll at the assuredness with which she said it.
But a few days later, as I packed up my suitcase to head back to Ohio, I realized what she had said had been an understatement. What I’d learned would change how I practiced – and who I was – forever.
–
The MAPS trainers at Usona hailed from a range of different cities and practice settings, but I couldn’t help but notice that none were from east of the Mississippi. And while there were a couple of students there from New York, I was alone in being from the Midwest. I wondered exactly how far behind the rest of the country we were in understanding these medicines.
The resurgence of interest in psychedelics as treatment had begun as early as the 1990s, with ketamine catching the attention of scientists for its stunning antidepressant effects. Back then, Dr. John Krystal, now head of psychiatry at Yale, had sort of stumbled upon the idea of using ketamine to treat severe depression. He hypothesized that at the right dose, ketamine would facilitate glutamate in the brain, a neurotransmitter that helps neurons talk to one another, as well as promotes learning and regulates anxiety. He was right, and soon researchers all over the world were replicating and extending his research.
Meanwhile, researchers were also conducting studies with what we call classical psychedelics, substances different from ketamine in that they were more naturally occurring, like psilocybin and LSD. These researchers were also working to understand just how these medicines had such profound effects, not just on one’s perception for a few hours, but on longer-term mental health outcomes. Studies were demonstrating significant improvement in patients treated with psychedelics on not just depressive symptoms, but also anxiety, existential angst, and trauma-symptoms. Beyond emotional disturbances, researchers were also finding benefit of using them with patients with chronic pain, dementia, migraines, and recent strokes.
My own training at Usona on MDMA was focused specifically on treating PTSD, the condition for which MAPS was seeking FDA approval. After decades of advocacy and research, there was a palpable excitement in the room as the researchers talked about the upcoming FDA review. I knew enough to know that approval was far from a slam dunk, but it was hard to reconcile that with the data I was seeing and the sessions I was watching.
In particular, my colleagues and I watched video recordings of sessions with a woman I’ll call Meera. Meera had been part of the Phase 3 Clinical Trial for MDMA, seeking help from the PTSD symptoms she had experienced for the last several years after witnessing the death of her husband in a traumatic accident. Like almost all of the participants in these trials, and like most who come to seek psychedelic therapy, Meera had tried everything available to her to ease the absolute agony she continued to feel and that impaired her ability to care for her young daughter.
We spent days watching the many hours of Meera’s MDMA sessions, and from the very beginning I could tell how different this felt than all of the other PTSD treatment approaches I’d learned before. This wasn’t just about Meera rehashing the trauma or trying to think about it in more useful or rational ways. Far from it. Under the influence of the medicine, Meera was invited to be with the experiences she had had in a profoundly different way. The psychedelic experience meant that Meera had the ability to tolerate going to some of the most painful memories she held, and to do so from a place of understanding, new perspective, and new learning. The goal wasn’t to minimize what had happened, but to widen Meera’s capacity for holding it. There was a moment in her sessions where she felt a connection to her deceased husband and to her grieving self in a profoundly new way, and even watching a video recording of it years after the fact, I felt utterly moved.
This capacity for holding trauma differently and uprooting it at the source is the theory being examined by some of the leading researchers in MDMA and other psychedelics. Gul Dolen is a researcher now at UC Berkeley who has been studying the “critical period” theory of psychedelics. Critical periods are windows of time in which the brain is especially malleable for certain learning – such as the critical period for learning language. If we don’t learn a new language during that sponge-like time in childhood, it’s difficult or impossible to do so later. The same is true for lots of human functions – like walking or building emotional attachment.
Dolen’s theory, which is at this point widely accepted, is that psychedelics open those critical periods and allow new learning. Whereas we previously believed that a trauma that happened was essentially stuck in the mind and body, the promise of psychedelics is that they give us a way to reopen the learning that happened in the trauma – ways to update and heal beliefs such as that we’ll always be alone or that everything is our fault.
Rachel Yehuda, a renowned professor of psychiatry and neuroscience at Mount Sinai and a leader in the VA system, also supports this theory. Her work, which includes nothing short of over 500 published papers, examines how we are changed not only by the traumas we directly experience, but by intergenerational traumas. She looks at epigenetics, which is the way our genes actually change in response to stresses and traumas and then are passed down in these altered states. Yehuda’s work has been demonstrating how psychedelics can help people exposed to trauma not only heal themselves, but protect and heal future generations through epigenetics.
