Molly, Psychedelic Drug, Shows Great Promise As Mental Health Treatment, New Study Finds

A couple hours after taking his first dose of the mind-altering drug 3,4-methylenedioxymethamphetamine, or MDMA, Bessel Van Der Kolk lay down on a couch in the presence of two psychotherapists, put on an eyeshade, and allowed himself to sink into a quiet, hypnotic state.

Van Der Kolk, one of the world's foremost experts on trauma, had agreed to ingest the potent compound, known to generations of recreational illegal drug users by its street names "Ecstasy" or "Molly," because he was the principal investigator in a rigorous 15-site, phase III, clinical trial. The object was to evaluate the effectiveness of MDMA-assisted psychotherapy in patients suffering from extreme Post Traumatic Stress Disorder (PTSD). As such, he'd been told, he was required to have first-hand experience with the drug.

The results from those sessions are striking. Two months after participating in the study, more than two-thirds of those who took MDMA no longer had diagnosable PTSD, investigators report in an article expected to be published in the prestigious journal Nature Medicine. The study's sponsors believe those results exceed the threshold of significance needed to prove efficacy—and enough for the U.S. Food and Drug Administration, they hope, to consider forgoing the second part of the trial and granting the drug approval. If the FDA does so, MDMA-therapy could be legalized in U.S. clinics as soon as 2023.

The Dutch-born psychiatrist's foray into mind-altering drugs is part of what may be the biggest mental health story of the decade: The remarkable rehabilitation and anticipated federal approval of a class of long-outlawed drugs, broadly defined as "psychedelics," that clinicians hope to use as treatments not just for PTSD but also for a long list of psychological maladies that have so far proven resistant to the best tools and techniques of modern medicine—depression, anxiety, drug addiction and the existential angst of terminally-ill cancer patients.

In 2019, the FDA granted approval of the psychoactive nasal spray called Spravato as a therapy to adults with treatment-resistant depression. The drug is a derivative of a long used anesthetic best known by its street name "Special K" or Ketamine, which is thought to blunt suicidal thoughts. Researchers are now experimenting with psilocybin, a substance found in mushrooms, and other drugs including dimethyltryptamine (DMT), a hallucinogenic compound and one of the main active ingredients in ayahuasca.

Van Der Kolk's experience with MDMA gives an inkling of the power of psychedelics as a therapeutic tool. For years, Van Der Kolk had downplayed the psychological toll working with traumatized people had taken on his own psyche. But what happened as he lay on the couch stunned him. Under the influence of the potent drug, the accumulated emotional weight of what he'd absorbed over four decades of practice flooded back—not concrete memories or stories so much as the unprocessed fragments and the raw feelings that went with them. "All that trauma that I had heard engulfed me," Van Der Kolk told Newsweek. "The feelings of all these people who had been hurt and raped and molested came back, and I felt all those feelings in a very deep way."

Rick Doblin
Rick Doblin, Ph.D. President of the Multidisciplinary Association for Psychedelic Studies, photographed at his home office. (Photo by Rick Friedman/Corbis via Getty Images) Getty Images

It was excruciatingly painful but also strangely tolerable. As these feelings overwhelmed him, a deep well of compassion welled up to meet them. He was infused with an overarching love for himself and for all humanity. Van Der Kolk, a seasoned scientific investigator who is perhaps best known for his bestselling 2014 book The Body Keeps Score, admits that sounds flaky. But under the influence of the drug, with the help of the trained therapists present that day and the next to help him process his experience, Van Der Kolk would later conclude, things that had long seemed too hot to touch and too threatening to even acknowledge had lost their menacing edge. He was able to see it clearly for the first time.

Van Der Kolk thought about that experience a lot in the months that followed, as patient trials got underway and he watched a series of transformations, as profound as any he'd seen over the course of four decades of practice, begin to play out in the trauma patients treated by his six-person team in Boston. It wasn't just what the patients said about the sessions. It was what they did after them. Some left longtime abusive relationships. Others tackled work problems that had long confounded them. One patient who was afraid of the opposite sex began dating for the first time.

