The future of psychedelic-assisted psychotherapy | Rick Doblin

譯者: Lilian Chiu 審譯者: Helen Chang

Preparing for this talk has been scarier for me

對我來說，準備這次演講

比準備用 LSD 迷幻藥治療還要可怕。

than preparing for LSD therapy.

(Laughter)

（笑聲）

"Psychedelics are to the study of the mind

「迷幻藥之於大腦相關研究，

what the microscope is to biology

就如同顯微鏡之於生物學，

and the telescope is to astronomy."

以及天文望遠鏡之於天文學。」

Dr. Stanislav Grof spoke those words.

這段話出自 斯坦尼斯拉夫•格羅夫博士。

He's one of the leading psychedelic researchers in the world,

他是全世界最出色的 迷幻藥研究者之一，

and he's also been my mentor.

他也是我的導師。

Today, I'd like to share with you how psychedelics, when used wisely,

今天，我想與大家分享， 如果明智地使用迷幻藥，

have the potential to help heal us,

它有什麼樣的潛能 來協助治癒我們，

help inspire us,

協助鼓舞我們，

and perhaps even to help save us.

甚至也許還能協助拯救我們。

In the 1950s and 60s,

在五〇、六〇年代，

psychedelic research flourished all over the world

迷幻藥研究在全世界興起，

and showed great promise for the fields of psychiatry,

在幾個領域展現出很好的前景，

包括精神病學、心理學與心理治療、

psychology and psychotherapy,

neuroscience and the study of mystical experiences.

神經科學，與神秘體驗的研究。

But psychedelics leaked out of the research settings

但是迷幻藥流出了研究環境，

and began to be used by the counterculture,

開始被用在反文化

and by the anti-Vietnam War movement.

以及反越戰的運動中。

And there was unwise use.

有些用法很不明智。

And so there was a backlash.

所以受到強烈反對。

And in 1970, the US government criminalized all uses of psychedelics,

七〇年代，美國政府將迷幻藥的 各種使用方式都視為犯罪，

and they began shutting down all psychedelic research.

他們開始終止所有迷幻藥研究。

And this ban spread all over the world and lasted for decades.

這個趨勢開始散播到 全世界，持續了數十年，

and it was tragic,

這是一齣悲劇，

since psychedelics are really just tools,

因為迷幻藥其實只是工具，

and whether their outcomes are beneficial or harmful

使用迷幻藥的結果是有益還是有害，

depends on how they're used.

取決於如何使用它們。

Psychedelic means "mind-manifesting,"

「迷幻」意思是「心靈呈現」，

and it relates to drugs like LSD, psilocybin, mescaline,

相關的藥物有 LSD、賽洛西賓、 麥司卡林（仙人掌毒鹼）、

iboga and other drugs.

伊玻加等等。

When I was 18 years old,

當我十八歲時，

I was a college freshman,

我還是大學新鮮人，

I was experimenting with LSD and mescaline,

我試用了 LSD 和麥司卡林，

and these experiences brought me in touch with my emotions.

讓我觸及到我的情緒，

And they helped me have a spiritual connection

協助我建立靈性的連結；

that unfortunately, my bar mitzvah did not produce.

很不幸，我的成年禮 並沒有產生這種連結。

(Laughter)

（笑聲）

When I wanted to tease my parents,

當我想要捉弄我父母時，

I would tell them that they drove me to psychedelics

我就會告訴他們， 是他們驅使我去使用迷幻藥，

because my bar mitzvah had failed to turn me into a man.

因為我的成年禮沒能 把我變成一個男人。

(Laughter)

（笑聲）

But most importantly,

但，最重要的是，

psychedelics gave me this feeling of our shared humanity,

迷幻藥讓我感覺到 我們共有的人性、

of our unity with all life.

我們和所有生命的合一。

And other people reported that same thing as well.

其他使用者也描述了同樣的感受。

And I felt that these experiences had the potential

我覺得這些經歷有潛力

to help be an antidote

可以成為解藥，

to tribalism, to fundamentalism, to genocide and environmental destruction.

協助對抗部落主義、基要主義、 大屠殺，以及環境破壞。

And so I decided to focus my life

所以我決定要專注投入心力，

on changing the laws

來改變法律，

and becoming a legal psychedelic psychotherapist.

