In the wake of the high-profile suicides of Kate Spade and Anthony Bourdain—and considering the less-publicized but no-less-tragic copycat suicides triggered by such events—the need for mental healthcare professionals to expand the arsenal of tools at their disposal feels more urgent than ever.
Efficacy rates of conventional treatments for depression, post-traumatic stress disorder (PTSD) and other life-threatening mental disorders hover around 30 to 40 percent, leaving many patients who’ve taken steps towards seeking help still suffering, having exhausted the only widely available options for relief.
Fortunately, our culture appears to be on the precipice of a revolution in mental healthcare. Recent research exploring the efficacy of psychedelic compounds as treatment for various mental health disorders has yielded overwhelmingly positive results. MDMA is currently being rushed through Phase 3 clinical trials as a treatment for PTSD after being designated a Breakthrough Therapy by the Food and Drug Administration (FDA) after its 60- to 80-percent success rate in eliminating PTSD symptoms in earlier trials. Esketamine, a nasal-spray form of Ketamine, was also granted Breakthrough Therapy status after trials suggested it's an incredibly fast-acting treatment for suicidal depression, relieving symptoms in hours rather than the weeks required for conventional treatments to take effect.
But as insidious as depression, PTSD, addiction and other mental disorders can be, they are not the most statistically deadly mental health disorders. That (unhappy) designation falls to eating disorders (EDs) such as anorexia and bulimia, which compound the increased risk of suicide and self-harming behavior with the dangerous physical deterioration that malnutrition wrecks on the bodies of ED sufferers.
A new study published by Laurentian University in Ontario made eating disorders the most recent target of research into psychedelic treatment. Researchers examined the effectiveness of ayahuasca—a plant admixture traditionally used in healing ceremonies by indigenous Amazonian peoples, which contains the psychedelic compound DMT—in treating both anorexia and bulimia in a qualitative study. What they found might be viewed by some as astonishing, but will come as no surprise to anyone familiar with similar psychedelic research conducted in recent years.
The study consisted of two rounds of interviews. Sixteen people who’d suffered from anorexia or bulimia and sought help both via standard treatments—such as various styles of psychotherapy and stays at inpatient treatment facilities—as well as through the ceremonial use of ayahuasca, were asked if participating in ayahuasca ceremonies helped heal their ED. A subset of 13 participants then underwent a second round of interviews regarding the comparative effectiveness of ayahuasca in contrast to their experiences with conventional modalities.
As with the trials conducted on MDMA, ketamine and psilocybin, the results of this small study appear shockingly positive. Nearly 69 percent of the initial 16 participants reported a “decrease or cessation of ED symptoms,” while more than 80 percent reported “improved emotional processing or regulation,” and having “developed greater capacity for self-love, - acceptance, -esteem, -forgiveness, -compassion.”
One participant said that, in the wake of his or her experience with ayahuasca, “My 18-year-long eating disorder has stopped. It has been two years since. I was at 95 pounds when I stopped my eating disorder. I am now 110-115 pounds…. I have dramatically reduced my exercise load. I have become a teacher and I have a successful career now!”
Another spoke of having achieved a sense of mindfulness and enjoyment while eating that he or she had been unable to feel while living with an ED: “Now I sit down and every meal I’m able to stop, to chew, to fully be mindful in my meal. I’m not reading, I’m not watching TV, I’m not listening to anything. I really enjoy that moment.”
The study also found that other health conditions, which had developed in participants as a result of their ED—such as polycystic ovarian syndrome (PCOS), chronic fatigue, elevated blood pressure and amenorrhea—improved or disappeared after the use of ayahuasca.
Findings like these are particularly impressive given just how difficult ED has proven for conventional methods of treatment to address. Cognitive behavioral therapy (CBT), the most common psychotherapeutic treatment for bulimia, only leads to a long-term reduction of bingeing and purging behaviors in 36 percent of patients. Conventional treatments for anorexia nervosa are even less reliable: The results of a 2010 clinical trial of a then-new breed of treatment called family-based therapy (FBT) were considered groundbreaking when they showed a 50 percent reduction in anorexia symptoms in teenagers, compared to the 23 percent reduction rate in teens treated with other therapeutic modalities.
Eating disorders are infamous in the medical community for being inherently difficult to treat, and structural changes in the brain have even been observed in ED patients that effectively lock them in patterns of harmful behavior. Still, the low efficacy numbers and the high incidences of treatment-resistant ED point to systemic flaws in conventional methods of treatment, particularly in light of the much higher success rate for ayahuasca as found in the Laurentian University study.
In comparison with ayahuasca, many participants felt that conventional treatments placed too high a value on concrete physical outcomes, such as weight gain, without addressing the root causes behind the eating disorder.
