New Ways Forward, Old Ways Back
Health Effects of Violence and Trauma; Psychedelics may provide Therapeutic Relief
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Family violence and trauma exists in high volume in our society, although quietly behind doors, under the radar of many. Violence experienced by adults, and children, can resurface in ways throughout a victim’s lifetime, affecting healthy development, quality of life, and abilities to cope with the challenges of everyday life. Alcoholism, treatment resistant depression (TRD) and anxiety, and treatment resistant post-traumatic stress disorder (pTSD) are a few of the mood disorders associated with trauma. Chronic pain, hormone imbalances, adrenal fatigue, and neuro-pathologies such as dementia exist in junction with these health issues. New therapies are needed and are being explored to help provide relief that traditional, allopathic medicine has failed to. Exploring the long term effectiveness of psychedelic compounds is a newly re-emerging area of research that has given hope to the community of doctors and therapist attempting to provide relief to those suffering life long adversities due to the effects of trauma.
According to the article Intimate Partner Violence and incidence of Common Mental Disorder by de Mendonca , a study by WHO aimed to assess the prevalence of intimate partner violence, assess the victim’s outcomes of the violence, their coping mechanisms, and provide risk and prevention. She cites Gracia-Moreno et all 2006 for this information.
The study was conducted in 15 sites in 10 different countries in 2000 to 2003. It involved 24,097 women ages 15-49.
The study determined that 30 – 60 percent of women had experienced some type of intimate partner violence, with physical and sexual being the most prevalent. Of 31 victims, 42% of the victims had between 1-20 health care visits for physical injuries, and 29% for mental health. 64% believed their mental health issues were due to domestic violence. Long term health problems included musculoskeletal issues, pulmonary, dermatological, gastrointestinal, cardiovascular, neurological. Other mood disorders like anxiety, psychosis, substance abuse and depression were equally prevalent .The long term effects of experiencing trauma have been not only ignored, but complicated by ineffective drugs to treat depression, PTSD, addiction, and many psychologic disorders. Treatment resistant depression and post traumatic stress disorder have been the focus for doctors' research in therapy. This research has shed some light on tools such as EMDR, psychedelics, and other self care therapy like yoga and meditation.
In The Biology of Being Frazzled, Arnsten explains the initial functioning of the nervous system in the immediate impact of traumatic, acute, and uncontrollable stress. Arnsten explains that there is a systematic, cascading effect of various parts of the endocrine, and central nervous system that shut down after experiencing this type of unbearable stress. Neurobiology can begin to explain the cognitive changes in response to stress. Our body will protect itself by activating certain parts of the brain, like the amygdala, and deactivating others, the pre-frontal cortex. The amygdala, when activated, inhibits our main functional reasoning and we operate from our "animal brain", unable to self regulate emotions, make quantitative decisions, plan and assess. The prefrontal cortex is our thought processing and language power house. This area of the brain shuts down in periods of stress. This will be explained later with cerebral blood flow and the poly vagal theory.
“During stress, the amygdala also induces increased catecholamine release in the prefrontal cortex. However, in contrast to the facilitative actions in subcortical structures, high levels of catecholamine release in prefrontal cortex result(s) in cognitive dysfunction.” (Arnsten)
In the US, the FDA has approved funding for more research of psilocybin with larger groups of subjects f. In 2020, Oregon measure 109/110 passed, making our state the first to decriminalize and legalize mushrooms for therapeutic use. This will make psilocybin accessible; administering it in treatment facilities and decriminalizing mushroom possession. The legalization is not to the extent that marijuana has been, but it is a huge steppingstone in that direction. Tom Eckert, a chief petitioner on the measure, says “psilocybin could help people struggling with issues from depression to anxiety and addiction”, and “We need options. And this is a valid therapeutic option that could help thousands of people”. The bill calls for a 2-year period to conduct more research and develop a plan for regulating and administering therapy.