並成為合法的迷幻藥心理治療師。

(Applause)

（掌聲）

Now, half a century after the ban,

至今，迷幻藥已經被禁了半個世紀，

we're in the midst of a global renaissance of psychedelic research.

我們正處在迷幻藥 研究的全球復興當中。

Psychedelic psychotherapy is showing great promise

迷幻藥心理治療 展現出很好的前景，

for the treatment of post-traumatic stress disorder, or PTSD,

可以治療創傷後壓力症候群、

depression, social anxiety, substance abuse and alcoholism

憂鬱症、社交焦慮症、 藥物濫用、酗酒，

and suicide.

及自殺。

Psychedelic psychotherapy is an attempt to go after the root causes

迷幻藥心理治療是在嘗試

找出問題的根本成因，

of the problems,

with just relatively few administrations,

相對不需要很多用藥，

as contrasted to most of the psychiatric drugs used today

相對之下，現今所使用的 大部分精神藥物

that are mostly just reducing symptoms

多半只是在減輕症狀，

and are meant to be taken on a daily basis.

且需要每天服用。

Psychedelics are now also being used as tools for neuroscience

現今，迷幻藥也被當作 神經科學的工具來使用，

to study brain function

可以研究腦部功能，

and to study the enduring mystery of human consciousness.

及研究長久以來的謎：人類意識。

And psychedelics and the mystical experiences they produce

針對迷幻藥以及它們 所產生出來的神秘體驗，

are being explored for their connections between meditation and mindfulness,

現在有研究在探究它們 與冥想及正念之間的關聯，

including a paper just recently published

包括有一篇近期發表的研究，

about lifelong zen meditators taking psilocybin

談到一生都在進行禪修的冥想者，

在冥想修行期間服用賽洛西賓，

in the midst of a meditation retreat

and showing long-term benefits and brain changes.

並展現出長期的益處與腦部改變。

Now, how do these drugs work?

迷幻藥是怎麼運作的？

Modern neuroscience research has demonstrated

現代的神經科學研究指出，

that psychedelics reduce activity

迷幻藥會降低所謂

in what's known as the brain's default mode network.

腦部預設模式網路中的活動。

This is where we create our sense of self.

我們的自我意識 就是在這裡形成的。

It's our equivalent to the ego,

自我意識也就同等於自我，

and it filters all incoming information

它會過濾所有接收到的資訊，

according to our personal needs and priorities.

過濾的依據是我們個人的需求 及重視的優先順序。

When activity is reduced in the default mode network,

當預設模式網路中的活動下降時，

our ego shifts from the foreground to the background,

我們的自我就會 從前景轉移到背景，

and we see that it's just part of a larger field of awareness.

它其實只是更大的 知覺領域中的一部分。

It's similar to the shift

哥白尼和伽利略也對人類 造成了類似的轉變，

that Copernicus and Galileo were able to produce in humanity

using the telescope

他們用望遠鏡展示出

to show that the earth was no longer the center of the universe,

地球並不是宇宙的中心，

but was actually something that revolved around the sun,

只是繞著比地球還大的太陽

something bigger than itself.

在做旋轉。

For some people, this shift in awareness

對某些人而言，這種知覺的轉變

is the most important

是最重要的，

and among the most important experiences of their lives.

且是他們人生中 最重要的經歷之一。

They feel more connected to the world bigger than themselves.

他們感覺和比他們自身 更大的世界有所連結。

They feel more altruistic,

他們感覺更無私，

and they lose some of their fear of death.

且他們會失去一些對死亡的恐懼。

Not all drugs work this way.

並非所有藥物都有這種效果。

MDMA, also known as Ecstasy, or Molly,

MDMA，也就是快樂丸，或稱衣服，

根本的運作方式就不同。

works fundamentally different.

And I'll be able to share with you the story of Marcela,

我想和大家分享一個 關於瑪賽拉的故事，

who suffered from post-traumatic stress disorder

她在受到一次暴力的性侵之後，

from a violent sexual assault.

得了創傷後壓力症候群。

Marcela and I were introduced in 1984,

瑪賽拉和我在 1984 年認識，

when MDMA was still legal,

當時 MDMA 還是合法的，

but it was beginning also to leak out of therapeutic circles.

但它也開始流出治療圈。

Marcela had tried MDMA in a recreational setting,

瑪賽拉曾經在玩樂的時候試過 MDMA，

and during that, her past trauma flooded her awareness

在那過程中，她過去的創傷 灌滿了她的知覺，

and it intensified her suicidal feelings.

