In a continuation of our first interview with an anonymous military psychologist and MDMA therapy recipient, we look to the future implications of MDMA therapy in the military, and discuss the broader moral questions and imperatives raised by this kind of treatment for war veterans.
As we were discussing before, MDMA-assisted psychotherapy changed your life and cured your PTSD, and as a psychologist who works in suicide prevention and PTSD treatment, you are very excited about it becoming more widely available for therapeutic work. How would you like to see this treatment adopted by the military? Would it just be for people being discharged from the military, or for active duty service members as well?
One thing to clarify: the military does not actually discharge troops who have PTSD. You can be in the military and have a diagnosed mental health condition as long as it does not impair your ability to deploy and function on military deployment. I have quite a few troops who have a diagnosis of PTSD and remained in the military, and they are good at their jobs.
This may surprise you, but a lot of troops with PTSD from combat actually want to go back. They volunteer to go back to Iraq or Afghanistan in part because when you are deployed, everything makes more sense. For example, if you are aggressive and quick to react with violence in Afghanistan, they give you medals for that. But when you come home to the States, if you are aggressive and quick to react with violence they put you in jail. Being deployed actually makes more sense in this case, because in that role we tend to be prone to aggression and preemptively acting on concerns for threats.
One of the things about PTSD is the constant belief “I am not safe, I need to be able to protect myself at all times” and so we are constantly scanning crowds and surroundings for potential signs of danger or threat. Going downrange is actually something we want to do. I volunteered to go back because it made more sense. So a lot of my troops want to deploy, and they can do fine downrange— it’s just home station where they can’t do well. They struggle with their marriage, with civilians, with their job, and with the civilian world.
MDMA-assisted psychotherapy could be an option in the military, because the protocol that MAPS is using is only 90 days, and they are getting astounding results. We could do that in the military— we just remove you from being deployable for 90 days while we treat you, then most likely they would want to see you 90 days after that to see that you are stable. So we’re talking about 6 months total. That would be doable under the current system— you could get treatment, get better, and stay in.
This therapy could save the military a lot of money in terms of needing to recruit new people, because when we train people, particularly for certain jobs like special forces, you’re spending a lot of money. With some special ops positions it takes half a million dollars to recruit and train somebody, so if they get discharged or they leave the service because of PTSD, that’s money that we’ve invested in a soldier that we can’t get back. We have to recruit and train another person at half a million dollar cost, so this is something that could save our troops’ careers, and save taxpayers a lot of money, while increasing military readiness. This is something I’m really excited about from a readiness perspective, as well as doing the right thing for our troops and getting them treatment that will work.
This is also something that I’m convinced would restore a lot of our troops to being deployable and qualified worldwide. Currently, the goldline medication recommendation for PTSD is Sertraline which is an SSRI. It’s well tolerated and relatively effective with few side effects, but the problem is that you can’t deploy to certain locations on Sertraline without them really closely scrutinizing your record. If you are on Sertraline and you deploy to Africa for example, we don’t have a medical infrastructure there like we have in the Middle East. Even if you have a supply of medication for months, let’s say you run out or lose it— we don’t know if you’re going to remain stable if you discontinue it. MDMA therapy could be a game changer because we know you’re stable and not reliant on a medication you are taking indefinitely. I think this would make things easier from a military readiness and deployability perspective because we don’t have to take you off medication and see if you are stable.
Interesting points. Do you think that after going through this kind of treatment soldiers could be reluctant to deploy again, or perhaps be less inclined to violence?
I know after I came back from Afghanistan and before my treatment, I didn’t kill anything for years. I didn’t fish, I didn’t hunt, I didn’t even kill bugs. A lot of times people come back from war with a renewed reverence and respect for life because they see how quickly and easily it can be extinguished, and how valuable it is.
I could definitely see how being under the influence of MDMA seems to foster a sense of oneness and connectedness with others as well as with all beings—animals, the earth, the connectedness of all life. I could see how MDMA could influence people in that direction, but at the same time, I pretty much became anti-war after I returned from Afghanistan, yet stayed in the military. My rationalization is that I’m a medic, and medics will treat anybody, be they our soldiers, or Taliban, ANA (Afghanistan National Army) troops, and so on. So I’m rationalizing staying in because I’m here to help people. A lot of our military people rationalize that war itself is evil, killing is evil, but doing it to serve their country is a necessary sacrifice that someone has to make.