Need for Alternative Therapies
There is strong evidence that alternative therapies are not only helpful but are needed for treating depression and pTSD, both long-term effects of domestic violence. Lenart in Magic Mushrooms are the Future of Mental Health Care makes claims that psychedelics like psilocybin are showing significant therapeutic potential for all kinds of mental and psychiatric disorders, referencing the extensive research on the subject at Johns Hopkins University (Griffiths) and Imperial College of London (Carhart-Harris).
Lenart recognizes the potential risks and the changes to roles and responsibilities of nurses and doctors as psychedelics are medicalized. The nursing profession needs to respond with training and information to support their staff, preparing for the curiosity from the public on psilocybin as a legitimate form of therapy, as well as training nurses to be the attendees monitoring psychedelic therapy sessions. Lenart recalls the last 20 years of research that has been conducted by Roland Griffiths, Robin Carhart-Harris and others. The Canadian Health Care system is paving the way for psilocybin into psychotherapy, which include psychedelic assisted therapy as alternative treatments for pTSD, anxiety, depression and addiction. Griffiths and Carhart-Harris are two of the most influential and published researchers on psilocybin, with extensive studies involving fMRI scanning. They have made huge progress, making mushrooms a powerful adjunct to traditional therapy.
Lenart points out that indigenous cultures around the world have used mushrooms and other naturally occurring psychedelics for centuries. The main goals and affects are “profoundly altered consciousness”. In a therapeutic session, patients expressed feeling emotions of love, joy, oneness and of transcending space and time. T
This altered state of consciousness allows the safe and introspective acceptance of past traumatic memories to emerge from the subconscious and be more fully processed. This may assist in a reset of the mind, allowing people experiencing debilitating mental disorders like treatment-resistant depression and pTSD; to process and adapt to reality, heal from past trauma, and avoid self-medicating. This type of advanced in treatment of mental disorders hopefully help avoid a lifetime of anti-depressant medications that don’t always have consistent results.
Psychedelic integration may help "reset" cerebral blood flow
Image (b) represents increased communication between brain networks. Left is placebo, right is after 1 psilocybin treatment (Imperial College of London, based on clinical trials by Carhart-Harris).
“When we ignore these quintessential dimensions of humanity, we are depriving people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self. Given the limitations of drugs, I started to wonder if we could find more natural ways to help people deal with their post-traumatic responses” (Van der Kolk p.38).
Dorsal Vagal Complex/ Poly Vagal Theory
The scans in Van der Kolk’s research suggest that the stored memories of traumatized people are recalled as if the event is taking place, activating the fight or flight response, and releasing hormones like cortisol, adrenaline and other stress hormones. His studies suggest that people who have been traumatized, from events such as abuse and accidents, take much longer to regulate these hormones, and return to baseline, while disproportionately spike much quicker response to mildly stressful situations. This cascade of stress hormones essentially keeps a person in a state of fight or flight, effecting sleep, memory, attention, irritability and many other long term health issues.
The opposite to fight or flight, yet equally as disabling response to trauma is activation of the dorsal vagal complex. P. 84 of The Body Keeps the Score describes the function of the ventral vagal complex (VVC) as our social engagement, and allows us to signal for help, alarming the body for action. During fight or flight, the sympathetic nervous system (SNS) activates, and we express rage or terror. During collapse, if there is no way out of an inevitably dangerous situation, we collapse and shut down, the dorsal vagal complex nerve is activated (DVC).
Poly Vagal Theory by Stephen W. Porges is a remarkable set of research and ideas on the complexities and branches of the vagus nerve. Darwin was the first to describe the reflexes that involve action, or withdrawal from a threat are controlled by a "pneumogastric nerve" (Van der Kolk p.83) . Darwin describes this nerve as the center of registering heartbreak and gut wrenching feelings. This brings me to a chapter in Heart a History where cardiologist Sandeep Juhar describes this event of dorsal vagal complex activation and its effects on the heart, causing a condition called Takutsubo cardiomyopathy, or broken heart syndrome. In this condition, the heart changes shape, almost weeping into the shape of a Japanese water jug (rounded at the bottom) loosing tone. People can spontaneously recover from Takutsubo syndrome, or it can be fatal.