“[Conventional ED therapies] don’t address at the deepest level, what might be causing someone to engage in the eating disorder or the self-harming behavior,” a participant reported. And the focus treatment methods tend to place on symptomology—e.g., on a patient’s weight as the main indicator of wellness—often proved “more traumatic than helpful” for patients, as it validated the irrational importance their disorder caused them to place on the number on a scale in the first place.
Across the board, participants in the ayahuasca study expressed that traditional methods were missing “something.” The study concluded, “Approaches that provided insight and understanding to the underlying source of their ED would be more beneficial in [patients’] process of healing from an ED than solely focusing on symptoms and food issues.”
While it is not yet understood exactly how—on a mechanical, neurochemical level—ayahuasca functions to heal eating disorders, researchers noted that it seems do so is by facilitating "healing in a holistic manner, where psychological, physical, social and spiritual aspects of the self are implicated in healing, in turn promoting an embodied wholeness.” This sits in stark contrast to the narrow specificity that defines standard treatments.
In the words of one participant: “Standard approaches are very top-down, very centered around the behaviors and fixing the behaviors so that you can become functional. Which is very similar to psychopharmacology as well. It’s like suppressing symptoms so that you can become functional, whereas the work with the medicine [ayahuasca]… is more of a bottom up approach that is very much really rewiring things, it’s getting to the root cause and bringing in what was missing and resolving it on a deep, deep level that doesn't I don’t think really get fully explored or touched upon in standard approaches.”
Traditionally, talk therapy has been considered the best way to affect any sort of psychological rewiring. But participants reported that ayahuasca was both faster and more effective than psychotherapy at prompting the emotional changes necessary to heal their ED. The difference, one participant reported, was one of “baby steps versus leaps and bounds.”
In highlighting the efficacy of ayahuasca over talk therapies, another participant suggested that, in talk therapy, patients are still in control of their own minds. So even when a therapist succeeds in bringing up a painful issue that the patient might need to address, the patient can then choose to either engage with that issue or to disassociate, become distracted and close up. Having ingested ayahuasca, this is not an option.
“During ceremony you can’t go anywhere,” the participant explained. “You can’t hide from it…. My experience in most therapies is that as soon as emotion is brought up it’s more a matter of stuffing it back down again. Whereas ayahuasca is like, ‘let’s feel it and let’s sit with it and feel it until it makes sense.’”
Using ayahuasca is not necessarily a pleasant undertaking. Discomfort, disorientation, vomiting and being forced to confront deep-seated, difficult emotions or memories are all common occurrences when ingesting the psychedelic brew. But, as participants in this study reported, it’s often those very difficulties that proved most beneficial to their healing.
“I had a really, really tough experience,” said one participant, “but I’m so grateful because I feel 10 times lighter. And that doesn’t have to do with just my body image, it’s emotionally, it’s like that stuff that I couldn’t get to, the stuff that I can’t even touch was touched and it’s gone. That I can’t touch with other methods.”
Still, the study notes that not all aspects of ayahuasca are ideal for use with ED patients and that some innate aspects of the experience could prove problematic. The vomiting that the trip tends to prompt could be triggering for sufferers of bulimia, and the dietary restrictions traditionally followed by those working with ayahuasca could similarly be uncomfortable for ED sufferers.
But in light of the study’s findings, it’s clear that more research into treating eating disorders with ayahuasca is warranted. Currently, ayahuasca is not widely known as a potential treatment for ED. And because it’s considered a fully prohibited Schedule I substance in the United States—necessitating most U.S. citizens travel to Brazil, Peru or Colombia if interested in using it—a raise in awareness wouldn’t necessarily make it an accessible treatment for most people.
In light of these results, such limitations might not be the case for much longer. Given that traditional treatments have proven largely ineffective in treating this deadly disorder, it is imperative that other options like ayahuasca be explored. Still, the researchers who conducted this study are careful to point out that, at this early stage, they, “are in no way suggesting that this potential modality replace conventional treatments or that it holds higher value." Instead, they “would like to encourage other ED clinicians and researchers to consider the possibility that this traditional indigenous healing modality may be helpful for some patients.”
This seems like quite the scientific understatement. Participants in the study were effusive in their positive feedback with regard to ayahuasca, reporting that “it showed me that I had greater choice, that I had the ability to choose to live differently in a way that I had never seen before, or thought of, or experienced before in any other form of therapy.”
Another participant who experienced a complete disappearance of some ED symptoms said, “If I’d known there was a way to make certain symptoms just go away, I would have done [ayahuasca] like, 20 years ago.”
As more studies are conducted—and as our culture's antiquated views on psychedelics continue to change—it’s possible that those currently struggling with an eating disorder won’t have to wait another 20 years for relief.
Photo credit: Terpsichore/Wikipedia.