Now that Van Der Kolk has concrete numbers to go with those stories, the subject is likely to get more attention in the months ahead. The official results from those sessions, part of a two-part, 200-person clinical trial, have now been combined with those produced by teams of investigators at NYU, UCSF, the University of Wisconsin, and myriad private practices across the US, in Canada and in Israel. The rigorous five-month protocol included 42 total hours of therapy for all 90 participants, consisting of 12 ninety-minute-long, non-drug psychotherapy sessions, spaced out over three and a half months. Interspersed were three day-long experimental sessions, in which one group underwent a day of therapy after taking MDMA, and a second group did so after taking an inactive placebo. To be sure, even those who got the placebo saw marked improvement from the therapy alone—about 30 percent saw reductions in their symptoms. But the effects were more than twice as potent for the group taking the drug.

"What the MDMA clearly did, is it allowed people to go into dark places where ordinarily they did not want to go," Van Der Kolk says. "Sometimes they were quite upset during the sessions. But they always came up with unexpected attitude changes, insights, insights that were more than just intellectual, that often gave them an entirely different orientation towards themselves. Self-forgiveness became a very important part of it also, replacing self-blame for what happened."

The therapeutic potential of hallucinogens is by no means a new discovery. Several substances from this broad class of mind-altering drugs, which includes the powerful hallucinogens LSD and "Magic Mushrooms," were originally hailed by reputable mental health professionals as potential miracle drugs when they were first discovered in the middle of the 20th century. But the prospect of widespread medicinal use was derailed in the 1960s after the drugs began to leak out of clinical settings and were embraced for recreational use by counter cultural icons like Timothy Leary, (who urged the Woodstock generation to "Turn on, tune in and drop out)." They were criminalized in the early 1970s. New laws put the kibosh on scientific research into the drugs' medicinal properties.

In recent years, thanks to the efforts of a few devoted psychedelic acolytes, who never stopped believing in their therapeutic potential, that's all begun to change. Armed with new scientific insights and fresh clinical data and aided by societal changes that have followed the embrace of other substances, like marijuana, for medicinal use, they have won the backing of powerful players in the medical establishment and appear poised to gain widespread acceptance. And with that acceptance, tantalizing new insights are likely to emerge about the neurological mechanisms at the center of diseases that have long tormented millions of patients suffering from intractable mental illnesses—and new avenues are likely to open up that some hope might finally heal them.

An Invisible Toll

Nearly one in five American adults today lives with a mental illness, about 51.5 million people in 2019. One of the cruelest of them all is Post Traumatic Stress Disorder (PTSD), which will afflict an estimated 7.7 million Americans at some point in their life.

The list of potential symptoms in nightmares, flashbacks, intrusive memories, hypervigilance, a sense of detachment from the present, self-destructive tendencies and an inability to form healthy lasting relationships. Traumatized individuals are tormented by their memories—which, a large body of evidence from brain scans and from the subjective experience of patients shows, are not ordinary memories at all: for PTSD patients, traumatic experiences long passed remain strikingly present and intrusive and often superimpose the darkness of the trauma onto everything new the victim encounters.

"My brain was like a smartphone and there was an app that you couldn't close and that app was fear and anxiety," recalls Lori Tipton, a 41-year-old bartender and writer from New Orleans, who participated in the PTSD study. "I could never be physically present in a moment because in my head I was running a scenario of every bad thing that could happen all the time."

When Tipton was still in her early 20s, her brother came to visit on his birthday and overdosed on opioids in her apartment. A few months later, Tipton walked in on a gruesome scene at her mother's home: Tipton's mother was slumped in a nearby rocking chair; nearby, her mother's former lover and another woman lay in pools of blood on the floor. After shooting the two women to death with a .38 Smith & Wesson Revolver, her mother had turned the gun on herself. Just a few months later, Tipton was brutally raped by a friend. She became pregnant and had an abortion. Somewhere in that sequence of events, Hurricane Katrina hit her hometown.

A decade later, Tipton contacted Multidisciplinary Association for Psychedelic Studies, or MAPS, an advocacy group for psychedelic treatments, about the MDMA trial. She was still haunted by fragmentary flashbacks from the rape and murder scenes, her day-to-day existence colored by paranoia and fear even when the trauma was far from her mind. She checked the locks multiple times before leaving home. A "borderline agoraphobic," she worried constantly about the safety of her young son and was afraid to let him outside. She suffered from insomnia, and the sound of a breaking glass or slamming door was sometimes enough to prompt panic attack. After contemplating suicide, she'd sought the help of a professional therapist, who quickly diagnosed PTSD.