The Evidence...
Robin Carhart-Harris is an author, researcher and psychiatrist that has designed an extensive study on the cerebral effects of the brain on psilocybin.
Carhart-Harris' research on psilocybin shows support and promise worldwide as a treatment model, but the therapeutic mechanisms are poorly understood. She measured cerebral blood flow (CBF), blood oxygen level dependent, resting-state functional connectivity (BOLD/RSFC) in 19 patients diagnosed with treatment resistant depression (TRD). "Whole brain analyses revealed post-treatment decreases in CBF of the temporal cortex, including the amygdala. Decreased amygdala CBF correlated with reduced depressive symptoms"(Carhart-Harris).
Included in this research is the recognition that psilocybin along with psychological treatment has the potential to be effective long term treatment for a variety of disorders including end-of-life anxiety and depression, alcohol and tobacco addiction, obsessive compulsive disorder, and pTSD. All of these life altering disorders and the long term health effects are directly related to violence and trauma, and most of the subjects studied in this and other studies were those that have had some adverse life events, like intimate partner violence and trauma.
In The Poly Vagal Theory, Poges conducted a study of a group of women that had experienced violence and struggled with pTSD years later. The subjects were healthy, and self reporting (this is a limitaiton to the study) as experiencing depression and other disorders. The Vagal brake is a mechanism in our brain that helps control the activation/deactivation of the ventral or dorsal vagal complex, and those with a history of trauma showed a slowing to be either excited (increased heart rate during exercise) as well as relaxing (recovering from exercise/ decreased heart rate). His subjects self reporting abuse and trauma all showed decline in the "vagal brake" for the sympathetic nervous system. This provides evidence that mental and physical trauma effects the way we interact to the stresses of everyday challenges, and how efficiently we react. The physiology of our nervous system and brain functioning is altered by trauma, and the level at which we are able to self regulate changes.
“During a time when there has been little improvement in the effectiveness of medication targeting anxiety and depression- despite the billions invested in research- psychedelics could be the answer psychiatry has been looking for” (Lenart)
There are many highly regarded authors on the effects of trauma on the body and mind. In The Body Keeps The Score, Van Der Kolk ties together the intense effects of trauma, PTSD, abuse, and touches on the subject of using psychedelics as therapeutic intervention. Van Der Kolk focuses on stepping beyond traditional psychological therapies and medications, into exploring tools and techniques to help create lasting improvement in behavior and quality of life. He encourages taking back your self awareness and self responsibility to change a traumatic memory into just a memory that happened long ago.
When Van Der Kolk was a medical student, he worked with a doctor that had treated Holocaust survivors with LSD. Although his study was lacking details and support to his claims, it supposedly was highly successful in treating PTSD and traumatic memories. Then, not until 2000, Michael Hoefer, a clinical researcher and psychotherapist, began research with ecstasy (MDMA methlenedioxy-methamphetamine). He mentions a study conducted that used MDMA, with permission from the FDA. Bessel mentions that there are still so many questions and need of research to understand how MDMA works. But it is known to increase the production of oxytocin, vasopressin, cortisol, and prolactin. Regarding treatment for trauma related disorders, MDMA reduces fear, increases feelings of love, and acceptance. It increases a sense of self awareness, curiosity, clarity, confidence and creativity. This is a monumental tool for taking back control and self-awareness.
These new ideas and research are evidence that there is hope for people experiencing trauma, and to the possible alternative therapies and ways to create healing and change.
“When we ignore these quintessential dimensions of humanity, we are depriving people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self. Given the limitations of drugs, I started to wonder if we could find more natural ways to help people deal with their post-traumatic responses” (Van der Kolk p.38).
