[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:11.20,0:00:16.80,Default,,0000,0000,0000,,(applause)
Dialogue: 0,0:00:16.80,0:00:22.07,Default,,0000,0000,0000,,3,4-Methylenedioxymethamphetamine: MDMA.
Dialogue: 0,0:00:22.07,0:00:27.49,Default,,0000,0000,0000,,Now you're probably heard of this compound\Nin the context of the recreational drug Ecstasy.
Dialogue: 0,0:00:27.49,0:00:31.77,Default,,0000,0000,0000,,But today I want to talk about MDMA not \Nas a recreational drug,
Dialogue: 0,0:00:31.77,0:00:35.63,Default,,0000,0000,0000,,but as a potential new treatment in medicine.
Dialogue: 0,0:00:35.63,0:00:39.75,Default,,0000,0000,0000,,And then very important treatment \Nfor psychiatry because MDMA could offer us
Dialogue: 0,0:00:39.75,0:00:44.61,Default,,0000,0000,0000,,in psychiatry for the first time the\Nopportunity to tackle trauma.
Dialogue: 0,0:00:45.08,0:00:49.29,Default,,0000,0000,0000,,And psychological trauma particularly that\Ncaused by child abuse and maltreatment
Dialogue: 0,0:00:49.29,0:00:57.14,Default,,0000,0000,0000,,is at the heart of all or most psychiatric\Ndisorders due to anxiety and addictions.
Dialogue: 0,0:00:57.76,0:01:02.07,Default,,0000,0000,0000,,Psychiatry is in need of this \Ninnovative approach,
Dialogue: 0,0:01:00.90,0:01:04.73,Default,,0000,0000,0000,,because current treatments \Nare failing patients.
Dialogue: 0,0:01:06.05,0:01:09.86,Default,,0000,0000,0000,,Hi, my name's Ben Sessa. I'm a child and\Nadolescent psychiatrist.
Dialogue: 0,0:01:09.86,0:01:12.35,Default,,0000,0000,0000,,Now that means I trained as a medical doctor,
Dialogue: 0,0:01:12.35,0:01:14.44,Default,,0000,0000,0000,,then specialized in mental health
Dialogue: 0,0:01:14.44,0:01:17.40,Default,,0000,0000,0000,,and then specialized in child \Nand adolescent mental health.
Dialogue: 0,0:01:17.40,0:01:20.22,Default,,0000,0000,0000,,But for the last five years I've \Nbeen working with adults with
Dialogue: 0,0:01:20.22,0:01:24.48,Default,,0000,0000,0000,,mental health disorders and addictions\Ndue to misuse of drugs.
Dialogue: 0,0:01:24.48,0:01:27.51,Default,,0000,0000,0000,,And that developmental pathway \Nof my own,
Dialogue: 0,0:01:27.51,0:01:30.30,Default,,0000,0000,0000,,from working with child abuse into adults
Dialogue: 0,0:01:30.30,0:01:34.07,Default,,0000,0000,0000,,with mental disorders and addictions has\Nbrought me to the door of MDMA.
Dialogue: 0,0:01:34.83,0:01:37.30,Default,,0000,0000,0000,,And I'm gonna propose today \Nthat MDMA could be
Dialogue: 0,0:01:37.30,0:01:41.70,Default,,0000,0000,0000,,important for the future of psychiatry\Nas the discovery of antibiotics was
Dialogue: 0,0:01:41.70,0:01:44.50,Default,,0000,0000,0000,,for general medicine a hundred years ago.
Dialogue: 0,0:01:44.100,0:01:51.09,Default,,0000,0000,0000,,So when we think about child abuse we think\Nabout physical abuse, mental abuse,
Dialogue: 0,0:01:51.09,0:01:54.43,Default,,0000,0000,0000,,emotional abuse, sexual abuse and neglect.
Dialogue: 0,0:01:55.37,0:01:58.18,Default,,0000,0000,0000,,And we think about noxious environments.
Dialogue: 0,0:01:58.18,0:02:00.22,Default,,0000,0000,0000,,We think about parents with mental disorder. \N
Dialogue: 0,0:02:00.22,0:02:02.45,Default,,0000,0000,0000,,We think about parents\Nwho are addicted to drugs.
Dialogue: 0,0:02:00.22,0:02:06.71,Default,,0000,0000,0000,,And social issues like poverty and\Npoor housing, poor education.
Dialogue: 0,0:02:07.39,0:02:10.26,Default,,0000,0000,0000,,Now I'm going to illustrate my talk\Ntoday with a patient
Dialogue: 0,0:02:10.26,0:02:12.33,Default,,0000,0000,0000,,and I'm going to call her Claire.
Dialogue: 0,0:02:12.33,0:02:16.02,Default,,0000,0000,0000,,Now Claire was no single particular\Npatient of mine.
Dialogue: 0,0:02:16.06,0:02:18.64,Default,,0000,0000,0000,,Rather she's an amalgamation\Nof many different people
Dialogue: 0,0:02:18.64,0:02:22.07,Default,,0000,0000,0000,,I've met in the last 18 years working\Nas a medical doctor.
Dialogue: 0,0:02:23.35,0:02:25.06,Default,,0000,0000,0000,,She's certainly not the worst.
Dialogue: 0,0:02:25.82,0:02:29.17,Default,,0000,0000,0000,,Now what was Claire's environment like \Nwhen she was growing up?
Dialogue: 0,0:02:29.17,0:02:31.38,Default,,0000,0000,0000,,Well, her mother was depressed.
Dialogue: 0,0:02:31.38,0:02:34.89,Default,,0000,0000,0000,,Now unfortunately the family\Ndoctor didn't have time to accurately
Dialogue: 0,0:02:34.89,0:02:37.67,Default,,0000,0000,0000,,diagnose and treat depression, rather,
Dialogue: 0,0:02:37.67,0:02:40.62,Default,,0000,0000,0000,,Claire's mother was put onto one\Nantidepressant after another,
Dialogue: 0,0:02:40.62,0:02:42.69,Default,,0000,0000,0000,,never really got therapy.