強化了她想要自殺的感受。

During our first conversation,

在我們第一次的對話中，

I shared that when MDMA is taken therapeutically,

我提到如果在治療上使用 MDMA，

it can reduce the fear of difficult emotions,

可以減輕難熬情緒的恐懼，

and she could help move forward past her trauma.

她就可以試著向前走，脫離創傷。

I asked her to promise not to commit suicide

我請她保證不要自殺，

if we were to work together.

這樣我們才能合作。

She agreed and made that promise.

她同意了，也做出了保證。

During her therapeutic sessions,

在治療療程中，

Marcela was able to process her trauma more fluidly, more easily.

瑪賽拉可以更順利、 更輕鬆地處理她的創傷。

And yet, she was able to tell

而且她能夠說出

that the rapist had told her that if she ever shared her story,

強暴犯告訴過她， 如果她把這件事說出來，

he would kill her.

他就會殺了她。

And she realized that that was keeping her a prisoner in her own mind.

她了解到，就是這一點 讓她一直被困在自己的腦中。

So being able to share the story

所以，能夠分享這個故事，

and experience the feelings and the thoughts in her mind

並體驗到她腦中的感受和想法，

freed her,

讓她獲得解放，

and she was able to decide

她才能夠決定

that she wanted to move forward with her life.

她想要繼續走下去，好好過人生。

And in that moment,

在那一刻，

I realized that MDMA could be very effective for treating PTSD.

我了解到 MDMA 在治療 創傷後壓力症候群上非常有效。

Now, 35 years later, after Marcela's treatment,

瑪賽拉的治療是三十五年前的事，

she's actually a therapist,

現在她自己也是位治療師，

training other therapists to help people overcome PTSD with MDMA.

訓練其他治療師用 MDMA幫助 患有創傷後壓力症候群的病人。

Now, how does MDMA work?

MDMA 是怎麼運作的？

How did MDMA help Marcela?

MDMA 是怎麼協助瑪賽拉的？

People who have PTSD have brains that are different

創傷後壓力症候群病人的大腦

from those of us who don't have PTSD.

和沒有創傷後壓力症候群的人不同。

They have a hyperactive amygdala, where we process fear.

他們用來處理恐懼的杏仁核 有活動過度的現象。

They have reduced activity in the prefrontal cortex,

他們用來做邏輯 思考的前額葉皮質，

where we think logically.

有活動降低的現象。

And they have reduced activity in the hippocampus,

他們用來將記憶做 長期儲存的海馬迴，

where we store memories into long-term storage.

有活動下降的現象。

MDMA changes the brain in the opposite way.

MDMA 會讓大腦發生 和上述相反的改變。

MDMA reduces activity in the amygdala,

MDMA 會降低杏仁核的活動，

increases activity in the prefrontal cortex

增加前額葉皮質的活動，

and increases connectivity between the amygdala and the hippocampus

以及增加杏仁核 和海馬迴之間的連結，

to remit traumatic memories to move into long-term storage.

讓創傷記憶比較不會 被移入長期儲存區。

Recently, researchers at Johns Hopkins published a paper in "Nature,"

最近，約翰霍普金斯大學的研究員 在《自然》期刊中登了一篇論文，

in which they demonstrated that MDMA releases oxytocin,

在文中，他們說明 MDMA 會釋放催產素，

the hormone of love and nurturing.

一種與愛及養育相關的荷爾蒙。

The same researchers also did studies in octopuses,

這些研究者也做了 關於章魚的研究，

who are normally asocial, unless it's mating season.

一般來說，章魚在交配季 以外的時間是不社交的。

But lo and behold, you give them MDMA,

但，看哪！給牠們 MDMA 之後，

and they become prosocial.

牠們變得很喜愛社交。

(Laughter)

（笑聲）

Several months after Marcela and I worked together,

在瑪賽拉跟我合作的幾個月後，

the Drug Enforcement Administration moved to criminalize Ecstasy,

美國緝毒局將使用快樂丸視為犯罪，

having no knowledge of its therapeutic use.

