Psychedelic Therapy and Dissociation: Challenges and Opportunities
Worldwide there is an ever increasing awareness and presence of the coming wave of psychedelic therapy. As of 2017, almost half of adults in the U.S. supported a psychedelic substance being made legal for medical use in all or most cases. Now in 2021 it is likely those numbers are much higher. There is growing legislation and various statewide measures to decriminalize drugs as is the case in Oregon. Many cities have also opted to decriminalize drugs.
This is all great news on many levels. Most people know that our current mental health system is broken. If current methods are working, why are the numbers of people with depression and anxiety increasing? Bottom line - current approaches are not working. This creates an imperfect storm of excitement over the promise of psychedelic therapy. This storm also has its pitfalls.
Psychedelic therapy is not a one size fits all fix for all of humankind's woes and illnesses. People are complex and those of us with trauma can have an entangled labyrinth of sexual abuse, physical abuse, emotional abuse and neglect. What adds to the complexity are many factors - how old was the person when it happened, was it from a close relative or primary caregiver, was it one time versus multiple events, were there other perpetrators? The earlier the abuse - the more complex the trauma. The expectation that a model that utilizes a one size fits all, non-directive approach with the notion that the insight gained during the psychedelic therapy session will “heal” the person is misguided, naive and inaccurate.
The great variable in all of this and the most misunderstood aspect of mental health is the unknown danger of the levels of dissociation that someone is walking around with. What happens when a psychedelic meets dissociation? I found out the hard way...
First of all - what is dissociation?
Most people walking around today have some level of dissociation tucked away in their system. A few things to better understand in this are primary and secondary consciousness. We operate on a daily basis utilizing secondary consciousness. Secondary consciousness allows us to drive a car, pay our mortgage, figure out dinner, etc. What controls our daily life from a subconscious level is primary consciousness - and this is where trauma lives along with its ally, dissociation.
Dissociation is a biological and evolutionary response to trauma. We all know of fight or flight, some people go further with fight/flight or freeze. The fight/flight response is a normal biological reaction to stress or threat. If someone is following us then chasing us with a knife we go into fight/flight mode. Our bodies are pumped full of adrenaline, our hearts race, our minds process very quickly, breathing becomes more rapid. It’s an intense biological response designed to help us survive.
If the threat becomes too intense or frightening and we cannot escape we become overwhelmed and drop into freeze or dissociation. Studies have shown that the freeze effect is when our bodies pump out naturally occurring opioids to numb us out. Dissociation shuts down our nervous system (conscious awareness of what is happening), while our body continues to record the abuse. Many survivors of sexual abuse or an assault will have a memory of seeing the abuse from above - or knowing something is happening but they are “not there.” They are removed from their body in order to survive the traumatic ordeal. The challenge is that the trauma lives on underneath the lid of dissociation. In the animal kingdom, animals who experience a threatening event and then escape, discharge the traumatic energy in a series of autonomic grunts, kicking of legs, convulsing and thrashing about. We humans stuff it all down. We keep it at bay, we distract. Netflix, sex, food, drugs, achieving, meditation, yoga, work, shopping, running, etc. The irony is our bodies want to process trauma - and we, unknowingly, keep it tucked away.
Our bodies, through millions of years of evolution have hardwired to process trauma. Your body is wired to process trauma - just like your body wants to stay at 98.6 degrees and move food through the digestive tract and then on out. Our challenge is secondary consciousness (mind) gets busy so that we do not have to feel the pain that is held. Our culture is a non-feeling culture, we are a feel-good culture. Feeling something? Take something to feel better! Distract yourself - stay happy, stay centered, take deep breaths, do yoga. Just don’t feel. But, our bodies want to feel…
Anxiety and depression and many PTSD symptoms are their body’s way of slowly leaking out the effects of trauma. You can think of it as off-gassing. If we imagine all of our trauma and its symptoms trapped in a balloon and we are just squeezing the top opening of the balloon to slooowly let the air out - it comes out in an annoying and slow squeal or squeak. If you are feeling anxious you are off-gassing trauma, feeling depressed - trauma… Triggered by your partner? Your body will see this as an opportunity to move out some of the held charge of trauma. Again, all our bodies want to do and are wired to do is process trauma. And when there is a lot of dissociation, the amount of held trauma/charge can be huge.
If a young child has repeated episodes of sexual abuse where they go dissociative during each of those events, the charge and effects of those events live on under the lid of dissociation. It’s important to understand that a young child has likely no possibility of fighting off a perpetrator. Their only avenue for defense is a defense of going blank - or dissociative. To check out, to mentally escape the horror that is taking place to them. To leave their body. To focus on the TV. To think about something, anything, else. Meanwhile that horror gets tucked away and lives on within them - affecting all aspects of their life, more and more as the years and decades go on. Again, the challenge is our dissociated experiences continue to be held within the body. And we spend our lives trying to manage and cope with that held traumatic charge that just wants to come out.