Dialogue: 0,0:02:42.69,0:02:45.14,Default,,0000,0000,0000,,Claire's mother also had a lot of aches and pains
Dialogue: 0,0:02:45.14,0:02:48.11,Default,,0000,0000,0000,,typical what we call \Npsychosomatic symptoms in depression,
Dialogue: 0,0:02:48.11,0:02:52.85,Default,,0000,0000,0000,,and as a result the family doctor \Nput her on to opiate based painkillers
Dialogue: 0,0:02:52.85,0:02:55.61,Default,,0000,0000,0000,,which she promptly became addicted to.
Dialogue: 0,0:02:55.95,0:02:59.10,Default,,0000,0000,0000,,Now Claire's father, now he was alcoholic and he was often
Dialogue: 0,0:02:59.10,0:03:01.11,Default,,0000,0000,0000,,not around in and out of prison.
Dialogue: 0,0:03:01.11,0:03:03.16,Default,,0000,0000,0000,,Which is just as well because when he was\Nthere
Dialogue: 0,0:03:03.16,0:03:06.39,Default,,0000,0000,0000,,he was physically abusive to Claire\Nand her mother.
Dialogue: 0,0:03:06.39,0:03:08.13,Default,,0000,0000,0000,,Okay so what does this kind
Dialogue: 0,0:03:08.13,0:03:10.94,Default,,0000,0000,0000,,of chaotic, frightening environment do
Dialogue: 0,0:03:10.94,0:03:13.72,Default,,0000,0000,0000,,to the developing child brain?
Dialogue: 0,0:03:13.72,0:03:16.71,Default,,0000,0000,0000,,I'm going to give you a brief\Nneurophysiology lesson if I may.
Dialogue: 0,0:03:16.71,0:03:19.65,Default,,0000,0000,0000,,There's a part of the brain called the amygdala.
Dialogue: 0,0:03:19.65,0:03:23.03,Default,,0000,0000,0000,,Now the amygdala is a very\Nancient part of the mammalian brain
Dialogue: 0,0:03:23.03,0:03:26.58,Default,,0000,0000,0000,,and many other animals other than humans\Nhave an amygdala.
Dialogue: 0,0:03:26.58,0:03:29.51,Default,,0000,0000,0000,,The amygdala lights up when stimulated by
Dialogue: 0,0:03:29.51,0:03:32.60,Default,,0000,0000,0000,,fear in the environment,\Nby a frightening stimulus.
Dialogue: 0,0:03:32.60,0:03:36.85,Default,,0000,0000,0000,,It lights up and it says:\Nfight-or-flight, get out!
Dialogue: 0,0:03:36.85,0:03:40.17,Default,,0000,0000,0000,,Now there's another part of the brain\Nmuch more sophisticated part,
Dialogue: 0,0:03:40.17,0:03:44.11,Default,,0000,0000,0000,,called the prefrontal cortex and it's\Nright here at the front above the eyes.
Dialogue: 0,0:03:44.11,0:03:47.36,Default,,0000,0000,0000,,Now the prefrontal cortex only humans have.
Dialogue: 0,0:03:47.36,0:03:52.50,Default,,0000,0000,0000,,And it's in the prefrontal cortex\Nwhere we use logic and reasoning to
Dialogue: 0,0:03:52.50,0:03:55.13,Default,,0000,0000,0000,,rationalize the situation and we can use
Dialogue: 0,0:03:55.13,0:03:57.78,Default,,0000,0000,0000,,our prefrontal cortex to overcome that
Dialogue: 0,0:03:57.78,0:04:00.67,Default,,0000,0000,0000,,instinctive fear response from the amygdala.
Dialogue: 0,0:04:00.67,0:04:02.75,Default,,0000,0000,0000,,Now when Claire was growing up
Dialogue: 0,0:04:02.75,0:04:04.71,Default,,0000,0000,0000,,she never knew from one moment to the next
Dialogue: 0,0:04:04.71,0:04:07.52,Default,,0000,0000,0000,,whether the adult coming into the room,\Nwere they going to give her a kiss
Dialogue: 0,0:04:07.52,0:04:09.77,Default,,0000,0000,0000,,or a cuddle or do a jigsaw with her,
Dialogue: 0,0:04:09.77,0:04:11.96,Default,,0000,0000,0000,,or were they going to punch her or kick her
Dialogue: 0,0:04:11.96,0:04:14.33,Default,,0000,0000,0000,,or burn her with their cigarette.
Dialogue: 0,0:04:14.33,0:04:16.71,Default,,0000,0000,0000,,Or were they going to rape her.
Dialogue: 0,0:04:16.71,0:04:20.41,Default,,0000,0000,0000,,Because throughout her childhood\NClaire was also subjected to sexual abuse.
Dialogue: 0,0:04:21.63,0:04:25.80,Default,,0000,0000,0000,,Now, there's a group of disorders\Ncalled the anxiety disorders,
Dialogue: 0,0:04:25.80,0:04:27.16,Default,,0000,0000,0000,,and one of the most important
Dialogue: 0,0:04:27.16,0:04:31.84,Default,,0000,0000,0000,,is what we call\Npost-traumatic stress disorder or PTSD.
Dialogue: 0,0:04:31.84,0:04:34.84,Default,,0000,0000,0000,,Now PTSD, some of the core features:
Dialogue: 0,0:04:34.84,0:04:38.61,Default,,0000,0000,0000,,very low mood, anxiety,\Nhigh levels of anxiety,
Dialogue: 0,0:04:38.61,0:04:40.83,Default,,0000,0000,0000,,what we call hyper vigilance:
Dialogue: 0,0:04:40.83,0:04:43.25,Default,,0000,0000,0000,,this edginess, this jumpiness.
Dialogue: 0,0:04:43.25,0:04:46.86,Default,,0000,0000,0000,,Exactly how Claire felt \Nthroughout her childhood and adolescence.
Dialogue: 0,0:04:46.86,0:04:49.65,Default,,0000,0000,0000,,Never knowing whether\Nthe next assailant or assault
Dialogue: 0,0:04:49.65,0:04:51.85,Default,,0000,0000,0000,,was around the corner.
Dialogue: 0,0:04:51.85,0:04:56.46,Default,,0000,0000,0000,,Another core feature of PTSD,\Nwhat we call re-experiencing phenomena.