Yet Tipton hadn't paid much attention to that information. Most people she knew had lived through Hurricane Katrina, and many also had a PTSD diagnosis. Besides, she figured, she didn't have time to focus on the past. She could only afford to see her shrink every couple weeks, and there were more urgent matters to discuss—like how to get out the door without checking the locks six times so she could arrive at work on time; like how to avoid killing herself.

It was only after seeing a posting about the MDMA study on social media, firing off an email on a lark, undergoing psychometric tests at a local therapist's office, and seeing her condition laid out in raw numbers that Tipton realized the severity of her condition.

Van Der Kolk is not surprised that many of his patients push forward and ignore the problem. Still, he would have recognized Tipton's symptoms right away.

"After trauma, the world is experienced with a different nervous system," he wrote in his 2014 book. "The survivor's energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their life. Being traumatized means continuing to organize your life as if the trauma were still ongoing—unchanged and immutable—as every new encounter or event is contaminated by the past."

In the 1990s, Van Der Kolk was among the first trauma experts to collaborate with neuroscientists when new brain-scanning technologies came online. To understand brain activity, Van Der Kolk and his collaborators played the study participants a recording of a research assistant reading back a script describing their trauma, while the patients lay in an MRI machine.

As one might expect, the primitive areas of the brain associated with the fight or flight instinct and emotion were lit up with activity. The limbic system and the primitive almond-shaped seat of emotion called the amygdala flooded the body with stress hormones. Standing outside the scanner monitoring vital signs, Van Der Kolk watched as their hearts began racing and their physiology entered a state of "frantic arousal."

The brain scans also revealed something more surprising. When Van Der Kolk's PTSD victims listened to scripts, it was almost as if they were experiencing them again for the first time. Areas of the visual cortex that normally only light up when images first enter our brains sprang to life.

Meanwhile other areas of the brain, important for understanding when an event is in the past, appeared ominously dark—as if they had been knocked offline. The area of the brain associated with speech production, known as Broca's area—which allows us to put things into words and categorize and make sense of them—had also gone conspicuously dark. When Van Der Kolk scrutinized this data for the first time, he realized what he was looking at might explain something he had long noticed in his patients: their inability to put the horror and experience into language and make sense of it using words—and why they often said, "you had to be there to understand."

The scans confirmed that the memories of PTSD victims weren't really memories at all.

Under normal circumstances, new images, upon arriving in the areas of the visual cortex, are rapidly diffused to higher-order areas of the brain, which interpret the meaning of visual stimuli. Eventually they are processed and routed through areas of the brain that "consolidate" them into long term memory.

In Van Der Kolk's trauma patients, however, there seemed to be a global disruption of function. In general, the survival-oriented right side of the brain—the areas most associated with intuition, emotional and sensory experiences, what some theorists call the primitive "fast" brain—came alive with activity. The opposite was true for the rational left, or "slow," part of the brain, which we rely upon to coldly analyze a situation, build a coherent timeline of events and put it all into words. This seat of executive functioning went dead, as if deactivated. The volume of the signals emanating from the brain's fear centers was so loud, it robbed Van Der Kolk's patients of the capacity to organize and make sense of their experiences. Time, for them, stood still.

Codename Adam

Although indigenous cultures around the world have used mind-altering drugs for millennia to expand their consciousness and heal, western mental-health professionals were initially attracted to psychedelics not to cure mental illness but to better understand it.

Not long after Albert Hoffman, a chemist working for the Swiss pharmaceutical company Sandoz, first synthesized lysergic acid diethylamide, or LSD, in 1938, word spread among psychiatrists and other mental health professionals that the drug could create an experience of temporary psychosis, which might give clinicians a better understanding of what their schizophrenic patients were going through. The discovery of LSD's potency was also an "important clue" that a class of microscopic brain molecules known as neurotransmitters might play a role in organizing our mental experience. Eventually this revelation would lead to a new class of drugs known as SSRIs, the most famous of which is Prozac.

It didn't take long for some psychiatrists to recognize that an LSD experience, properly supervised by a trained professional, might actually have powerful therapeutic benefits. It seemed to hasten the formation of a bond between patient and therapist and often helped break through the psychological defenses that impeded healing and insight. Experiments in the 1950s and 1960s explored the therapeutic potentials of LSD and other hallucinogens.

Eventually, however, the drugs leaked out of doctors' offices into youth culture. The first many Americans heard of LSD was in 1963 from Harvard psychologists Timothy Leary and Richard Alpert , who were fired after being accused of administering the drugs to undergraduates while under the influence themselves, and actively encouraging recreational use. In the years that followed, President Richard Nixon declared Timothy Leary "public enemy number 1," launched a "war on drugs," and signed legislation that banned LSD and a wide variety of other drugs.

