By now, it has already been established that MDMA is a promising treatment for post-traumatic stress disorder (PTSD). In August 2017, the U.S. Food and Drug Administration (FDA) granted it "breakthrough therapy" status, accelerating its approval to be prescribed. In randomized clinical trials of Doubleblind, MDMA has been consistent in healing veterans' trauma when traditional treatments failed. This therapy alleviated their nightmares, allowed them to move around the world without debilitating flashbacks, and ultimately brought them back to life. But will it also work for all the other people in our society who need healing? And if so, will those people have access to it?
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A large-scale study, conducted in 2011 by researchers at the Harvard School of Public Health, found that 8.7% of African Americans experience PTSD at some point in their lives, compared with 7% of non-Latinx whites. And yet, according to a review by Monnica Williams (Ph.D., clinical director of the Behavioral Wellness Clinic), more than 80% of participants in psychedelic therapy trials since 1993 have been white.
This neglect is not a problem unique to the psychedelic community. Williams tells us that there is currently no protocol for treating ethnic-based trauma in the U.S. In addition, he does not believe that the federal government has any desire to grant researchers the funds to develop it. MDMA could play a key role in circumventing this problem, as it can be a tool for people who have suffered racial trauma to heal independently.
However, there are unique challenges to conducting MDMA research among people of color and those suffering from racial trauma. Williams was leading the first trial of its kind at the University of Connecticut when it was canceled. Still, she is totally dedicated to continuing it. It is scheduled to return to operation at its private clinic this year, and other researchers in the U.S. are following suit in their own locations. We chatted with Williams about why he has committed to diversifying the psychedelic field and the challenges that will come.
I wanted to start by talking about racialized stress and trauma Can you tell me a little bit about your work in this area and what racial trauma looks like for an individual?
It's basically when people have symptoms of PTSD as a result of racism.
I was reading that African Americans have a much higher rate of PTSD than white Americans, but the rate of African Americans seeking treatment for PTSD is lower. Can you talk about why that is?
There are several reasons. First, mental health care isn't really part of our (African-American) culture, so people tend not to get that care unless it's absolutely necessary, as a last resort. At that moment you go because you are "really crazy", that is the perception. It's just not something people do, especially the older generation. And then if they do, they keep it a secret so no one knows and that continues to keep it somewhat stigmatized.
The other reason is that when African Americans (and I think this probably applies to all people of color) decide to do therapy, it's often hard for them to find a therapist from their own ethnic group or culture. We know that the entire field of mental health care is mostly white, so people end up seeing white therapists, at least initially.
Then what happens when they see the therapist blancx is that they often experience microaggressions, small acts of racism on the part of the therapist. And if one of the things that's traumatizing you is racism, well, the last thing you want is to experience more racism coming from your therapist. That's very, very harmful. Therefore, people leave therapy and may never come back. They may continue to suffer from something that is very treatable for years or even their entire lives because of that experience.
How do you think MDMA-assisted therapy can help marginalized people with racial trauma?
Unlike rape trauma or combat, where we have a long history of being able to help through traditional psychotherapy, there is no golden rule or empirically validated treatment manual to help people with racial trauma. And frankly, it doesn't seem like the National Institutes of Health has any interest in funding the research that that treatment manual would give us. Therefore, therapists who help people with racial trauma are taking part in other therapies to work with them.
But I think with MDMA therapy we can overcome a lot of those protocol-specific issues, because with MDMA and therapist support people are healing themselves. That said, it is still very important that the therapist has a basic level of competence when treating people of color suffering from racial trauma with MDMA. This is because, again, you definitely don't want them to commit an act of racism against their patient when they are in such a vulnerable state, under the influence of MDMA.
Why do you think there is so little diversity in psychedelic studies?
Well, there are two problems. One is that psychedelic drugs are seen by many communities of color as a 'white thing'. In addition, people of color are not really included in psychedelic communities, so there is no positive knowledge or vibe about these substances within communities of color.
The other problem is that the researchers who are doing this work are almost all white and the research teams are almost all white. So, they don't attract people of color, because those people look at researchers and say "researchers aren't like me, so they may not understand my problems."
What can researchers do to change this?
The most important thing is to diversify your research team and say, "Well, what communities do we serve in our geographic area? Do we have people who represent those communities on our team as therapists and leaders?"
I know maps [the Multidisciplinary Association for Psychedelic Studies] asked you to help them make your research more enjoyable for people of color. Is there anything that has changed about the research itself?
We've addressed a lot of small things that could have a big impact on people seeking help. For example, in the African-American community, there is a long history of investigative abuses, so only the word 'inquiry' in the African-American community can be uncomfortable. So if you don't need to say the word "research" 500 times on the consent form, don't. With once at the top reaches. Also, the word 'research' is sometimes used as a synonym for 'research study' and that can be very scary for Hispanic American participants who associate that with things like being researched and deported. Why use traumatic language if it's not necessary?
I would like to know more about your research. Were you running a trial to administer MDMA-assisted psychotherapy to people of color? Is that correct?
Yes, that's right. We were doing that work at the University of Connecticut Health Center and it was very exciting. We had a whole team, all people of color, and we were treating and enrolling people of color. It was quite remarkable, it had never been done before.
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What happened? Not still open?
Unfortunately we are no longer doing that work. First of all, the study is very controversial and the university was very nervous about working with psychedelics. So, they imposed a lot of restrictions and requirements, and they asked for ridiculously extreme safety protocols, things the FDA didn't even ask for. This made the study very heavy.
But the biggest problem, too, was that they required us to use their psychiatrists. The psychiatrist we were given didn't have the skills or knowledge to do the job. It was too much for him and he broke away so we didn't have a psychiatrist, and you can't run the study without a psychiatrist. We weren't allowed to use an externx professional even though we had someone on our team who was a psychiatrist at NYU and was fantastically qualified. They were afraid that something would go wrong.
That's very disappointing. Are there plans to do something similar elsewhere? What do you think the future holds for this research?
Unfortunately, things didn't work out at all so I could do this research at the University of Connecticut. They were too inflexible and were not interested in working with me cooperatively. I encounter this a lot, being a black woman. They called meetings about our project at the highest levels and didn't let me know. They didn't invite me to meetings, and presumably they solved some of these issues that I drew their attention to. But they couldn't really solve the problems because they never gave me a voice.
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I'm so sorry to hear that. So does that mean there are no plans to do this kind of work?
We're going to do an expanded off-campus access site at my private clinic in Connecticut. That site will prioritize and target people of color, so that's coming soon. There are actually a few other places that also want to do this expanded access work with a focus on people of color. There are a couple of people in the Bay Area, in Oakland, who want to focus on marginalized people. And I have a colleague in Michigan who is looking to start an expanded access site. So this is starting to catch on, and I really hope it will, because it's so necessary.
** In a statement, a spokesperson for the University of Connecticut Health Center said, "As an academic medical center, patient safety is our highest priority, especially in experimental clinical trials. The clinical trial was suspended for several reasons, but the psychiatrist's experience was not one of them. Last year, the Department of Psychiatry and Dr. Williams decided to separate and she no longer holds a position in that department. The Department of Psychiatry works diligently to welcome all individuals as well as to foster faculty to help them achieve success, whether in clinical, research or teaching efforts."