Dialogue: 0,0:04:56.46,0:05:01.52,Default,,0000,0000,0000,,Flashbacks, when the patient has sudden\Nremembrances of painful traumatic memories.
Dialogue: 0,0:05:01.52,0:05:02.94,Default,,0000,0000,0000,,They can just pop into the head
Dialogue: 0,0:05:02.94,0:05:07.32,Default,,0000,0000,0000,,at any time, triggered by\Nsome cue in the environment.
Dialogue: 0,0:05:07.32,0:05:10.77,Default,,0000,0000,0000,,And when they have those experiences,\Nthose daytime flashbacks,
Dialogue: 0,0:05:10.77,0:05:15.05,Default,,0000,0000,0000,,they relive the trauma in all the\Nsensory modalities and this results in
Dialogue: 0,0:05:15.05,0:05:19.22,Default,,0000,0000,0000,,them freezing or dissociating\Nto try and block out the pain.
Dialogue: 0,0:05:19.85,0:05:23.41,Default,,0000,0000,0000,,Claire experienced all of this\Nas she was growing up.
Dialogue: 0,0:05:24.45,0:05:29.45,Default,,0000,0000,0000,,High levels of self-harm and suicide\Nare associated with PTSD.
Dialogue: 0,0:05:29.45,0:05:32.07,Default,,0000,0000,0000,,Claire would cut her thighs and her breasts.
Dialogue: 0,0:05:32.67,0:05:37.27,Default,,0000,0000,0000,,Pretty common form of cutting in\Nchildren who've been sexually abused.
Dialogue: 0,0:05:37.27,0:05:40.01,Default,,0000,0000,0000,,She was being sexually abused\Nby her mother's clients,
Dialogue: 0,0:05:40.01,0:05:43.60,Default,,0000,0000,0000,,because her mother had moved on\Nfrom the addiction to painkillers and
Dialogue: 0,0:05:43.60,0:05:46.89,Default,,0000,0000,0000,,was using street heroin\Nwhen Claire was a teenager.
Dialogue: 0,0:05:46.89,0:05:51.31,Default,,0000,0000,0000,,Because of the way the war on drugs has\Nset up that reduces access to treatment
Dialogue: 0,0:05:51.31,0:05:54.79,Default,,0000,0000,0000,,for people with opiate dependence,\Nshe had to pay for her
Dialogue: 0,0:05:54.79,0:05:58.94,Default,,0000,0000,0000,,heroin using sex work and the clients\Nwould sexually abuse Claire.
Dialogue: 0,0:06:00.32,0:06:05.17,Default,,0000,0000,0000,,It's very hard to treat PTSD and it has a high treatment resistance,
Dialogue: 0,0:06:05.17,0:06:09.38,Default,,0000,0000,0000,,50% of people do not respond to the traditional treatments.
Dialogue: 0,0:06:09.92,0:06:11.32,Default,,0000,0000,0000,,How do we treat it?
Dialogue: 0,0:06:11.32,0:06:14.98,Default,,0000,0000,0000,,We can treat it with medications. We can treat it with psychotherapies.
Dialogue: 0,0:06:14.98,0:06:18.90,Default,,0000,0000,0000,,And the medications we use:\Nthere's a broad range of drugs.
Dialogue: 0,0:06:18.90,0:06:24.52,Default,,0000,0000,0000,,No single drug, and this is very important,\Nno single drug cures PTSD.
Dialogue: 0,0:06:24.52,0:06:27.21,Default,,0000,0000,0000,,Rather we treat the disorder symptomatically:
Dialogue: 0,0:06:27.22,0:06:30.25,Default,,0000,0000,0000,,If the patient's depressed\Ngive them an antidepressant.
Dialogue: 0,0:06:30.25,0:06:33.80,Default,,0000,0000,0000,,If their mood fluctuates give them a mood stabilizer.
Dialogue: 0,0:06:33.80,0:06:36.67,Default,,0000,0000,0000,,If they can't sleep give them a hypnotic.
Dialogue: 0,0:06:36.67,0:06:40.80,Default,,0000,0000,0000,,And if that edginess and that fear \Nspills over into paranoia and psychosis,
Dialogue: 0,0:06:40.80,0:06:43.88,Default,,0000,0000,0000,,give the patient an anti-psychotic drug.
Dialogue: 0,0:06:43.88,0:06:48.24,Default,,0000,0000,0000,,And they have to take these drugs\Nday in day out for weeks, months, decades.
Dialogue: 0,0:06:48.24,0:06:53.71,Default,,0000,0000,0000,,They have to keep taking them because\Nthe drugs we use to treat trauma when it's
Dialogue: 0,0:06:53.71,0:06:59.32,Default,,0000,0000,0000,,due to this level of severity do not attack the root cause of trauma.
Dialogue: 0,0:06:59.32,0:07:01.57,Default,,0000,0000,0000,,They paper over the cracks.
Dialogue: 0,0:07:01.57,0:07:07.70,Default,,0000,0000,0000,,A good analogy would be taking aspirin\Nor ibuprofen when you have a fever.
Dialogue: 0,0:07:07.70,0:07:13.10,Default,,0000,0000,0000,,A fever is caused by an infection, by a microorganism.
Dialogue: 0,0:07:13.10,0:07:17.68,Default,,0000,0000,0000,,Sure, you can take paracetamol or ibuprofen\Nand this will lower the temperature
Dialogue: 0,0:07:17.68,0:07:22.19,Default,,0000,0000,0000,,and make you feel a bit better but it doesn't attack the root cause.
Dialogue: 0,0:07:22.19,0:07:26.56,Default,,0000,0000,0000,,And that's what we do when we give these patients these daily SSRI drugs.
Dialogue: 0,0:07:26.56,0:07:27.86,Default,,0000,0000,0000,,We paper over the cracks.
Dialogue: 0,0:07:27.86,0:07:32.09,Default,,0000,0000,0000,,We maintain the symptoms at a manageable level.
