Full text of consultant psychiatrist Ben Sessa’s talk: Is MDMA psychiatry’s antibiotic? at TEDxUniversityofBristol conference.
Listen to the MP3 Audio here:
Ben Sessa – Consultant psychiatrist
Now you’ve probably heard of this compound in the context of the recreational drug Ecstasy.
But today I want to talk about MDMA, not as a recreational drug, but as a potential new treatment in medicine, and then a very important treatment for psychiatry, because MDMA could offer us, in psychiatry, for the first time, the opportunity to tackle trauma.
And psychological trauma, particularly that caused by child abuse and maltreatment, is at the heart of all or most psychiatric disorders due to anxiety and addictions.
Psychiatry is in need of this innovative approach because current treatments are failing patients.
Hi, my name’s Ben Sessa. I’m a child and adolescent psychiatrist. Now that means I trained as a medical doctor, then specialized in mental health, and then specialized in child and adolescent mental health.
But for the last five years, I’ve been working with adults with mental health disorders and addictions due to misuse of drugs. And that developmental pathway of my own, from working with child abuse into adults with mental disorders and addictions, has brought me to the door of MDMA.
And I’m going to propose today that MDMA could be important for the future of psychiatry as the discovery of antibiotics was for general medicine a hundred years ago.
So when we think about child abuse, we think about physical abuse, mental abuse, emotional abuse, sexual abuse, and neglect. And we think about noxious environments, we think about parents with mental disorders, we think about parents who are addicted to drugs, and social issues like poverty, and poor housing, poor education.
Now I’m going to illustrate my talk today with a patient, and I’m going to call her Claire.
Now, Claire was no single particular patient of mine. Rather, she’s an amalgamation of many different people I’ve met in the last 18 years working as a medical doctor. She’s certainly not the worst.
Now, what was Claire’s environment like as she was growing up?
Well, her mother was depressed. Now unfortunately, the family doctor didn’t have time to accurately diagnose and treat depression. Rather, Claire’s mother was put onto one antidepressant after another, never really got therapy.
Claire’s mother also had a lot of aches and pains, typical of what we call psychosomatic symptoms in depression, and, as a result, the family doctor put her onto opiate-based painkillers which she promptly became addicted to.
Now, Claire’s father, he was alcoholic, and he was often not around, in and out of prison, which is just as well because when he was there, he was physically abusive to Claire and her mother.
Okay. So what does this kind of chaotic, frightening environment do to the developing child brain?
I’m going to give you a brief neurophysiology lesson, if I may. There’s a part of the brain called the amygdala. Now, the amygdala is a very ancient part of the mammalian brain, and many other animals, other than humans, have an amygdala.
The amygdala lights up when stimulated by fear in the environment, by a frightening stimulus. It lights up and it says, “Fight or flight, get out!”
Now, there’s another part of the brain, a much more sophisticated part, called the prefrontal cortex, and it’s right here, at the front, above the eyes.
Now, the prefrontal cortex, only humans have, and it’s in the prefrontal cortex where we use logic and reasoning to rationalize the situation, and we can use our prefrontal cortex to overcome that instinctive fear response from the amygdala.
Now, when Claire was growing up, she never knew, from one moment to the next, whether the adult coming into the room, were they going to give her a kiss, or a cuddle, or do a jigsaw with her, or were they going to punch her, or kick her, or burn her with their cigarette.
Or were they going to rape her. Because, throughout her childhood, Claire was also subjected to sexual abuse.
Now, there’s a group of disorders called the anxiety disorders, and one of the most important is what we call posttraumatic stress disorder, or PTSD.
Now, PTSD, some of the core features: very low mood, anxiety, high levels of anxiety, what we call hypervigilance – this edginess, this jumpiness. Exactly how Claire felt, throughout her childhood and adolescence, never knowing whether the next assailant or assaulter was around the corner.
Another core feature of PTSD, what we call re-experiencing phenomena, flashbacks, in which the patient has sudden remembrances of these painful traumatic memories. They can just pop into the head at any time, triggered by some cue in the environment.
And when they have those experiences, those daytime flashbacks, they relive the trauma in all the sensory modalities, and this results in them freezing or dissociating to try and block out the pain.