Tuesday, February 28, 2012

Stopping suicides at the October Gallery

Talk by Dr Ben Sessa, "MDMA: Could it have been designed in with psychotherapy in Mind?", in the series Ecology, Cosmos and Consciousness lecture series, organised by Dr David Luke in association with the Scientific and Medical Network. 6:30 - 8:30 pm at the October Gallery, Old Gloucester Road, London.

The British Government should hang its head in shame for failing to do its utmost to resolve Post-Traumatic Stress Disorder (PSTD) in the men and women who volunteer to fight for their country. Irrespective of whether one agrees or disagrees with this or that military intervention, the Government has a clear and urgent duty of care towards those individuals who put their lives in danger to carry out the nation's military objectives. That the authorities refuse even to evaluate the therapeutic value of MDMA on the grounds that it is a drug that some people take recreationally is of a failing such vicious asininity as to shame the whole country.

Of course, it is not just servicemen and women who suffer PTSD, but they undergo more violent stress and more extreme violence than most other people. A wide range of horrors in our fast and violent world creates this psychological disorder in people. One source quotes a range of incidence from 13% in suburban police officers to 50% in abused children.

Like other pioneers of psychedelic medicine, Dr Ben Sessa has been pushing for years to be allowed to study the clinical use of psychedelics. In 2009 he became the first person in forty years to be given, in a legal clinical study, an illegal drug -- when he was injected intravenously with psilocybin by Professor David Nutt.

In this talk, Sessa gave us an overview of MDMA, and the small but highly promising set of clinical data on its use for treating PSTD. He hopes to carry out the first clinical trial of MDMA for PSTD in the UK.

MDMA is unusual among psychedelics in almost always producing a positive affect: it is very much a 'happy drug'. It is also non-addictive and has very low toxicity, making it very and manageable and safe to use in robust clinical settings. The gutter press (referred to collectively as the "Daily Mail" by Dr Sessa) makes a lot of fuss about the deaths of people who have taken Ecstasy, a recreational pill that formerly contained MDMA on a predictable basis but apparently is now heavily adulterated. In fact, he said, in almost all cases, people who had taken Ecstasy before dying also had in their bodies potentially fatal doses of other stuff such as alcohol and heroin. In only six cases was MDMA the only plausible cause of death. Given the millions of people who use Ecstasy on weekly basis, often while stressing their bodies by dancing for long hours without necessarily drinking enough water, this makes Ecstasy, and hence MDMA, a comparatively safe substance in relation to other recreational products such as tobacco, alcohol, caffeine, and sugar.

Sessa emphasised several times that MDMA was not "safe" simpliciter, as no pharmaceutical product is absolutely safe, not even apsirin or adhesive plasters. But in the general scheme of things taking MDMA is less dangerous than most things you might want to do during course of a normal day.

There is one point where I would urge a little caution, which is the story that is in circulation that in war veterans, suicide triggered by PTSD takes far more lives than the actual fighting. Any statistics about death should bear in mind a number of basic considerations. (a) Sadly a lot of people kill themselves anyway, even without experience of war: the suicide rate among US males is generally quote as around 1.1%. (b) A period of active combat is comparatively short in relation to the years that follow, and any suicide in that period adds to the statistic. (c) Modern warfare is much safer for rich countries such as the UK and USA, which now have the technology to bomb a country to shit with comparatively little exposure of its own troops to death and injury. This is rather different from Vietnam or the Korean War, or the World Wars.

When I first heard the story that suicide kills more soldiers than fighting does, I filed it in the back of my mind as "doubtful, but possibly true". My usual first response on hearing of any thing that looks like a dodgy story is to look it up on http://www.snopes.com/, that great graveyard of urban myths. It was only after Ben Sessa's talk that I was prompted to look up the suicides story. The story first emerged in respect of veterans of the Vietnam war, and has been repeated for subsequent military conflicts. Sessa cites it specifically for Western interventions in Iraq and Afghanistan (and suggested it might apply to any future war in Iran). Snopes led me to Michael Kelley's thorough study of post-'Nam suicides: "The Three Walls Behind the Wall: The Myth of Vietname Veteran Suicide". His conclusion was pretty much in line with what one would have expected: the suicide rate in combatants who saw action is higher than for those of us who stay safely at home in Civvy Street, but it is nowhere near the death rate from the actual fighting. (As Kelley points out, most troops who went in-country in 'Nam did no fighting. The intensification of PTSD and consequent increase in suicide is specific to those who fought the Vietcong.) 54,000 Americans were sent to their deaths in Vietnam, but probably no more than 4000 took their own lives afterwards.

The death rate in Iraq and Afghanistan during low-intensity periods (i.e. not during the times of intense fighting such as the invasion of Iraq), is vastly lower. And in some particular years, the death rate from suicide happens to be higher than that due to fighting. According to an article in Congress.org, "More troops Lost to Suicide", in 2009 the suicide rate was slightly higher: "Overall, the services reported 434 suicides by personnel on active duty, significantly more than the 381 suicides by active-duty personnel reported in 2009. The 2010 total is below the 462 deaths in combat, excluding accidents and illness. In 2009, active-duty suicides exceeded deaths in battle." In 2008 and previous years, however, the ratio was reversed: during the intense violence that is normally associated with the word "war", the casualties from fighting were higher.

It is, I fear, disingenuous for Sessa to make the unqualified and out-of-context claim that suicide kills more soldiers than combat does. That suicides exceeded combat deaths in one comparatively quiet year is not the message one would read from his slide. Undoubtedly PSTD is a large and serious problem, but I suspect that Sessa's case will be hindered rather than helped by making misleading claims about its prevalence.

Other than than glitch, Dr Sessa's talk was very well made. Despite the sweltering heat produced by cramming a large crowed into the lecture hall at the October Gallery (according to the Facebook site, 140 people said they would come), he gripped the audience's attention with clarity and compassion. I hope he is allowed to run his trial of MDMA.

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