Despite this loss of respectability, some researchers were unwilling to give up on psychedelics. To get around Nixon's drug laws, chemists made slight modifications to the molecules in question. In 1977, MDMA was "rediscovered" by chemist Alexander Shulgin, an independent scientist formerly employed by Dow Chemical, who was looking for a replacement for a popular 1960s drug called MDA, or methylenedioxyamphetamine. (MDMA was first synthesized in 1912 by Merck, but never marketed). Shulgin passed it on to a psychotherapist named Leo Zeff, an established leader of an underground psychedelic therapy movement, who, along with other advocates of psychedelic-assisted therapy, began quietly exploring its healing properties.

Zeff and his allies recognized its potential immediately. MDMA, they found, often induced a deep feeling of well-being, emotional warmth, extroversion and empathy towards others. It also heightened sensory perception and often made people more willing to discuss emotionally-charged memories. Chastened by their experience with LSD, Zeff and his allies tried to keep the drug close to their vests, referring to it by the codeword "Adam," an anagram of MDMA. Over the next decade, Zeff and his allies were responsible for about half a million doses used in personal growth settings, such as the Esalen Institute in Big Sur, according to Rick Doblin, the founder and executive director of MAPS.

Doblin first heard of the drug in 1982 at an Esalen workshop led by Stan Grof, a former psychiatrist and psychedelic researcher at Johns Hopkins University who left to take up a new position as scholar in residence at the new-age Mecca and pioneered a form of drug-free therapy known as "holotropic breathwork." Doblin, who had already decided to pursue a career in psychedelic therapy. When he tried MDMA for the first time in 1982 with his girlfriend, we was "blown away" by the experience.

By then, the drug had taken off as a popular club drug called Ecstasy, attracting the attention of the U.S. Drug Enforcement Agency (DEA). In the summer of 1984, the agency announced plans to criminalize Ecstasy, opening a 30-day public comment period. This time, its defenders were ready. Doblin stepped forward to help lead the charge. He traveled to Washington, D.C. and requested a hearing with a DEA administrative-law judge, then quarterbacked a rigorous defense of the drug. At the time, he says, the agency had no knowledge of the drug's therapeutic uses. Armed with testimonials from psychiatrists, data from informal research and lawyers from Dewey Ballantine, which took the case pro bono, Doblin won the hearing.

"There were no controlled trials, but there was a lot of anecdotal evidence suggesting that there should be," recalls Michael Mithoefer, a South Carolina-based psychiatrist, who is leading research at MAPS.

The judge ruled that MDMA should be downgraded from Schedule 1, a list of drugs that imposes restrictions on use and availability based on an assessment of their danger and utility, to a Schedule 3 drug, meaning it would remain legal for medical use. The DEA overruled the judge's decision. Doblin sued on appeal—twice. Eventually, the DEA convinced the courts that the DEA administrator had the last word. MDMA was criminalized.

Doblin was not so easily dissuaded, however. In 1986, he founded MAPS, the Multidisciplinary Association for Psychedelic Studies to fight for psychedelic therapy, and enrolled in a PhD program at Harvard with the express purpose of figuring out how to open up psychedelic research from inside the establishment. The best way to bring the drug back, he figured, was by convincing the FDA to bless research on the drug's potential and slowly build an irrefutable scientific case.

In 1992, the FDA greenlit Doblin's petition to perform a human safety trial of MDMA on terminal cancer patients suffering from anxiety. By 2000, the group was ready to fund Phase II pilot studies for patients suffering from PTSD. And in November 2016, MAPS finally won permission to proceed with Phase III clinical trials. In 2017, the FDA conferred a "breakthrough therapy" status on the MDMA-PTSD, trials, a designation that comes with extra ­guidance, a faster review process and, perhaps most important, a stamp of establishment legitimacy, indicating that the drug is seen as having potential to fill a gap in the treatment landscape.

A few years ago, not many researchers thought such an accomplishment was possible. Van Der Kolk certainly didn't. "I said, 'it's as a great idea'," Van Der Kolk recalls telling Doblin and Mithoefer when they first approached him about the idea of clinical trials for psychedelic-assisted therapy in the early days of the effort. "'But you'll never get it past the feds. Politically you'll get killed for it.' The fact that they were able to do this is really quite an astonishing accomplishment, actually. It's a miracle."