What makes this all more fascinating, and troubling, is what happens to infants and children under 7 who have yet to form secondary consciousness - the maker of meaning, rationalization and understanding to help frame events. If we experience trauma prior to being able to put meaning, words or understanding to what is happening, then that energy, the held charge, the physical sensations, and the emotions and feelings, are undefined, unformed. These early childhood traumatic events can be recorded in a way that does not make sense to secondary consciousness/mind.
Enter psychedelics into the world of someone with early childhood trauma and layers of dissociation. Two things can typically happen. One is rather benign - a person can have a non-response kind of experience. This is seen in studies, in ayahuasca circles, in underground MDMA sessions. Someone takes a psychedelic substance and they have minimal to no effect. It is something I have experienced on my own with MDMA and have witnessed countless times in psilocybin, MDMA and ayahuasca ceremonies. There’s that person who has no effect or may feel a little “high.” Traditionally, we tell that person to “trust the medicine - you get what you are ready for.” What can actually be happening is the person is dissociative or during the “come on” of the medicine their system became overwhelmed and did what it likely normally does when something gets overwhelming - flood the body with endogenous opioids. If a psychedelic meets a large dose of endogenous opioids the opioids will overpower the psychedelic.
The other more insidious and dangerous response when a psychedelic meets dissociation, which can be extremely overwhelming and hellish, is a bad trip. To clarify, this is not just encountering a challenging experience. Again, held traumatic charge lives under the lid of dissociation. If that lid is cracked open or, worse yet fully opened, the flood of held charge/emotions that comes out can be horrific - a deluge of nightmarish imagery and feelings. As we all know, psychedelic substances amplify the user's experience. If under the influence of psilocybin you take a bite of an orange, it will be the best orange you ever tasted. Listening to the Beatles is like hearing angels sing from the heavens. On the other end of the spectrum, if the held charge/energy of trauma comes out - especially if it is early childhood trauma that does not have standard “meaning” to it, the results can be pure horror/terror/confusion - the feeling of going insane. As someone who has experienced this with ayahuasca and psilocybin it is unfathomably awful - and retraumatizing since the trauma is not processed. One just ends up in a hellish loop with no resolution.
I suffered for a year after a three night ayahuasca experience. For a solid year with a month off in the middle I would go into spontaneous “sessions” in which it felt like I was being ripped in two. These sessions could last from a few minutes up to eight hours. It was horrendous. I became suicidal from the hellish torment of the sessions. In hindsight what I now know is that the trauma/held charge that was tightly contained under my dissociation got cracked open during the ayahuasca ceremony. Unknown at the time of my ayahuasca journey, I later discovered I experienced a very intense and traumatic childbirth which created extreme dissociation. Additionally, I recently discovered early childhood sexual and phsyical abuse. The ayahuasca opened this up and my mind tried to put meaning on the energy that was held from that event - it made no sense and was amplified by mind. For a solid year I sought professional help from some of the leading experts in psychedelic therapy - their best advice, never do ayahuasca again. I know I’m not the only one who has gone through hellish realms post ceremony. I lost two friends to suicide after ayahuasca ceremonies. One person killed themselves after their first night of ceremony and the other 6 months after getting back from Peru. As I was working on this article I got a text from a therapist friend who had a friend commit suicide after several ayahuasca sessions. When a psychedelic meets dissociation all bets are off on the outcome for that person.
I had a similar experience when I was enrolled in an FDA study of psilocybin. Three escalating doses of pure psilocybin over three months. The study was researching the pharmacokinetic properties of psilocybin along with measuring adverse reactions to large doses of psilocybin. All three of my sessions were in hell realms - it was horrendous. And again, in hindsight I was looping in dissociation and the held charges from my birth trauma, physical abuse and sexual abuse.
There is a severe misconception in the world of psychedelic therapy around the phrase/idea, “there are no bad trips - only challenging experiences.” This is blatantly false. There are bad trips/bad experiences. There are casualties when it comes to psychedelic therapy. The biggest is the misinformation and misunderstanding around dissociation and how to work with it. Also, the phrase, “trust the medicine,” needs to be reconsidered in how it is used. Again, when it comes to a person with dissociation, it’s a gamble as to who will have a positive experience and who will encounter hell realms. The gamble is higher risk with C-PTSD.
There needs to be not only a renaissance for psychedelic therapy - but more importantly we need to keep the body center stage when it comes to dealing with PTSD, anxiety, depression and any level of trauma. There’s a need for the body first when it comes to deep forms of therapy. Working from a biological/body perspective allows a client to process their held charge/emotions and trauma - before attempting to head out into transpersonal spaces.