Dialogue: 0,0:07:32.09,0:07:35.64,Default,,0000,0000,0000,,We also use psychotherapies to treat PTSD, and there's
Dialogue: 0,0:07:35.64,0:07:41.79,Default,,0000,0000,0000,,again a broad range of these: DBT, CBT,\NEMDR, trauma focused psychotherapy,
Dialogue: 0,0:07:41.79,0:07:45.01,Default,,0000,0000,0000,,CAT, APT... Now all of them have a pretty
Dialogue: 0,0:07:45.01,0:07:48.81,Default,,0000,0000,0000,,similar approach which actually is an old wives tales which is:
Dialogue: 0,0:07:48.81,0:07:51.21,Default,,0000,0000,0000,,a problem shared is a problem halved.
Dialogue: 0,0:07:51.21,0:07:56.32,Default,,0000,0000,0000,,"Let's talk about your trauma.\NClaire tell me about your rape."
Dialogue: 0,0:07:56.32,0:08:03.85,Default,,0000,0000,0000,,Now that's fine for 50% of patients but for\Na significant half they just cannot do that.
Dialogue: 0,0:08:03.85,0:08:07.44,Default,,0000,0000,0000,,As soon as Claire is asked to talk about her rape she freezes,
Dialogue: 0,0:08:07.44,0:08:10.36,Default,,0000,0000,0000,,she flees, she drops out of treatment.
Dialogue: 0,0:08:10.36,0:08:14.32,Default,,0000,0000,0000,,By the time she was 15 Claire had been\Nremoved from the family home and she was
Dialogue: 0,0:08:14.32,0:08:18.32,Default,,0000,0000,0000,,brought up in a succession of foster\Nplacements and children's houses and
Dialogue: 0,0:08:18.45,0:08:21.56,Default,,0000,0000,0000,,hostels where the abuse continued.
Dialogue: 0,0:08:22.16,0:08:25.34,Default,,0000,0000,0000,,She was self-harm cutting and\Nshe started drinking and
Dialogue: 0,0:08:25.34,0:08:29.26,Default,,0000,0000,0000,,by the time she was 18,\Nshe was using heroin as well.
Dialogue: 0,0:08:29.26,0:08:34.01,Default,,0000,0000,0000,,Sometimes working in psychiatry can feel\Npretty desperate, can feel pretty hopeless.
Dialogue: 0,0:08:34.41,0:08:39.16,Default,,0000,0000,0000,,Sometimes it feels as if psychiatry\Nis a palliative care profession.
Dialogue: 0,0:08:39.16,0:08:42.11,Default,,0000,0000,0000,,And this is the truth because\Nthe treatments we use do not get to the
Dialogue: 0,0:08:42.11,0:08:44.56,Default,,0000,0000,0000,,root cause of the problem, the trauma.
Dialogue: 0,0:08:44.56,0:08:46.74,Default,,0000,0000,0000,,They paper over the cracks.
Dialogue: 0,0:08:46.74,0:08:50.09,Default,,0000,0000,0000,,And I think the pharma industry know this\Nand they queue up and they
Dialogue: 0,0:08:50.09,0:08:53.51,Default,,0000,0000,0000,,provide us with product after product to\Ngive to our patients that doesn't quite
Dialogue: 0,0:08:53.51,0:08:58.38,Default,,0000,0000,0000,,cure them but it gets them slightly better to function.
Dialogue: 0,0:08:58.38,0:09:00.37,Default,,0000,0000,0000,,And they have to keep taking them.
Dialogue: 0,0:09:00.37,0:09:04.80,Default,,0000,0000,0000,,I would say that we're in psychiatry today where\Nwe were in general medicine 100 years ago.
Dialogue: 0,0:09:04.80,0:09:06.54,Default,,0000,0000,0000,,100 years ago in general medicine,
Dialogue: 0,0:09:06.54,0:09:10.16,Default,,0000,0000,0000,,humanity was losing the battle to the infectious diseases.
Dialogue: 0,0:09:10.16,0:09:12.76,Default,,0000,0000,0000,,Oh we were very good at classifying and diagnosing them.
Dialogue: 0,0:09:12.80,0:09:14.77,Default,,0000,0000,0000,,We knew who got smallpox.
Dialogue: 0,0:09:14.77,0:09:17.32,Default,,0000,0000,0000,,We knew people died of post-operative surgery.
Dialogue: 0,0:09:17.32,0:09:20.64,Default,,0000,0000,0000,,We knew there were microorganisms \Nbut we didn't have a treatment.
Dialogue: 0,0:09:20.64,0:09:25.85,Default,,0000,0000,0000,,And then at the beginning of the 20th century we discovered the antibiotics.
Dialogue: 0,0:09:25.85,0:09:29.81,Default,,0000,0000,0000,,Not symptomatic treatment but treatment\Nthat goes to the core of the cause
Dialogue: 0,0:09:29.81,0:09:33.66,Default,,0000,0000,0000,,and we started getting on top \Nof infectious disease.
Dialogue: 0,0:09:33.76,0:09:37.09,Default,,0000,0000,0000,,Psychiatry today is in a similar place.
Dialogue: 0,0:09:37.09,0:09:39.55,Default,,0000,0000,0000,,We're very good at classifying and diagnosing.
Dialogue: 0,0:09:39.55,0:09:41.67,Default,,0000,0000,0000,,Our epidemiology is superb.
Dialogue: 0,0:09:41.67,0:09:44.00,Default,,0000,0000,0000,,We write these thick diagnostic manuals.
Dialogue: 0,0:09:44.00,0:09:45.53,Default,,0000,0000,0000,,We know who gets depression.
Dialogue: 0,0:09:45.53,0:09:47.07,Default,,0000,0000,0000,,We know who gets anxiety.
Dialogue: 0,0:09:47.07,0:09:53.70,Default,,0000,0000,0000,,We even know the cause: trauma, child abuse,\Nmaltreatment, poor social conditions.
Dialogue: 0,0:09:53.70,0:09:56.15,Default,,0000,0000,0000,,But our treatments are lousy.
Dialogue: 0,0:09:57.81,0:10:00.82,Default,,0000,0000,0000,,And I'm quite shocked the way the empathy
Dialogue: 0,0:10:00.82,0:10:05.03,Default,,0000,0000,0000,,switch and our understanding of these\Npatients seems to be switched off.
