Post-traumatic stress an injury, not a disorder, veterans say

First Canadian MDMA-assisted trauma therapy trial wraps up in Vancouver


Dr. Ingrid Pacey, a psychiatrist and lead investigator of the recently completed MDMA-assisted psychotherapy trial — the first of its kind in Canada — in her Vancouver home.

By: David P. Ball Metro Published on Thu Nov 24 2016

Several Vancouver psychotherapists behind a head-turning Canadian drug study may not be raving ecstatically or blissed out about their findings.
But after wrapping up Canada’s first-ever trial treating trauma using the drug MDMA — the pure form of what’s popularly called ecstasy — they are nonetheless quite optimistic, Metro has learned.
According to psychiatrist Dr. Ingrid Pacey, the study’s principal investigator, the MDMA-assisted psychotherapy trial showed promising results for its six patients with post-traumatic stress disorder (PTSD) so severe that no previous treatments had worked.

Because MDMA — or methylenedioxymethamphetamine — is an empathogen, meaning it generates feelings of empathy and trust, the therapists hoped to see how patients might respond to counselling while they were on the drug.
“The biggest thing was there was a very increased level of trust,” Pacey told Metro in a phone interview. “They were really able to talk about painful material from the past that they were never able talk about before in their life — they’d been so frightened they’d block it.
“With the MDMA, they’d be distressed and crying, but they could talk it through and come to understand it in a way they couldn’t before. The trauma became a more manageable part of their history and they could go forward with their lives.”
PTSD is mental health condition associated with being exposed to threatening events or abuse, often afflicting victims of violence, soldiers, first responders, and sexual and childhood abuse survivors.
The illness is often tough to treat because many people with PTSD have developed a deeply engrained sense of mistrust in others, numbing, hyper-vigilance and isolation — and because it changes the brain itself.


The Multidisciplinary Association for Psychedelic Studies (MAPS) Canadian chair Mark Haden, left, and its clinical trial leader Dr. Allison Feduccia appear at the Military and Veteran Health Research Forum in Vancouver on Tuesday.

Three of Pacey’s subjects had experienced childhood abuse; the other three survived adult traumas.
Except for two given placebos for the first part of the trial, subjects were given 125 mg of MDMA with eight hours of therapy, followed by a supervised sleepover at the clinic site; the next day, they got further counselling. Months later, they were given half the original dose and offered more therapy, followed up after a year.
The study was part of an international initiative funded by Multidisciplinary Association for Psychedelic Studies (MAPS). Pacey’s trial legally imported its MDMA from a Swiss lab; studies have ordered theirs from U.S. labs.
Although the results of the federally approved study — quietly authorized by Health Canada in 2013 — are still being “collated” alongside similar research in the U.S., other studies have backed up Pacey’s initial findings.
“We’re facilitating a healing process, not just a treatment of symptoms,” explained Dr. Allison Feduccia, MAPS’ clinical trial leader, in an interview. The neuropharmacologist was in Vancouver on Tuesday presenting MAPS’ findings at the Military and Veteran Health Research Forum — for which she won the forum's Homewood Mental Health Treatment Award for "improving and innovating clinical mental health" practice.
“Some people have been hurt by other people so much that they may not even want to let anybody else in," she told Metro. “MDMA facilitates an empathetic rapport between the therapists and the participants.”
MAPS Canada chair Mark Haden, an adjunct professor UBC School of Population and Public Health, told Metro that the Vancouver experiment is being formally wrapped up this week and another site in the city is being considered for the next phase of their research.
So far, MAPS-supported scientific research — much of it crowd-funded on the Internet — has treated more than 100 severe PTSD cases.
“Most PTSD therapy takes years,” Haden said in an interview. “We do it in three months.”
Feduccia said that after only two treatment sessions in MAPS’ research so far, 56 per cent of subjects “no longer met the criteria for PTSD” at all.
“What's even more remarkable,” she said, “is when we followed up 12 months later, 66 per cent of people no longer met criteria for PTSD … the effects of the treatment are continuing to grow.”
Pacey doesn’t need to see the collated data to know the treatment has “promise.”
“We have trauma survivors and war veterans here too,” she said. “For them to actually have a treatment to finally break through what before was something that brought their lives to a halt — that is very exciting.”

http://www.metronews.ca/news/vancouver/2016/11/24/first-canada-mdma-trauma-therapy-concludes-in-vancouver.html

The PTSD crisis isn’t a crisis, and inventing one doesn’t help

Colby Cosh November 24, 2016


Canadian soldiers patrol southwest of Kandahar, Afghanistan, on June 7, 2010.

Yesterday the Surgeon General of Canada issued the latest in a series of annual technical reports on Canada’s great soldier suicide crisis. If you occasionally read the newspapers, and particularly if you ever pick up the Globe and Mail, you have probably been left with the impression that it is astonishing anyone who fought in Afghanistan in a Canadian uniform is still alive and sane. There is a tradition in newspapering, admittedly a recent one, of being very cautious and elliptical in reporting on suicides for fear of encouraging imitators. The Globe observed the run-up to Remembrance Day this year by blowing out the sphincter of that tradition, offering intimate details of suicides by a sequence of Canadian Armed Forces veterans left to struggle with the psychic aftereffects of witnessing combat.