Reports show when a patient has a flashback of a past traumatic incident, the brain activity shifts to the right side, and shuts down on the left. The two halves communicate and coordinate to a certain degree yet having one side completely take over is disabling. The left side of the brain is responsible for language, sequential details and memories, facts, statistics… more logical processes. Without the ability to organize and recall event accurately, we can’t identify cause and effect, grasp long term effects of our actions, or create coherent plans for the future.
The left-brain controls Broca’s area, which is responsible for speech; this area goes completely offline during a traumatic flashback. This is relative to the article “The Biology of Being Frazzled”. Arnsten explains how catecholamines, neuromodulators, are released into the peripheral and central nervous system. This “turns on” our heart and muscles, preparing for fight or flight, and “turns off” stomach and other organs in preparation for an event. Catecholamines are responsible for activation of the amygdala, and impairing function of the prefrontal cortex (PFC). The PFC guides our behavior, permits our working memory, inhibits inappropriate behavior and allows us to plan and organize effectively.
“Traumatic brain injury is a frequent sequela of domestic violence, from which many victims sustain multiple injuries without seeking medical care. Brain injuries are often sustained over many years and lead to lasting physical, behavioral, and cognitive consequences. Better understanding of these injuries will lead to improved care for this population” (Zeiman)
Light at the end of the Tunnel
The effects of family and intimate partner violence bear a heavy burden on our society, one that is often and easily overlooked and under considered. In traditional therapy, the cognitive process of analyzing one's position in reality, and being able to distinct that from a feared past reality, dilutes traditional talk therapy's effectiveness.
Parts of the brain are actually not able to process reality, because of mechanisms like the dorsal vagal complex, adrenaline, and subconscious memories ridicule the physiology of awareness, causing a cloudy sense of reality.
Finding new ways to reduce the intense arousal mechanisms that are implanted after adverse child events, intimate partner violence and the effects of violence are highly needed and research has only just re-emerged into science. Credible authors and researchers such as Carhart-Harris and Roland Griffiths are building new platforms, creating hope, and providing some light at the end of a tunnel that so many are trapped inside. Many alternative therapies (EMDR, movement therapy, mind mapping) are in practice, yet psilocybin and other psychedelic therapies show a higher rate of consistent effectiveness in treating long term treatment resistant mental disorders linked to violence and trauma...treatment resistant depression (TRD), pTSD, and addiction.
Reintegration of cerebral blood flow (CBF) and brain functioning, acceptance and ability to process with conscious thought, self awareness on a global level to help find purpose and connectivity. Psilocybin and other psychedelic therapies may provide a sense of oneness, love and peace... these are only parts of the light, to help those suffering from trauma.
Additional Media
In this radio interview, I was shocked to hear a 35 min interview, highly organized and which hit every topic of my research. Georgia Public Broadcasting/ On Second Thought, reporter Virginia Prescott interviewed Dr. Broadie Dunlop and Will Stone. Dunlop is the director of Mood and Anxieties Program at Emory University, and Will Stone is an independent health journalist. This interview is clearly focused and creates very close links to treatment resistant depression (TRD) and PTSD, and the developing use of psychedelics as successful treatment. One particular subject had struggled with treatment resistant PTSD, and followed a 3 month/ 1x/month session of MDMA in conjunction with traditional talk therapy. Dunlop correlates his research as MDMA being specifically effective for pTSD, and psilocybin applied to depression as well as pTSD. They describe psilocybin as being a deeper experience, one more complex in length and intensity, and it holding a wider breadth of possible psychological applications.
“I just see so many patients who get stuck," Dunlop explained. "and they do their best in therapy, they do their best with medicines, and we still cant get to where we need to be. So, I think this is very exciting" (Dunlop)
Below is a link to the interview in December 2019.
GRB Interview onPTSD/Depression and Psilocybin
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