Dialogue: 0,0:10:05.55,0:10:09.52,Default,,0000,0000,0000,,We have lots of gushing sentimentality for\Nthe little five and six year old who's
Dialogue: 0,0:10:09.52,0:10:14.71,Default,,0000,0000,0000,,being abused and we throw money at our\Ntelevision sets on these campaigns to
Dialogue: 0,0:10:14.71,0:10:17.93,Default,,0000,0000,0000,,improve the lives of these\Npoor little innocent victims.
Dialogue: 0,0:10:17.93,0:10:20.50,Default,,0000,0000,0000,,Well, let me tell you what happens to that little five or six year old,
Dialogue: 0,0:10:20.50,0:10:23.18,Default,,0000,0000,0000,,when they're 11 or 12.
Dialogue: 0,0:10:23.18,0:10:26.83,Default,,0000,0000,0000,,On goes the hood, start smoking weed.
Dialogue: 0,0:10:26.83,0:10:29.36,Default,,0000,0000,0000,,By the time they're 16 they're buying and selling amphetamine
Dialogue: 0,0:10:29.36,0:10:31.49,Default,,0000,0000,0000,,and by the time they're Claire's age in their mid-20s,
Dialogue: 0,0:10:31.49,0:10:33.67,Default,,0000,0000,0000,,they're addicted to heroin and alcohol.
Dialogue: 0,0:10:33.67,0:10:36.58,Default,,0000,0000,0000,,And suddenly we have lost our empathy.
Dialogue: 0,0:10:36.58,0:10:39.45,Default,,0000,0000,0000,,These people are public enemy number one.
Dialogue: 0,0:10:39.45,0:10:45.16,Default,,0000,0000,0000,,"It's your fault Claire. You brought this\Nupon yourself. It's your lifestyle choice."
Dialogue: 0,0:10:45.16,0:10:50.40,Default,,0000,0000,0000,,And I'm quite shocked and having worked in\Npediatrics and seen the developmental
Dialogue: 0,0:10:50.40,0:10:55.30,Default,,0000,0000,0000,,trajectory that is so inevitable from\Nearly trauma into adolescent and then
Dialogue: 0,0:10:55.30,0:10:59.08,Default,,0000,0000,0000,,adult mental health and addictions, we have\Nto hold on to that sense of compassion
Dialogue: 0,0:10:59.08,0:11:04.47,Default,,0000,0000,0000,,and evidence-based understanding\Nabout the developmental trajectory there.
Dialogue: 0,0:11:05.72,0:11:08.72,Default,,0000,0000,0000,,So it does sound desperate,\Nbut all is not lost.
Dialogue: 0,0:11:09.74,0:11:14.22,Default,,0000,0000,0000,,MDMA. MDMA has some fascinating qualities.
Dialogue: 0,0:11:14.22,0:11:19.41,Default,,0000,0000,0000,,I would suggest that if you were to invent\Na hypothetical drug to treat trauma,
Dialogue: 0,0:11:19.41,0:11:21.94,Default,,0000,0000,0000,,it would be MDMA.
Dialogue: 0,0:11:21.94,0:11:25.61,Default,,0000,0000,0000,,The way it works in terms of its receptors\Nand its subjective psychological effects
Dialogue: 0,0:11:25.61,0:11:27.55,Default,,0000,0000,0000,,ticks all the right boxes.
Dialogue: 0,0:11:27.55,0:11:31.42,Default,,0000,0000,0000,,At one level of receptors it causes\Na increased positive mood.
Dialogue: 0,0:11:31.42,0:11:34.20,Default,,0000,0000,0000,,Lowering of depression, lowering of anxiety.
Dialogue: 0,0:11:34.20,0:11:37.16,Default,,0000,0000,0000,,At another group of receptors it speeds\Nthe patient up,
Dialogue: 0,0:11:37.16,0:11:41.57,Default,,0000,0000,0000,,mild stimulation which motivates them\Nto engage in therapy.
Dialogue: 0,0:11:41.57,0:11:45.14,Default,,0000,0000,0000,,At another level it relaxes\Nthe patient paradoxically
Dialogue: 0,0:11:45.14,0:11:50.12,Default,,0000,0000,0000,,at the same time as the stimulation and this\Nputs the patient into the optimal arousal
Dialogue: 0,0:11:50.12,0:11:53.33,Default,,0000,0000,0000,,zone where they can engage in psychotherapy.
Dialogue: 0,0:11:53.33,0:11:58.61,Default,,0000,0000,0000,,But perhaps the most important thing about\NMDMA and the most important clinical tool
Dialogue: 0,0:11:58.61,0:12:06.02,Default,,0000,0000,0000,,is its ability to provide a sense of empathy\Nand understanding and emotional security.
Dialogue: 0,0:12:06.96,0:12:12.23,Default,,0000,0000,0000,,It can hold the patient in a place where\Nthey can think about and access their trauma
Dialogue: 0,0:12:12.23,0:12:15.31,Default,,0000,0000,0000,,like they've never been able to do before.
Dialogue: 0,0:12:15.71,0:12:17.69,Default,,0000,0000,0000,,One of the ways in which MDMA works is
Dialogue: 0,0:12:17.69,0:12:21.65,Default,,0000,0000,0000,,it increases the release of a\Nhormone called oxytocin.
Dialogue: 0,0:12:21.65,0:12:25.60,Default,,0000,0000,0000,,Oxytocin is released from the brains of\Nbreastfeeding mothers.
Dialogue: 0,0:12:25.60,0:12:28.76,Default,,0000,0000,0000,,It's a hormone that engenders a sense of\Nattachment and bonding.
Dialogue: 0,0:12:28.76,0:12:32.71,Default,,0000,0000,0000,,And that's what's happening in the\Npatient who takes MDMA.
Dialogue: 0,0:12:32.71,0:12:36.45,Default,,0000,0000,0000,,And also it acts directly on\Nthe amygdala to reduce
Dialogue: 0,0:12:36.45,0:12:41.28,Default,,0000,0000,0000,,that fear response whilst at the same\Ntime boosting the prefrontal response,
Dialogue: 0,0:12:41.28,0:12:44.24,Default,,0000,0000,0000,,allowing the patient to see things in a new light.