Love Chemicals

Much of what is known about the impact MDMA has on the brain remains preliminary. But one thing neuroscientists do know is that it seems to unleash a flood of the neurotransmitters oxytocin and serotonin. Sometimes known as "the love drug," oxytocin is a hormone that plays a key role in social bonding—it's the chemical that fuels a mother's love for her baby upon giving birth and fills us with warmth as we fall in love. Serotonin plays a role in a wide variety of biological functions but is known to exert a powerful effect on mood. Of particular relevance to PTSD patients, in large doses it can have a powerful inhibitory effect on the amygdala, the primitive part of the brain thought to govern the fight or flight instinct and the human fear response.

Gul Dolen, a neuroscientist at John Hopkins University, who conducted experiments on mice using MDMA, believes the drug's ability to flood the brain with a combination of these two chemicals may also work to make the brain more malleable and open to forming new connections—returning the areas involved in social bonding to a state similar to early childhood. That may allow the horrific imprint of social trauma caused at the hands of other people in the patient's past to be overwritten by a new imprint of support and love. It may also allow powerful bonds to form between therapist and patient, helping establish trust. In a 2019 study published in the journal Nature, Dolen found that MDMA made social interaction far more rewarding and far more influential in adult mice than under normal circumstances, effects that could be blocked by administering a drug that prevented the brain from absorbing oxytocin—suggesting that it was the massive release of the "love" chemicals caused by MDMA that affected social learning in the mice. (She also showed in a separate study that MDMA elicited social behavior in octopuses, which are normally extremely anti-social.)

In a separate study, neuroscientists at the University Hospital of Psychiatry in Zurich, Switzerland used Positron Emission Tomography (PET) to track cerebral blood flow in two small groups of human subjects, the first of which had been fed MDMA, and the second a placebo. They found that MDMA significantly decreased blood flow to the limbic system, particularly to structures associated with fear, anxiety and aggression.

Van Der Kork emphasizes that subjective reports and the impact drug-assisted therapy has had on his patients have had a more powerful effect on the decisions he makes about his patients than any brain scan. But more scans, including ongoing studies that will look at the brains of PTSD patients who are exposed to the therapy at Emory University and Yale, are likely to provide some confirmation of the effectiveness of the therapy, he believes. When he has scanned the brains of patients who have healed from PTSD using other therapies, he sees new pathways opened and new circuits formed that seemed to engage the frontal areas of the brain, which play a role the perception of time—in other words, they allow us to say: "It's not happening now. This is happening back then."

The Road to Approval

Despite the promise of MDMA, it still must clear a number of regulatory hurdles before it wins approval as a therapy in the U.S. and becomes available for wide use.

In March, 2019, the U.S. Food and Drug Administration approved the first psychedelic drug—a fast-acting, psychoactive nasal spray called Spravato—as a therapy to treat patients with suicidal thoughts and treatment-resistant depression. The drug, long used as an anesthetic, is best known by its street name "Special K" or Ketamine, and is being produced by the pharmaceutical company Janssen, a Johnson & Johnson subsidiary. Its effects in high doses include altered perception of sights and sounds, hallucinations, and sedation. But it also appears to have a profound effect on depression that is not yet fully understood. Its approval was touted in newspapers as the most significant federally approved depression medication since Prozac was approved in 1987.

Many in the mental health field expect that other drugs will not be far behind. In 2019, the FDA conferred a "breakthrough therapy" status on clinical trials that are using synthetic doses of the hallucinogen psilocybin, the active ingredient in mushrooms, to treat drug-resistant depression. In December, Britain greenlit the first clinical trial of dimethyltryptamine (DMT), a hallucinogenic compound and one of the main active ingredients in ayahuasca, a South American brew made out of the Banisteriopsis caapi vine, the Psychotria viridis shrub, and other ingredients used in shamanistic rites associated with a number of indigenous Amazonian cultures. It is known to produce hallucinations and distortions of time, space, sound and color in the user.

But MDMA is likely to be next big domino to fall. In 2017, the FDA granted the drug status as "breakthrough therapy," noting the treatment "may demonstrate substantial improvement over existing therapies." The status is a potent signal, experts say, that the agency has seen enough preliminary data to suggest there is a good likelihood both that the drug does something new and that it has the potential to fill an urgent need not currently met by existing treatments.