A New Approach
At our therapy practice, OmTerra, we conduct a form of psychedelic therapy we have termed “Holistic Psychedelic Therapy.” Holistic Psychedelic Therapy is based on a body first perspective, followed by mind then spirit. At the very core of our being is our body - it's our foundation and anchor into the here and now. The body is also extremely misunderstood by many in its role in trauma, PTSD, anxiety and depression. Standard therapy and even psychedelic therapy has its primary focus on the mind - or transcending the mind. The challenge is the core of our anxiety, depression, PTSD, sexual abuse, etc. exists not primarily in our mind but our bodies. Our mind's role is primarily managing trauma, and its symptoms - and constantly suppressing what the body is trying to bring forward.
The bottom line is insight will never fully heal trauma. Insight is a modality of secondary consciousness. It is an aspect of healing trauma - but, it is not the core element that will bring about symptom resolution. We cannot think our way out of trauma. Until we release the held charge and emotions that stem from our traumatic events, we will continue to engage these events subconsciously on a daily basis. Anxiety and depression need to be seen as a biological attempt at releasing held charge/emotions versus a mental illness or condition. Someone who is experiencing anxiety/depression is having a natural and normal biological response. There is nothing wrong with them - other than the simple fact that they are trying to manage the unmanageable. Our culture and our lives are based on feeling good and suppressing feelings. Even things like yoga, exercise or meditation that are seen to be a positive force in working with the symptoms of trauma are actually halting the body’s need to process trauma - to have feelings and move them out. Once these held charges/emotions are moved out, overall reactivity can go down - less reactivity can mean less anxiety and depression.
One of the models we use is called Psychedelic Somatic Interactional Psychotherapy (PSIP). PSIP follows a lineage from Peter Levine’s early work that was further enhanced and deepened by Eric Wolterstorf, PhD and then Saj Razvi, LPC who introduced MDMA to Eric’s model during his work with MAPS as a clinical investigator. This model is focused on a methodology utilizing cannabis and a process called selective inhibition to activate the body's natural and innate ability to process trauma/held charge and emotions.
This model is excellent in working with dissociation. Most trauma models such as EMDR, neurofeedback and polyvagal therapy avoid working with trauma that is held in dissociative states. Most therapists will try to get someone out of dissociation if they go there during a therapy session. When working with someone with dissociation there needs to be a nuanced and paced approach to working with the dissociation. At OmTerra we incorporate a form of therapy called Internal Family Systems (IFS) to help facilitate the access to and through dissociation along with the PSIP model. Dissociation is a protective layer, it has kept someone safe for possibly decades - the challenge is the level of trauma that lives underneath the dissociation is in a constant hum of anxiety, depression and all the classic signs of PTSD. There does need to be a cautious approach to not just “rip the bandaid off” and overwhelm someone's system. There is also a need to allow for integration with the material, emotions and the knowledge of what happened. Until the material from one event is integrated it is not advised to work specifically at targeting dissociation. Slow and steady will allow someone to move through the dissociation and the potential mountain of repressed feelings and emotions that may be there. It is possible to find symptom resolution vs. symptom management.
Another driving factor with this model is a directive and interactional component. Standard psychedelic therapy relies on a person ingesting a psychedelic substance and then having an internal experience with the medicine - a non-directive approach. The challenge with the classic psychedelic therapy model is that held charge, emotions and trauma exists in primary consciousness at the age of when the events happened - primary consciousness has no sense of time. Today is no different than 40 years ago. Expecting a 40 year old who hits sexual abuse from age 3 and is experiencing what happened from a 3 year old mind and now to think they can work out their trauma through insight from a psychedelic is truly absurd. The other major point here with trauma is that trauma did not happen in a vacuum. Usually there is a perpetrator and the experience of the abused person/child is, “no one was there to help me, I was all alone.” At OmTerra we focus heavily on building a positive relationship with our clients and creating safe space that then allows us to be more interactional and directive with our clients. Once a person is activated and charge is moving we are more hands off and allowing the body to process their trauma.
Holistic Psychedelic Therapy follows the body's natural path of progression when processing trauma. By first allowing the body to biologically release the trauma we can then focus on the mind, then move to spirit, or transcendental spaces. It’s a pyramid with Body as the foundational element to the bottom of the pyramid that needs to be strong and in place before ascending up. When the body is allowed to naturally process what is being held it then allows us to work with mind and the constructs, habitual patterns and thinking that arose from managing years/decades of trauma and held charge. Once we have the body and mind secured and functional we can take people into transpersonal spaces for maximum benefit and effect. There is beauty in transcendence - but at OmTerra our philosophy is biology before psychology as we allow the innate ability of the body to prepare itself for life and a return to authentic self before exploring higher states of consciousness. Within this framework is a way into and through dissociation that can have positive and life lasting benefits for a client.