Back at Usona, we watch a video interview of Meera years after her treatment with MDMA. She is describing how vastly different her life is today, no longer shackled by the flashbacks and hopelessness of PTSD. Meera’s face is bright and hopeful, and at one point, her daughter shows up on camera. She looks affectionately at the girl she is raising, and the love between them is palpable. I can’t help but think of how lucky they both are for this healing.
–
I’m lying on my back on a padded mat, my head resting on a firm pillow. I notice my fingers first – no discernable sensation, just the awareness of their presence and a sense that they are mine. This awareness creeps slowly to the palms of my hands and then to the soft mound of my belly where they are resting, which I’m now noticing is rising and falling with waves of air. I’m coming back into myself now, my conscious mind settling back into my physical body.
The music, full of synthetic tones and surreal movement, is still playing through the speakers, but I no longer feel part of it. I can sense my separateness from it now, and I notice a brief sadness at this realization. I consider whether to take my eye mask off and let the rush of the world in. One more moment, I decide. I remind myself that there is no urgency here, that there may be more for me to gather.
After another couple of minutes, I start to hear others around me shifting and moving. I lift the dark mask from my eyes and let them slowly open, the wideness of the room filling my field of vision. There are people standing and stretching, while others still lie motionless on their own mats. Still others sit together speaking in whispers across the room.
I’m back in the expansive conference room of the retreat center, back among the couple dozen clinicians I’ve joined for these several days to deepen our ketamine knowledge. We’re here among the redwood trees, in a place that seems almost psychedelic, mind-manifesting, itself in its design and its connection to the natural world.
I’ve just finished the second of my two ketamine journeys here. The first, a couple days prior, had been difficult for me, and so I’d felt so apprehension going into this second journey. I’d heard of ego dissolution happening with psychedelics, of course. It was what some thought was the whole point (though I disagree). But my first journey here had felt not like dissolution, but like evisceration. For the forty minutes or so that I was in the psychedelic space, it was as if the internal structures that held up my sense of who I was had been washed away. I was in unknown territory, forced to be a curious explorer, unable to rely on what I thought I could hold as truth.
I had spent a lot of time after the first experience trying to integrate it, a process that’s vital in psychedelic-assisted therapies. Without integration, these experiences could feel overwhelming in a way that’s untethered and disorienting. Integrating the experience with a trusted therapist or guide is part of what differentiates it from just being an interesting or even harmful recreational trip. I had gotten to download the experience with my peer group at the training, and with Lauren, a highly experienced psychedelic therapist and trainer. What resulted were a series of realizations that existed not just in the informational part of my brain, but deep in my core self.
Still, I had felt some anxiety going into this next journey. Childbirth had also been a transformative experience, but I wasn’t signing up to do it again a couple days later. I had sat with the question of whether to do it, though, having been given full support to opt in or out, and I had decided to lean in. There was something about being among the 1200-year-old redwoods that whispered to me, We’ve weathered some storms. You can too.
Now on the other side of this second journey and coming back into my consciousness, my eyes began welling with tears. This journey had been different, not full of the disorientingly colorful psychedelic landscapes of my last one, but instead a more grounding experience. It wasn’t the imagery that had stood out, but instead a deep sense of connection.
A few hours before my ketamine experience, I had gotten a text message that my very old Jewish grandmother had died that morning. I had actually never met her, as I’d been raised apart from that side of my family. In fact, I’d been told that she was selfish and not very nice, that I was better off not knowing her. In recent years, though, I’d had the longing to meet her, at least once, if only to see if I could see myself in the lines on her face. It was one of those things that I had in my mind to do, but never made it past the more pressing demands on life. Now, she was gone, and I’d wrestled with a strange grief that morning about losing a part of me that I never got to know.
I hadn’t gone into my ketamine journey this afternoon with any conscious intention around this, but as psychedelics are wont to do, it pulled hard on this thread when I let my unconscious mind go free. In my journey, my grandmother wasn’t there as a discrete figure, but I knew her presence. I could sense it both inside and outside of me, and I let myself be awash with grief. It was grief for the person, but more so for the ways I had not let myself meet and get to know these parts of me, these parts that had come from her. Whether I’d met her or not, her DNA lived and breathed in me. This Jewish faith, this self-protectiveness likely masked as selfishness, this fear. I hadn’t ever experienced the things that she had, but they existed within me. You could call it epigenetics or whatever you wanted, but they were there. I could see that now.
