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Psychedelic Medicine for Healing

By Michael Sharp, MD

The neurobiology of anxiety is becoming understood. Turns out it is not all that complicated. Anxiety is our body’s way of telling us it feels endangered. Sometimes the trigger for that feeling is obscure—but it looks like an almost universally reliable way to understand the root causes of that most unsettling of all emotions.

Michael Sharp, MD

One way to begin to sort out the reasons for anxiety is to explore triggers. Triggers are cues to the nervous system that “conditions favor” something bad happening. The conditions are often ones similar to the conditions surrounding us when we felt unsafe in our past. Our bodies have an uncanny capacity to record and remember even the finest details of the circumstances surrounding trauma. That is, those frightening and/or painful experiences that activated the fight or flight response for survival, but without the capacity or help to do anything about it, we are prevented from fighting or fleeing. The survival energy is trapped in the nervous and limbic memory systems. This is what trauma is.

For many of us, the origins of the feelings of “not-safe” are in our childhood. No person I’ve ever met was perfectly parented, so there are in all of us some reasons to feel insecure. In some of us, however, there is a profound and deep seated “not-safe.”

The newer understanding of anxiety has to do with what we can imagine as our inner “trash compactor.” The idea is that the unsafe moments of our past, especially from childhood, where we felt small and vulnerable, were overwhelming and we don’t want to go there in our memory, so we stash them away. We put them in a box and try and throw away the key. But that box contains elemental parts of ourselves and these want expression. So they rumble around in there. Our natural survival instincts want protection from reminders of being hurt and overpowered, so we continue to push down and compact those contents. Sadly, our anxieties keep us from truly knowing our authentic selves.

The majority of medications used to treat anxiety work on the symphony of our neurotransmitters, trying to calm us down. By and large they don’t work all that well. Here’s why: our nervous system is wired to be hypervigilant when feeling unsafe, and medications designed to calm us down reduce the hypervigilance in such a way as to make the body feel like it is not adequately protecting itself. We don’t want anybody opening that box when we’re not looking.

So symptom reduction via medication is a poor band aid. What works? Opening the box, and allowing those contents to be seen, known, and befriended.

This is no small task. In general, the closer we get to the box, the more anxious we become, and the more our bodies want to go the other way. If you are like most of my patients you’ve read about the usefulness of psychedelic medications. These psychedelics change our minds in such a way that the box becomes softer and more easily opened. And if we are accompanied on the journey by a friendly and skilled other, whose calm and attentive presence makes it safe, we are helped to visit the locked-away contents of the box with compassion. True and profound healing can ensue.


Ketamine is the medication with psychedelic effects that is legal in North Carolina. It is commonly used as an intravenous infusion, with no attendant psychotherapy. This can provide effective relief, particularly in severe treatment resistant depression and suicidality, however relapse is common. The effect seems to be primarily pharmacologic, through a medicinal effect on the brain neurotransmitter symphony in a way that is different than virtually all other psychoactive medications—through a neuroreceptor called the NMDA receptor. An emerging use of ketamine places the use of the psychedelic experience in the context of a healing, therapeutic relationship. This model has been pioneered in research trials currently underway by MAPS (Multidisciplinary Association for Psychedelic Studies) exploring the treatment of PTSD with the use of another medication, MDMA. The MAPS process combines the MDMA and the presence of a skilled ‘flight attendant’ who helps the client carefully unpack their trash compactor.

In the MAPS MDMA trials, the results have been so favorable that the FDA has permitted the compassionate use of this treatment in situations where other medications have not been effective. Additionally, “fast track” status has been granted to the Phase III research trials because early positive results show promise for the many people with PTSD still suffering in spite of current best efforts.

Ketamine’s effect is similar to that of MDMA, and the MAPS process has been adapted for use with ketamine, which has a long and positive record of safe use. Many good clinical trials have proven its usefulness for depression and other mental health conditions. It is proving to be life changing for many individuals with complex illness rooted in the detrimental effect on wellbeing of the chronically hypervigilant nervous system. The MAPS results have shown that maximum long-term benefit of its use comes in the context of a therapeutic relationship with well trained, compassionate attendants who can assure the safe flight to visit and befriend the inner box.

To Your Health!