Dialogue: 0,0:12:44.24,0:12:46.13,Default,,0000,0000,0000,,A positive light.
Dialogue: 0,0:12:46.13,0:12:48.32,Default,,0000,0000,0000,,So let's go back to Claire.
Dialogue: 0,0:12:48.32,0:12:50.34,Default,,0000,0000,0000,,She's 40 now.
Dialogue: 0,0:12:50.34,0:12:52.95,Default,,0000,0000,0000,,She's been in and out of psychiatric hospitals,
Dialogue: 0,0:12:52.95,0:12:55.21,Default,,0000,0000,0000,,having tried to take her own life\Nand the inception.
Dialogue: 0,0:12:55.21,0:12:58.64,Default,,0000,0000,0000,,She's been on all the antipsychotic and antidepressant mood stabiliser drugs.
Dialogue: 0,0:12:58.64,0:13:01.56,Default,,0000,0000,0000,,She's tried all the psychotherapies but she cannot engage
Dialogue: 0,0:13:01.56,0:13:05.89,Default,,0000,0000,0000,,because she will not talk about her feelings.
Dialogue: 0,0:13:05.89,0:13:11.16,Default,,0000,0000,0000,,So she comes into a course of\NMDMA-assisted psychotherapy.
Dialogue: 0,0:13:11.86,0:13:13.38,Default,,0000,0000,0000,,What does it look like?
Dialogue: 0,0:13:13.38,0:13:17.81,Default,,0000,0000,0000,,It's weekly sessions, maybe eight, ten,\Ntwelve weeks long.
Dialogue: 0,0:13:17.81,0:13:20.60,Default,,0000,0000,0000,,There're two therapists, male-female pair.
Dialogue: 0,0:13:20.60,0:13:25.36,Default,,0000,0000,0000,,You do not take MDMA everyday,\Nyou do not take it every week.
Dialogue: 0,0:13:25.36,0:13:29.26,Default,,0000,0000,0000,,Over that course of 12 sessions you'll\Ntake the MDMA three times and the
Dialogue: 0,0:13:29.26,0:13:34.39,Default,,0000,0000,0000,,other sessions you talk about the material\Nthat's released on the MDMA session.
Dialogue: 0,0:13:35.01,0:13:39.91,Default,,0000,0000,0000,,So what does Claire actually feel\Nwhen she takes this MDMA?
Dialogue: 0,0:13:39.91,0:13:46.29,Default,,0000,0000,0000,,What she feels is a sense of warmth and\Nunderstanding and a sense of containment
Dialogue: 0,0:13:46.29,0:13:51.10,Default,,0000,0000,0000,,within that relationship she's having\Nwith the therapist.
Dialogue: 0,0:13:51.10,0:13:55.55,Default,,0000,0000,0000,,MDMA is like a lifejacket like a bulletproof vest\N
Dialogue: 0,0:13:55.55,0:13:58.87,Default,,0000,0000,0000,,to wear to go into battle with your trauma.
Dialogue: 0,0:13:58.87,0:14:01.17,Default,,0000,0000,0000,,This is not ecstasy!
Dialogue: 0,0:14:01.17,0:14:06.31,Default,,0000,0000,0000,,She's not enjoying some raver's euphoric ecstasy delight.
Dialogue: 0,0:14:06.31,0:14:10.79,Default,,0000,0000,0000,,This is still trauma focused psychotherapy\Nand it is still hard and distressing for her,
Dialogue: 0,0:14:10.79,0:14:14.93,Default,,0000,0000,0000,,but she can just about do it with MDMA on board.
Dialogue: 0,0:14:14.93,0:14:19.91,Default,,0000,0000,0000,,So when the therapist says:\N"Claire, tell me about your rape".
Dialogue: 0,0:14:19.91,0:14:22.32,Default,,0000,0000,0000,,In the past just the word rape and she'd be out the door,
Dialogue: 0,0:14:22.32,0:14:25.89,Default,,0000,0000,0000,,but on MDMA she says:\N"yeah, I can talk about that!
Dialogue: 0,0:14:25.89,0:14:31.90,Default,,0000,0000,0000,,I can see him now coming into the room.\NI can smell the whiskey on his breath and
Dialogue: 0,0:14:31.90,0:14:35.83,Default,,0000,0000,0000,,I can feel the stubble on his face\Nas he's raping me".
Dialogue: 0,0:14:35.83,0:14:40.28,Default,,0000,0000,0000,,And she talks about it and she explores it\Nand she reflects upon it
Dialogue: 0,0:14:40.28,0:14:42.99,Default,,0000,0000,0000,,and she can begin the process of healing.
Dialogue: 0,0:14:42.99,0:14:45.64,Default,,0000,0000,0000,,And from here she can start her journey.
Dialogue: 0,0:14:45.64,0:14:48.89,Default,,0000,0000,0000,,She can attack the root cause of her problems.
Dialogue: 0,0:14:48.89,0:14:52.73,Default,,0000,0000,0000,,Not just maintain the symptoms at a level.
Dialogue: 0,0:14:54.99,0:14:56.83,Default,,0000,0000,0000,,So, does it work?
Dialogue: 0,0:14:56.83,0:14:59.44,Default,,0000,0000,0000,,Well, we've known about MDMA\Nfor very long time
Dialogue: 0,0:14:59.44,0:15:04.53,Default,,0000,0000,0000,,and indeed we've used MDMA in\Nunderground therapy for 30 or 40 years.
Dialogue: 0,0:15:04.53,0:15:07.41,Default,,0000,0000,0000,,And there are thousands of\Npositive anecdotal cases.
Dialogue: 0,0:15:07.41,0:15:12.73,Default,,0000,0000,0000,,I get five emails a week from all over the\Nworld: "Dr. Sessa, I've had PTSD for years.
Dialogue: 0,0:15:12.73,0:15:17.39,Default,,0000,0000,0000,,I've tried everything and now I tried MDMA\Nand I'm starting to make a breakthrough!"\N
Dialogue: 0,0:15:17.47,0:15:21.27,Default,,0000,0000,0000,,Now, anecdotal reports like that are\Ninteresting but they're not science so
Dialogue: 0,0:15:21.27,0:15:23.15,Default,,0000,0000,0000,,we've done the science.