The idea was to point an accusing finger at an unfeeling, ignorant state and to awaken the consciences of those who elect representatives to it. We are all to blame, you see: Canadian soldiers come home with nerves shattered by conflicts to which we have dispatched them, and yet at election time we overlook a lengthening trail of dead and a choir of the emotionally tormented. Veterans scarcely ever turn up in the newspaper, as veterans, without the words “suicide” or “PTSD” nipping at their heels. They are stalked by drink, painkillers, nightmares, uncontrollable outbursts of violence, homelessness. Only by the wildest of chances will one turn up in the news as a successful, well-adjusted individual.

So it is with trepidation and nausea that one turns to the Surgeon General’s report, hoping for a careful epidemiological documentation of the crisis. What one quickly
finds is that when the overwhelmingly male Canadian Forces are compared to the ordinary male population… there is no crisis. Until very recently, CAF members have had significantly lower rates of suicide than male civilians in the same age brackets. The rates are statistically indistinguishable for the most recent time period in the table, 2010-12, owing to a transitory spike in CAF suicides in 2011.

Until very recently, CAF members have had significantly lower rates of suicide than male civilians in the same age brackets

Soldiers are, by this measure, healthier if anything than the average chap. This is not really surprising if you do not read the newspaper, and you merely hold to the old-fashioned idea that the military is pretty good at taking man-children and giving them purpose, abilities, structure, and a social network.

The authors of the report worry, on the basis of the most recent numbers, that the established protective effect of military service, which is a feature often seen by epidemiologists in other countries, may be fading. If so, it is collapsing at a time of ultra-high awareness of post-traumatic stress. This is hard to account for if awareness and treatment helps to prevent rather than foster PTSD.

Who ever mentions in the newspaper that military service might be good for one’s mental or moral health in any respect? An intelligent young person who was accustomed to consuming a steady diet of PTSD porn might well regard a military recruiter as a fatal seducer, a living vector of psychiatric disorder. That young person might even choose some other career known by epidemiologists to carry an actual elevated risk of suicide: jobs involving access to guns, deadly chemicals, or pharmaceuticals are notable for doing so.


Brig. Gen. Lise Bourgon spent months in the Kuwaiti desert leading Canada’s combat contribution to the air war against ISIL in Iraq and Syria.

Award-hunting newspaper editors don’t weave garish tapestries of dead farmers or dentists who did away with themselves at a bad moment in middle age. They could, but, as we say in the business, there’s no peg.

This well-intended anecdote-gathering is bound to become a problem for the military-civilian relationship in this country. We have a permanent bad conscience about soldiers (and sailors and airmen). Through the two World Wars veterans came home in large enough numbers to be familiar — literally to be family — to most of us. Now, in a world of volunteer armed forces, they are reduced to a small group of eccentrics who made a life choice that is mystifying, perhaps even suspicious, to many of us. Military service was rewarded with welfare benefits — education, healthcare, pensions — now granted to all as a matter of right. This leaves us to express appreciation with store-bought yellow ribbons and other gestures we all know to be pathetic.

Newspapermen know they can do something: they can police the failings of the Veterans Affairs department, chronicle snafus in military pensions, housing, and care, and do everything they can to “humanize” vets. Unfortunately, we are best at “humanizing” victims when there is a horror story to tell. Your softball teammate who came home from Kandahar, mind and body intact, to sell Sea-Doos? He’s not good copy. But, like most people who aren’t, he’s the statistical norm.

Perhaps most journalists do not notice what they are collectively teaching: that veterans are sure to be deranged, despairing, and volatile, secretly or otherwise

Veterans, as a group, are outstanding for success in the military afterlife, and most have few regrets about serving their country. Portraying them as a stream of broken toys pouring back from foreign wars on a blood-stained conveyor does not really seem to be helping the less fortunate among them. I defy any colleague, at any title, to deny that this is the picture we have painted. No individual editor or reporter is at fault, although whatever mechanisms our trade has for preventing exploitation do not seem to be functioning well.

Our duty as journalists to uphold political and social obligations to veterans is undoubted, and those who excel at it deserve praise. Perhaps most journalists dislike the sight of a uniform anyway, and do not notice what they are collectively teaching: that veterans are sure to be deranged, despairing, and volatile, secretly or otherwise. Out of truthful stories, we unwittingly build a grand, harmful falsehood.

National Post

http://news.nationalpost.com/full-comment/colby-cosh-the-ptsd-crisis-isnt-a-crisis-and-inventing-one-doesnt-help

Home for good: We must honour living veterans

TIM BLACK
Special to The Globe and Mail
Published Wednesday, Nov. 23, 2016 5:00AM EST
Last updated Tuesday, Nov. 22, 2016 7:58PM EST

Tim Black is director of the Department of Educational Psychology and Leadership Studies at the University of Victoria.