完全不知道它的治療用途。

So I went to Washington,

所以，我前往華盛頓，

and I went into the headquarters of the Drug Enforcement Administration,

我到了美國緝毒局的總部，

and I filed a lawsuit demanding a hearing,

我提出告訴，要求開聽證會，

at which psychiatrists and psychotherapists

在聽證會上，精神病學家 以及心理治療師

would be able to present information about therapeutic use of MDMA

就可以提出資訊，說明 MDMA 在治療上的用途，

to try to keep it legal.

讓它繼續合法。

And in the middle of the hearing, the DEA freaked out,

在聽證會過程中， 藥品管理局失控了，

declared an emergency

宣佈緊急狀況，

and criminalized all uses of MDMA.

將所有的 MDMA 使用都視為犯罪。

And so the only way that I could see to bring it back

我能想出唯一的反轉方式，

was through science, through medicine

就是透過科學、透過醫學，

and through the FDA drug development process.

及透過食品及藥物管理局的 藥物開發流程。

So in 1986, I started MAPS

所以，1986 年，我創立了 MAPS，

as a nonprofit psychedelic pharmaceutical company.

它是一間非營利的迷幻藥公司。

It took us 30 years, till 2016,

我們花了三十年，直到 2016 年，

to develop the data that we needed to present to FDA

才擁有我們所需要的資料， 可以提交給食品及藥物管理局，

to request permission to move into the large-scale Phase 3 studies

以取得許可，開始進行 大規模的第三階段研究，

that are required to prove safety and efficacy

完成這個階段才能證明 藥物的安全性和效力，

before you get approval for prescription use.

然後才能取得核准， 做為處方藥來使用。

Tony was a veteran in one of our pilot studies.

東尼是我們前導研究中的退伍軍人。

According to the Veterans Administration,

根據退伍軍人事務部，

there's over a million veterans now disabled with PTSD.

現有超過一百萬名退伍軍人 都有創傷後壓力症候群。

And at least 20 veterans a day are committing suicide,

每天至少有二十名退伍軍人自殺，

many of them from PTSD.

當中有許多都是因為 創傷後壓力症候群。

The treatment that Tony was to receive was three and a half months long.

東尼要接受三個半月的治療。

But during that period of time,

但在那期間，

he would only get MDMA on three occasions,

他只被給予三次 MDMA ，

separated by 12, 90-minute non-drug psychotherapy sessions,

分散在十二次各為九十分鐘的 非藥物心理治療療程之間，

three before the first MDMA session for preparation

在第一次給予 MDMA 之前 有三次心理預備療程，

and three after each MDMA session for integration.

每一次用了 MDMA 之後 有三次心理整合療程。

We call our treatment approach "inner-directed therapy,"

我們將此治療方式 稱為「內在導向治療」，

in that we support the patient to experience whatever's emerging

在這種治療中，不論病人的 腦中或身體中出現什麼變化，

within their minds or their bodies.

我們都會支持他們去體驗。

Even with MDMA, this is hard work.

即使有 MDMA，這工作也不容易。

And a lot of our subjects have said,

許多我們的病人都說過：

"I don't know why they call this Ecstasy."

「我不知道為什麼 這會被稱為快樂丸。」

(Laughter)

（笑聲）

During Tony's first MDMA session,

在東尼的第一次 MDMA 療程中，

he lay on the couch, he had eyeshades on,

他躺在沙發上，戴上了眼罩，

he listened to music,

他聽著音樂，

and he would speak to the therapists,

跟一男一女組成的治療師團隊說話，

who were a male-female co-therapy team,

whenever he felt that he needed to.

只要他覺得他需要說什麼就可以說。

After several hours,

在幾個小時後，

in a moment of calmness and clarity,

在一個平靜、清澈的時刻，

Tony shared that he had realized

東尼分享說，他了解到，

his PTSD was a way of connecting him to his friends.

他的創傷後壓力症候群是 他用來和他的朋友連結的方式。

It was a way of honoring the memory of his friends who had died.

用這種方式，他可以 向死去朋友的記憶致敬。

But he was able to shift and see himself through the eyes of his dead friends.

但他能做出轉換，透過他 已故朋友的雙眼來看他自己。

And he realized that they would not want him to suffer,

他了解到，他們不會希望他 受苦、浪費他的人生。

to squander his life.

They would want him to live more fully,

他們會希望他全心過生活， 這是他們無法做到的。

which they were unable to do.

And so he realized that there was a new way to honor their memory,

所以，他了解到，可以用 其他方式來向那些記憶致敬，

which was to live as fully as possible.