Dialogue: 0,0:15:23.15,0:15:26.12,Default,,0000,0000,0000,,And some important studies in recent years.
Dialogue: 0,0:15:26.12,0:15:32.61,Default,,0000,0000,0000,,Big study in the States showed that a single\Ncourse of MDMA therapy, 16-week course,
Dialogue: 0,0:15:32.61,0:15:36.46,Default,,0000,0000,0000,,patient takes MDMA three times\Ntested against a placebo.
Dialogue: 0,0:15:36.46,0:15:44.13,Default,,0000,0000,0000,,At the end of that course 85% of the people no\Nlonger met the diagnostic criteria for PTSD.
Dialogue: 0,0:15:44.13,0:15:48.82,Default,,0000,0000,0000,,Not just a relief of symptoms,\Nthey didn't have PTSD!
Dialogue: 0,0:15:48.82,0:15:54.01,Default,,0000,0000,0000,,Now that cohort were then followed up\Nthree years later, the same no PTSD.
Dialogue: 0,0:15:54.01,0:15:57.95,Default,,0000,0000,0000,,Many of those people had come of\Ntheir daily medications.
Dialogue: 0,0:15:57.95,0:16:03.19,Default,,0000,0000,0000,,They were cured! We don't use the word\N"cure" in psychiatry.
Dialogue: 0,0:16:03.19,0:16:08.35,Default,,0000,0000,0000,,We've become learned helplessness\Nposition of--This is the truth!
Dialogue: 0,0:16:08.35,0:16:11.100,Default,,0000,0000,0000,,If you're diagnosed with a severe\Nmental disorder like anxiety or depression
Dialogue: 0,0:16:11.100,0:16:16.58,Default,,0000,0000,0000,,in your 20s, and the developmental route\Nof that disorder is severe child abuse,
Dialogue: 0,0:16:16.58,0:16:19.43,Default,,0000,0000,0000,,there's a pretty good chance chance--\Nand I'm sorry to say this--
Dialogue: 0,0:16:19.43,0:16:21.93,Default,,0000,0000,0000,,there's a pretty good chance you\Nwill still be going to
Dialogue: 0,0:16:21.93,0:16:24.05,Default,,0000,0000,0000,,psychiatric clinics in your 60s and 70s.
Dialogue: 0,0:16:24.05,0:16:28.81,Default,,0000,0000,0000,,Now that is not good enough and
Dialogue: 0,0:16:26.59,0:16:33.37,Default,,0000,0000,0000,,we're in this position because we're not
Dialogue: 0,0:16:28.81,0:16:36.82,Default,,0000,0000,0000,,tackling trauma. So, it works but is it
Dialogue: 0,0:16:33.37,0:16:39.61,Default,,0000,0000,0000,,safe? Well, when we talk about safety of
Dialogue: 0,0:16:36.82,0:16:42.64,Default,,0000,0000,0000,,clinical MDMA, what we must not do is
Dialogue: 0,0:16:39.61,0:16:45.79,Default,,0000,0000,0000,,look at the risks of recreational
Dialogue: 0,0:16:42.64,0:16:46.72,Default,,0000,0000,0000,,ecstasy. I don't even know what ecstasy
Dialogue: 0,0:16:45.79,0:16:48.79,Default,,0000,0000,0000,,is anymore!
Dialogue: 0,0:16:46.72,0:16:51.55,Default,,0000,0000,0000,,Ecstasy is over here, what is ecstasy?
Dialogue: 0,0:16:48.79,0:16:54.10,Default,,0000,0000,0000,,Some dodgy pill bought in some dodgy
Dialogue: 0,0:16:51.55,0:16:56.89,Default,,0000,0000,0000,,club of some dodgy geezer, that may or
Dialogue: 0,0:16:54.10,0:17:00.48,Default,,0000,0000,0000,,may not contain MDMA plus or minus
Dialogue: 0,0:16:56.89,0:17:03.04,Default,,0000,0000,0000,,whatever far more toxic substance. And
Dialogue: 0,0:17:00.48,0:17:05.11,Default,,0000,0000,0000,,indeed when you hear about the very
Dialogue: 0,0:17:03.04,0:17:10.36,Default,,0000,0000,0000,,high-profile deaths of people who take
Dialogue: 0,0:17:05.11,0:17:12.22,Default,,0000,0000,0000,,ecstasy, it invariably is not MDMA. So,
Dialogue: 0,0:17:10.36,0:17:15.22,Default,,0000,0000,0000,,let's not look at ecstasy as a measure
Dialogue: 0,0:17:12.22,0:17:18.40,Default,,0000,0000,0000,,of MDMA. Let's look at clinical MDMA. Now,
Dialogue: 0,0:17:15.22,0:17:20.71,Default,,0000,0000,0000,,when you use clinical MDMA, you take
Dialogue: 0,0:17:18.40,0:17:23.28,Default,,0000,0000,0000,,it under medical supervision. It is pure.
Dialogue: 0,0:17:20.71,0:17:30.29,Default,,0000,0000,0000,,The MDMA that I'm using in my studies is
Dialogue: 0,0:17:23.28,0:17:32.85,Default,,0000,0000,0000,,99.98% pure! Very expensive! \N(laughter)
Dialogue: 0,0:17:30.29,0:17:34.47,Default,,0000,0000,0000,,We do it under medical supervision with
Dialogue: 0,0:17:32.85,0:17:37.95,Default,,0000,0000,0000,,a doctor and a nurse and a psychologist.
