‘Stuff starts to get real, real quick,’ recalls former US Marine, Tyler Flanigan. An Iraqi sniper had just shot out the tyres of his truck and a key member of his team had been killed. ‘We were sitting ducks.’ ‘I couldn’t easily name a single day in Iraq that I wasn’t shot at or didn’t have something explode next to me,’ says his fellow US Marine veteran, Nigel McCourry.
Combat experience is hard to forget. Civilian life offers daily triggers that throw you back down ‘IED alley’, reliving the flailing feeling of being blown up and the horror of gathering friends’ body parts in bags.
These former US Marines discussed their trauma in the documentary Dead Dog on the Left. It chronicles their journey through the no-man’s land of complex PTSD, which in turn triggered alcoholism and suicidal thoughts, to an eventual recovery, aided by MDMA-led psychotherapy.
Their stories are not unusual. For the past eight years I have been the patron of a charity called Supporting Wounded Veterans, which helps veterans who have suffered life-changing injuries. Increasingly, our work is less to do with physical injury and more to do with mental injury, as complex post-traumatic stress disorder, or C-PTSD, does not necessarily arise until some time after the trauma. We are the only British charity conducting medical research with trials using MDMA-led therapy, first at King’s College London and now at Addenbrooke’s hospital, Cambridge.
When I was chief of the general staff, the professional head of the British Army, eight years ago, we recognised that while we had an excellent focus on physical health, we were not doing enough for mental health. So we introduced training for commanders at all levels and developed a mental first aid assessment. But, most importantly, we worked to change the culture. We wanted to make it acceptable for soldiers to talk about mental health and to ask for help.
Recently, I took three weeks out and travelled to a retreat to try to understand the effect that multiple year-long combat tours in Afghanistan have had on my own mental wellbeing. It was an extraordinary experience to bring one’s real feelings out of a sealed box. I am fortunate – my issues are entirely manageable. But imagine what it is like for those with complex PTSD.
The guilt of surviving when others have died. Living in a society that does not want to know what you saw and seems not to care. Losing your sense of purpose and belonging. And the desperation that comes from finding no treatment that works. Suicide rates in young veterans are two to four times higher than the same age group in the general population. Hence my purpose in writing this article – for there is a treatment that may work, if only government would get behind it.
At the risk of sounding ‘woo woo’, I am talking about psychedelic therapy. It is not new. Between the 1950s and 1970s, LSD, MDMA and psilocybin were used in psychiatric clinics across Europe and North America to treat alcoholism, trauma and end-of-life anxiety. Tens of thousands received care before prohibition abruptly ended the work.
The methods were sub-par by modern standards, but one insight endured: these compounds seemed to activate the mind, not just medicate it. Patients described experiences that were vivid, challenging, often profound, and outcomes improved when those experiences were supported before and after by specialised care.
We have MDMA-led therapy, the most rigorously studied psychedelic intervention for PTSD. MDMA doesn’t produce hallucinations. Instead, it reduces activity in the amygdala, the part of the brain where fear-based emotions are processed, allowing patients to revisit trauma without being overwhelmed.
Psychedelic therapy doesn’t simply suppress symptoms. It may help reshape the system generating them. Neuroscientists speak of a ‘window of plasticity’ – a brief period in which the brain becomes more responsive and open to learning. It’s not alchemy. It’s structured, supervised psychological work.
Psychedelic therapy doesn’t simply suppress symptoms. It may help reshape the system generating them
Phase three trials in the US and earlier studies in Australia, Canada and Israel have shown sustained reductions in symptoms. But sadly, despite the US Food and Drug Administration designating MDMA-assisted treatment as a ‘breakthrough therapy’, there is still no formal approval. Even so, momentum continues. In March, the US Department of Defense awarded $9.8 million for MDMA research, including studies with active-duty troops. Regrettably, Britain is not keeping up: we are losing research talent, innovation and the chance to shape the field. Our infrastructure remains underpowered. Though MDMA and psilocybin show promise in trials, both remain Schedule 1 substances here, labelled as having ‘no medical use’. That legal status triggers licensing hurdles, a regulatory burden and huge additional costs.
Government research shows that a single gram of research-grade MDMA can cost as much as £10,000, compared with a street price of maybe £30 to £50. Trials involving controlled substances incur higher insurance and oversight costs. Anyone who handles the drug must be trained, vetted and approved. Thus a small clinical trial involving MDMA can cost millions of pounds.
America is investing in healing her warriors while the UK hesitates. Ministers cite regulation, but the deeper issue is a lack of commitment to collaborative research, to therapeutic innovation and to serious investment in mental health care. The US president Calvin Coolidge had it right when he observed: ‘The nation which forgets its defenders will itself be forgotten.’ A century later, that warning feels painfully relevant.
Britain has world-class clinicians, leading neuroscientists and veterans who are more than ready to take part in trials. What it lacks is the infrastructure and the political will to act. This isn’t just a military concern. Police, paramedics and NHS staff absorb trauma in silence, often with little support.
Psychedelic therapy is no miracle. But it may offer something other options rarely do – and that is depth, meaning and a way to engage with suffering rather than sideline it.
So my message to our government is that the UK doesn’t need to wait for the US to license this treatment. It should recategorise MDMA for research purposes to enable trials to happen faster and at vastly reduced cost. If the trials are as successful as the ones we have seen so far, then the government and the Medicine and Healthcare products -Regulatory Agency needs to allow full licensing – and at pace. This is a moral obligation to those who serve our country.
Comments