As I was coming more and more back into myself in the large conference room, starting to journal what I was noticing, the trainer, Lauren, said softly to the group, “I’d like to share with you a song from my own faith practice. I hope that will be alright.” She began to sing in a low tone, a Hebrew song of blessing. I didn’t understand a word of what she was saying, but I didn’t need to. It was familiar, and I loved it deeply.
–
At first I tried to resist the urge to bring psychedelics into my practice. I have plenty on my plate, I thought, I don’t need to be learning something new. I also wondered how my colleagues here in the Midwest, not exactly known for being early adopters of innovation, might see this. But it felt a bit like how physicians must have felt when they discovered antibiotics. It felt impossible to know that something was out there that could offer such healing, that could turn what we know – or think we know – on its head, and not shout it from the rooftops.
So I started incorporating Ketamine-Assisted Psychotherapy into my practice this year, currently the only legal psychedelic in the U.S. outside of Oregon and a few other municipalities. Ketamine lends itself really beautifully to therapy in many cases, in fact, which is why it’s taken off in recent years. Its half-life is also short, which means the active effects are reasonably timed – usually around 45 minutes – unlike the three to eight hours that other psychedelics often last.
But the power of ketamine is not always, or at least not only, in the dissociative-type experience that it creates. Scientists have found that ketamine works on several different levels. On one level is, yes, the psychedelic experience. In that ketamine space, patients will often describe being able to disconnect enough – finally – from the automatic scripts that run through their brain constantly that they can see things from a different perspective. The insights that come from that experience can be transformative in some cases. I’ve had patients describe being able to feel self-compassion, for example, in a real and embodied way for the very first time.
But what may be even more significant for patients using ketamine is the rapid antidepressant effect, which researchers find can last for weeks to months. Even more exciting, from my perspective, is the neuroplastic window that opens up after a ketamine experience. Just as Gul Dolae and other neuroscientists describe, the ketamine compound helps to open up learning networks in the brain. What this means in therapy is that those seemingly intractable beliefs and feelings are suddenly much more flexible and able to be altered.
It must be said here too that ketamine is far from a panacea, despite all of the excitement currently buzzing in the psychiatric community. First, it’s not all rainbows on a psychedelic journey. People do have difficult experiences, and if not in the context of a safe and knowledgeable guide, that can be highly problematic. And while very few with ketamine, there are medical risks as well, which is why practices like monitoring blood pressure and being supervised is so imperative. But when this medicine is used safely and with deep care, it has the potential for a healing that many in the mental health community had long written off as impossible.
Experiencing that potential has certainly changed me. It’s made me both more excited for the freedom that can come when we shed old patterns, while also somehow more patient. For a long time after my ex-husband rejected my suggestion of trying psychedelics to heal our relationship, I added it to the file in my brain that was full of evidence that I was trying and he wasn’t. Doing my own work with these different psychedelic states has let that certainty dissolve. I can still find myself in that file at times, rummaging through old stories of what he did wrong, how he couldn’t see me, but I also see myself in that image now, the one hunched over the file, trying to protect my sense of self as good. I can go to her now, gently rub her back, close the file in front of her, and give her a hug.
I don’t know if you’d call it a spiritual perspective or a psychological one or something else entirely, but I trust that there was a reason we didn’t take that particular path at that particular time. There is a foundational principle in psychedelic therapy that the journey will be exactly what you need it to be, even if it takes time to integrate it. Maybe not taking MDMA to save our marriage was our journey. Maybe something else needed saving more.
But I can’t help but tell you my dream now, with the hope that sharing it will help it come further to life in its own time. I hope to be able to use these psychedelic medicines to help partners in relationship turmoil find their way back to each other. I’m actually especially interested in working with couples who have decided to or already have split and yet still need healing from anger or other pain that they hold toward each other. I want them to be able to see each other in their full humanity, to let go of the poison of resentment that blocks us from being fully human ourselves.
I’ve been starting to put that dream into action, and I’m excited to share more with you all about that soon. In the meantime, though, I’m continuing to soak up all of the knowledge and wisdom I can about these medicines. And, I’m relieved to say, I’m feeling so hopeful about the future of mental health.