In Canada, veterans’ issues have become almost exclusively focused on post-traumatic stress disorder and suicide as a result of military service in conflict zones. Because of this narrow focus, we’ve learned a tremendous amount in the last 25 years about how to treat PTSD and other mental-health disorders. But there’s a down side. While we’ve been paying such close attention to these more clinical issues, we may be missing the bigger picture of struggles that military members face as they make the transition to civilian life.

As a trauma counsellor working with Canadian veterans for almost 20 years, and as a researcher at the University of Victoria, I’ve witnessed firsthand the tremendous gifts that military service can bestow upon its members. I’ve also seen the devastating costs it can exact not only on veterans but on their families and friends as well.

A few years ago, I conducted a study asking veterans what would have helped them make a more successful transition out of the military. One of veterans’ most common responses, and what really stuck with me, was that it would have helped if civilians understood more about the military way of life.

Men and women who wear the uniform sign a contract agreeing to die for their country, as part of their job, if required. Based on what veterans have shared with me, I’ve come to understand that this changes a person’s perspective of the world. Combat, killing, and witnessing death changes a person, as does service and sacrifice.

All those changes take hold and then, one day, the military member leaves the place where everything makes sense. (Or they are asked to leave because they can no longer meet “universality of service” requirements.) They arrive back in the civilian world and find themselves to be a stranger in a strange land.

Issues of identity loom large for many veterans as they attempt to rejoin a society that often fails to help veterans reconstruct a sense of who they are that helps them find their way in postmilitary life. They suffer with feelings of loneliness, shame, isolation and fear. Reservists are often the hardest hit. I’ve learned that leaving the military doesn’t ensure the veteran will join the world again.

Despite the fact that I grew up in the nation’s capital beside a military family, I knew virtually nothing about their lives. While in Canada, we honour those who died in their service every Nov. 11, I worry that we have yet to find a meaningful way to honour the living, ill and injured veterans who may live in the house right beside us.

Perhaps it is time for we civilians to examine how to help the veteran community return people to their full and rightful place in society and bring them home for good.

I propose that we as a nation establish a day in the spring to honour all living veterans, including those who are ill and injured, for their service.

Tim Black is co-founder of and lead researcher for Couples Overcoming PTSD Everyday, a national program helping veterans and their families learn to manage PTSD in the home.

http://www.theglobeandmail.com/opinion/home-for-good-we-must-honour-living-veterans/article32993270/

Post-traumatic stress an injury, not a disorder, veterans say

By AMANDA FERGUSON
POSTED NOV 10, 2016 4:27 PM EST



Canada’s wounded veterans want the definition of Post-Traumatic Stress Disorder (PTSD) changed — They say growing sentiment and science shows that what soldiers and emergency responders experience is actually an injury.

Joel Guindon, a veteran of the Canadian Armed Forces, says he was diagnosed with PTSD in 2006. It wasn’t until he tapped into a growing movement calling it Post-Traumatic Stress Injury that he began to feel hope.

“When we say an injury, for me, there’s an automatic sensation that I don’t feel as bad about it,” he said. “It’s liberating.”

Guindon completed tours in Bosnia and Afghanistan, and PTSD eventually ended his military career in 2008. He says even then he didn’t feel the word disorder accurately described what he was experiencing.

“It felt like an injury. It felt like something I had sustained,” he said. “A hyper state of vigilance. Constant adrenaline rush. Either numb or extremely angry. Nightmares. Inability to sleep.”

Meanwhile, the Canadian Armed Forces is already behind the growing movement embracing the term PTSI, referring to it as an Operational Stress Injury.

Michael Bains, CEO of Toronto’s Invictus Games, says evidence already shows a positive association among soldiers when using the word injury over disorder. He says the latter carries with it a heavy stigma, especially in the military.

“It’s not about the treatment,” Bains said. “Where it’s going to have a huge impact — and we’ve already seen it here in Canada — [is] those who need help are more likely to come forward if it’s described as an injury and not a disorder.”

Some of Canada’s leading researchers in PTSD say the science also backs up this approach.

Judith Andersen, an assistant professor in psychology at the University of Toronto, says her research with veterans has determined post-traumatic stress can lead to serious physical ailments like cardiovascular disease, metabolic disorders and rheumatoid arthritis.

“I do support the term PTSI,” Andersen said. “My own research and that of my colleagues does indicate that post-traumatic stress is associated with actual injury and physical health conditions.”

For Guindon, who competed in archery for Team Canada in the 2016 Invictus Games in Orlando, says the new name hits the bulls-eye when explaining what he’s been feeling for more than a decade.

“My understanding is that a disorder is something sometimes you are born with,” he said. “I wasn’t born with this. This is injury.”

http://www.citynews.ca/2016/11/10/post-traumatic-stress-injury-not-disorder-veterans-say/[/b]