This has been backed up by a series of small clinical trials that, while not large enough to prove efficacy, have produced results promising enough to highlight the potential. In 2018, when MAPS' Mithoefer and collaborators published the results of their five-year, phase II clinical trial of MDMA-assisted therapy in the medical journal Lancet Psychiatry, it generated nationwide headlines and raised the hopes of veterans groups that it might help with a mental health crisis that has almost 17 veterans a day committing suicide.

Similar studies drawing from larger pools of PTSD patients were completed in Colorado, Vancouver, Switzerland and Israel. The cumulative results were promising enough that in January 2020, the FDA approved MAPS' application for an expanded-access program that allows early access to MDMA-assisted therapy for individuals who are facing life-threatening conditions, have not responded to available treatments and are unable to participate in the Phase 3 trials.

In February, Doblin and his team met with the FDA to share data from the first 100 patients, and requested the agency move ahead with approval before the second phase of the study is completed. But since such a review would likely take 6-to-8 months, MAPS has already begun enrolling its second cohort of 100 patients.

Once MAPS proves safety and efficacy, it then has to demonstrate that it has the capacity to mass produce medical grade tablets and propose and win approval for a commercial brand name. It is in the process of completing more toxicity studies, as well as studies aimed at determining the effects of taking the drug on an empty stomach, or after a meal, to determine dosing instructions.

If the drug gets past an advisory committee and wins approval, yet more steps remain. While 25 states automatically reschedule the drug when the FDA approves it, some, like California, require a specific state law be passed to reschedule the drug.

Even then, its unclear how widespread access would be. If the FDA approves the drug, it is likely to do so with a number of restrictions and conditions aimed at ensuring the drug is safely administered, which are likely to have a significant impact on cost and practicality of the treatment. In the case of Janssen's Spravato, the depression-nasal spray, patients are only allowed to receive the drug in a physician's office and must be monitored for two-hours afterward for safety reasons. This requirement is proving a barrier at some medical centers that do not have the requisite staffing. The FDA is likely to mandate even more onerous monitoring of MDMA-assisted therapy, which may affect how willing insurance providers are to pay for the treatment.

Even so, the therapy has encountered surprisingly little opposition from drug enforcement and has the support of veterans groups and a growing number of clinicians who treat PTSD as well as a vocal group of PTSD patients who have experienced MDMA's healing power first hand.

Down in New Orleans, as soon as Tipton started MDMA sessions, under the watch of the two therapists, she felt a flood of new memories and emotions return for the first time in years. She remembered playing in the snow with her brother Davin, who had long since died of a drug overdose. She recalled happier times with her mother. "I had become so blunted of my feelings from just repressing them and being afraid all the time that I had lost how to feel," Tipton recalls. "In the first session, I was able to feel my feelings again—and all of a sudden I felt all of them. I felt sadness and guilt, and loss, anger, surprise, fear, confusion, love, and I hadn't felt those things in so long that it was overwhelming to me."

Grief arrived during the second session. "When I came out of it, I was seeing everything about my life very differently—my relationships, the way that I interacted, the way that I loved the people I loved. And it was very frightening. It's really hard to look at your life and to grieve the amount of time that I had spent sick like that and missed out on so much of my son's life." For the first time, she could clearly see how much fear had poisoned her life.

In the third session, under the calming influence of the drug, she and her therapists Shari Taylor and Ray Worthy began to revisit the two traumas that had poisoned her life—the brutal rape and the day she found her mother's murder scene. Tipton was overwhelmed with empathy for herself and others. She forgave herself and her mother.

During the session, Tipton got up off the couch, asked the two therapists to stand on either side of her, and assumed a yoga pose known as a plow. As she raised her legs over her head, she felt a familiar panic—a poisonous brew of the shame, anger, helplessness, and sense of violation. The reason she could never do this pose in the yoga classes she taught was because it reminded her of the rape.

"What do you need right now, what does this feeling need?" one of the therapists asked.

"I just need to be heard," Tipton responded. "I just need someone to hear this and to know that it's the truth and that it happened to me."

Once the session had ended, Tipton knew there was plenty more healing to do. But she could see the path forward. The future no longer overwhelmed her.

Correction (5/10/2021, 4:06 pm EDT): Spravato was not approved by the FDA for treatment of adults with suicidal thoughts, as Newsweek originally reported. Also, due to an editing error, the article originally misstated the perpetrator of the double murder and suicide, which was Lori Tipton's mother. The article has been modified to correct both errors.