Dialogue: 0,0:17:34.47,0:17:40.74,Default,,0000,0000,0000,,And under those conditions the risks are
Dialogue: 0,0:17:37.95,0:17:42.99,Default,,0000,0000,0000,,reduced to a absolute minimum. Indeed
Dialogue: 0,0:17:40.74,0:17:45.69,Default,,0000,0000,0000,,after 40 years of MDMA research, there
Dialogue: 0,0:17:42.99,0:17:48.63,Default,,0000,0000,0000,,has not been a single serious adverse
Dialogue: 0,0:17:45.69,0:17:53.58,Default,,0000,0000,0000,,drug reaction, not one! And certainly no
Dialogue: 0,0:17:48.63,0:17:55.50,Default,,0000,0000,0000,,deaths. So, we need to do this research
Dialogue: 0,0:17:53.58,0:17:59.88,Default,,0000,0000,0000,,and we need to do this research in an
Dialogue: 0,0:17:55.50,0:18:02.97,Default,,0000,0000,0000,,evidence-based, compassionate way. Looking
Dialogue: 0,0:17:59.88,0:18:05.16,Default,,0000,0000,0000,,at the data. We need to ignore the
Dialogue: 0,0:18:02.97,0:18:06.63,Default,,0000,0000,0000,,socio-political agenda that says any
Dialogue: 0,0:18:05.16,0:18:11.61,Default,,0000,0000,0000,,drug that's being used recreationally
Dialogue: 0,0:18:06.63,0:18:15.78,Default,,0000,0000,0000,,must also be very bad and dangerous. That
Dialogue: 0,0:18:11.61,0:18:19.32,Default,,0000,0000,0000,,sort of attitude hampers research. And we
Dialogue: 0,0:18:15.78,0:18:21.72,Default,,0000,0000,0000,,need scientists to drive this. It works,
Dialogue: 0,0:18:19.32,0:18:23.76,Default,,0000,0000,0000,,it's safe. And it offers patients like
Dialogue: 0,0:18:21.72,0:18:25.59,Default,,0000,0000,0000,,Claire for the first time in their life
Dialogue: 0,0:18:23.76,0:18:27.84,Default,,0000,0000,0000,,an opportunity to break through from
Dialogue: 0,0:18:25.59,0:18:31.11,Default,,0000,0000,0000,,that trauma and not become a lifelong
Dialogue: 0,0:18:27.84,0:18:33.18,Default,,0000,0000,0000,,chronic PTSD sufferer. So where were we
Dialogue: 0,0:18:31.11,0:18:35.19,Default,,0000,0000,0000,,going with MDMA research? Well, we've had
Dialogue: 0,0:18:33.18,0:18:37.05,Default,,0000,0000,0000,,some studies, we've got more coming here.
Dialogue: 0,0:18:35.19,0:18:38.67,Default,,0000,0000,0000,,I'm doing a study in Cardiff with
Dialogue: 0,0:18:37.05,0:18:41.94,Default,,0000,0000,0000,,neuroimaging in which we're going to
Dialogue: 0,0:18:38.67,0:18:43.32,Default,,0000,0000,0000,,give patients with PTSD MDMA and placebo
Dialogue: 0,0:18:41.94,0:18:44.70,Default,,0000,0000,0000,,and we're going to look at
Dialogue: 0,0:18:43.32,0:18:47.73,Default,,0000,0000,0000,,that relationship between the
Dialogue: 0,0:18:44.70,0:18:49.16,Default,,0000,0000,0000,,amygdala and the prefrontal cortex. We're
Dialogue: 0,0:18:47.73,0:18:51.42,Default,,0000,0000,0000,,also doing a study here in Bristol
Dialogue: 0,0:18:49.16,0:18:54.84,Default,,0000,0000,0000,,giving patients with alcohol use
Dialogue: 0,0:18:51.42,0:18:58.23,Default,,0000,0000,0000,,disorder MDMA, because underlying the
Dialogue: 0,0:18:54.84,0:19:00.81,Default,,0000,0000,0000,,root of this addiction is trauma. So this
Dialogue: 0,0:18:58.23,0:19:02.46,Default,,0000,0000,0000,,is an exciting time. Now people say: "This
Dialogue: 0,0:19:00.81,0:19:04.32,Default,,0000,0000,0000,,is controversial!" And indeed, I was
Dialogue: 0,0:19:02.46,0:19:06.27,Default,,0000,0000,0000,,introduced as a controversial speaker.
Dialogue: 0,0:19:04.32,0:19:08.88,Default,,0000,0000,0000,,I'm not controversial, I'm a very boring
Dialogue: 0,0:19:06.27,0:19:11.88,Default,,0000,0000,0000,,conservative doctor. I like data.
Dialogue: 0,0:19:08.88,0:19:14.43,Default,,0000,0000,0000,,I like evidence-based data that helps my
Dialogue: 0,0:19:11.88,0:19:16.86,Default,,0000,0000,0000,,patients. I'll tell you what's
Dialogue: 0,0:19:14.43,0:19:19.11,Default,,0000,0000,0000,,controversial! What's controversial is
Dialogue: 0,0:19:16.86,0:19:21.18,Default,,0000,0000,0000,,that more people have died returning
Dialogue: 0,0:19:19.11,0:19:22.59,Default,,0000,0000,0000,,from Afghanistan and Iraq because
Dialogue: 0,0:19:21.18,0:19:25.50,Default,,0000,0000,0000,,they've committed suicide because of
Dialogue: 0,0:19:22.59,0:19:27.51,Default,,0000,0000,0000,,their untreated PTSD then ever died in
Dialogue: 0,0:19:25.50,0:19:32.76,Default,,0000,0000,0000,,the conflict out there. That is
Dialogue: 0,0:19:27.51,0:19:35.15,Default,,0000,0000,0000,,controversial and that is unethical! So
Dialogue: 0,0:19:32.76,0:19:38.34,Default,,0000,0000,0000,,this is a important time for science.
Dialogue: 0,0:19:35.15,0:19:40.62,Default,,0000,0000,0000,,MDMA could be the antibiotic that
Dialogue: 0,0:19:38.34,0:19:42.42,Default,,0000,0000,0000,,psychiatry has been waiting for. We owe
Dialogue: 0,0:19:40.62,0:19:43.63,Default,,0000,0000,0000,,that population of patients who are
Dialogue: 0,0:19:42.42,0:19:46.69,Default,,0000,0000,0000,,being failed,
Dialogue: 0,0:19:43.63,0:19:50.22,Default,,0000,0000,0000,,we owe them this research! We owe this
Dialogue: 0,0:19:50.22,0:19:53.75,Default,,0000,0000,0000,,Claire! Thank you.\N(applause)