I recently had two different soldiers come through my office, and both had over 10 years in service. Usually if you are over 10 years in, you want to stay until 20 because then you can retire with a check. Both said they were done and were on their way out—they didn’t believe in war anymore, didn’t believe in killing. One said, “If my country was attacked I would go to war, but this war is not a moral war; there’s no reason for it.” The other one had become very much a pacifist and thought war was illegitimate under any circumstances. Neither one of them had used MDMA or anything else, but their experience of war had led them to that conclusion.
So I could see how drugs in this class could influence people in that direction, but I think that most of our military people have already rationalized their role and how it sometimes includes violence, and the people who are becoming reluctant to continue are arriving at that conclusion on their own without MDMA.
That’s fascinating. I wonder if a soldier gets PTSD and is treated with MDMA, is it a good thing if they have more reverence for life, or would it get in the way of the operational necessities of following orders? It seems like you can’t have everyone trying to make a moral judgement all the time, you just have to follow what your superiors are saying.
The oath that we take is that we will obey all lawful orders, and part of our training is to instantly obey those orders unless you don’t think they are lawful. You’re right— I went through a 2-year period where I asked myself if I could stay in the military because of my concerns about the morality of killing. After I came back from Afghanistan, I was no longer enlisted or in combat arms, I was in medical, so I was actually helping people. So that’s how I was able to rationalize it.
I had a soldier a few months ago who was able to rationalize it because he was in communications. He was no longer in a killing position, so he could continue on. A lot of times when people are no longer comfortable doing one job, they simply transfer and retrain into a different job. So that could be an option for some people if that were to happen. I think that would be a small percentage of people, but I could be wrong— because you’re right, it does really give you a renewed perspective on life and on the act of killing. Until you brought it up, I hadn’t really thought about it. That would be an interesting research question.
I would wonder what the top brass thinks about this issue.
I think our first ethical responsibility is to treat our wounded service members, because we put them in harm’s way. Our first obligation should always be to do what’s right for our troops. And then if it were to become a problem that they no longer felt right with violence and couldn’t serve in the military, then you know what? They served honorably, they went downrange, they did what we asked them to do and got hurt, we treated them, and now we’re going to release them in a good state back into the civilian world instead of in a damaged state where they could be a liability to others. When we harm people, we have a moral obligation to restore them before they reenter society, in whatever way possible. This is how we do right by our troops. So worst case, we would have at least restored them and made them whole before releasing them on the public again.
I completely agree. This is a vast moral question, but the one thing that I feel is rock solid is that these soldiers absolutely deserve help. And I’m curious too, out of those who are reluctant to go back to Afghanistan specifically, how many would still be willing to protect the country in a war that was more understandable and not morally vague.
I think there’s a difference when your country has been attacked or threatened versus a preemptive war. A preemptive war by definition violates the Christian doctrine of just war theory which is widely taught in the military as a moral perspective. When a military action is taken which doesn’t seem like self defense, I think that in the future you’re probably going to see more people questioning it, because it has happened so often.
We’ve been almost continuously at war for decades, and we’ve only been attacked once. I used to think the US was a peaceful country, but I think now we’re pretty militaristic and violent. It’s hard to argue that we’re a peaceful country when we’re always attacking countries that never attacked us. I could see how wider use of medications such as MDMA or other similar ones could increase respect for life and awareness of the value of life, and cause some to question the use of military force around the world.
Right, and maybe that’s a good thing. Of course there has to be a balance— we can’t just naively give up all security and readiness, because then someone else would exploit us. But in my opinion, if we seek a peaceful world and want to retain legitimacy at home and abroad, we should be more discerning and reluctant to use force unless absolutely necessary.
Today I still believe that war is sometimes necessary. I don’t like war, I hate war, but I think it’s sometimes necessary. I think it’s possible that we have sometimes been too quick to use the military and go to war.
Right, and as you were saying, many people are already having these second doubts, so the military has to deal with this issue whether MDMA becomes legal or not. It’s just that this therapy might somewhat accelerate that process.
For some people, maybe. As powerful as the MDMA experience is, the realities of war and killing already force people to face this moral issue, so I doubt it will be disruptive.
Do you think that once MDMA therapy is legalized, the military will instantly adopt it? Will there be a lag time?
I don’t think there will be much of a wait, because it addresses so many problems. One of the things about the military is that a lot of people don’t report and don’t seek mental health treatment because they are afraid to be kicked out. But if they know they can get treatment and get better and stay in their jobs, they will be more likely to seek help. And for those on their way out, we can get them the help they need so they can reenter society without a debilitating condition. With MDMA, we are not treating the symptoms or relying on an ongoing prescription, we are actually treating the trauma itself—and that’s one of the most remarkable things about this medication.