那就是盡可能好好過日子。

He also realized that he was telling himself a story

他也了解到，他一直在說服自己，

that he was taking opiates for pain.

說他吃鴉片劑是為了止痛。

But actually, he realized, he was taking them for escape.

事實上，他了解到， 他吃鴉片劑是為了逃離。

So he decided he didn't need the opiates anymore,

所以，他下定決定， 他不再需要鴉片劑了，

he didn't need the MDMA anymore,

他不再需要 MDMA 了，

and he was dropping out of the study.

他從研究中退出。

That was seven years ago.

那是七年前的事。

Tony is still free of PTSD,

至今東尼仍未再患 創傷後壓力症候群，

has never returned to opiates

且沒有再服用鴉片劑，

and is helping others less fortunate than himself in Cambodia.

他還在柬埔寨協助其他 沒有像他這麼幸運的人。

(Applause)

（掌聲）

The data that we presented to FDA

我們提交給食品及藥物管理局的資料，

from 107 people in our pilot studies, including Tony,

來自前導研究的 107 位 受試者，包括東尼，

showed that 23 percent of the people that received therapy without active MDMA

資料顯示， 23% 接受 非活性 MDMA 治療的受試者，

no longer had PTSD at the end of treatment.

在治療尾聲時已不再有 創傷後壓力症候群。

This is really pretty good for this patient population.

這方式對於這類病人 是真的很不錯。

However, when you add MDMA,

然而，當加上了 MDMA，

the results more than double, to 56 percent no longer having PTSD.

結果超過兩倍，56% 的受試者 不再有創傷後壓力症候群。

(Applause)

（掌聲）

But most importantly,

但最重要的是，

once people learn that if they don't need to suppress their trauma,

一旦病人了解到他們 不需要壓抑他們的創傷，

but they can process it,

他們可以處理創傷，

they keep getting better on their own.

之後他們就會靠自己變得更好。

So at the 12-month follow-up one year after the last treatment session,

所以，最後一次治療結束後一年的 十二個月追蹤資料顯示，

two-thirds no longer have PTSD.

三分之二的受試者不再有 創傷後壓力症候群。

And of the one-third that do,

至於剩下的三分之一受試者，

many have clinically significant reductions in symptoms.

有許多人的症狀 在臨床也有顯著減輕。

(Applause)

（掌聲）

On the basis of this data,

根據這些資料，

the FDA has declared MDMA-assisted psychotherapy for PTSD

食品及藥物管理局宣佈由 MDMA 輔助的創傷後壓力症候群心理治療

a breakthrough therapy.

是一項突破性治療。

FDA has also declared psilocybin a breakthrough therapy

食品及藥物管理局也宣佈 用賽洛西賓是一項突破性治療，

for treatment-resistant depression

可用於難治型憂鬱症，

and just recently approved esketamine for depression.

且最近核准使用 氯胺酮（K他命）治療憂鬱症。

I'm proud to say that we have now initiated our Phase 3 studies.

我能很自豪地說，我們已經 啟動了第三階段的研究。

And if the results are as we hope,

如果結果如我們預期，

and if they're similar to the Phase 2 studies,

如果結果和第二階段差不多，

by the end of 2021, FDA will approve MDMA-assisted psychotherapy for PTSD.

到了 2021 年末， 食品及藥物管理局就會

核准使用 MDMA 輔助心理治療 來治療創傷後壓力症候群。

If approved,

如果核准了，

the only therapists who will be able to directly administer it to patients

唯一能夠直接提供 這項治療給病人的治療師

are going to be therapists that have been through our training program,

就是通過我們訓練方案的治療師，

and they will only be able to administer MDMA

且他們只能夠在臨床環境中的

under direct supervision in clinic settings.

直接監控之下提供 MDMA。

We anticipate that over the next several decades,

我們預期，在接下來幾十年，

there will be thousands of psychedelic clinics established,

會開設數千家迷幻藥診所，

at which, therapists will be able to administer MDMA,

在這些診所中， 治療師可以提供 MDMA、

psilocybin, ketamine and other psychedelics

賽洛西賓、K 他命，及其他迷幻藥

to potentially millions of patients.

給也許數百萬名病人。

These clinics can also evolve into centers where people can come

這些診所也可以再演化成 治療中心，病人可以前往這些地方

for psychedelic psychotherapy for personal growth,

接受迷幻藥心理治療， 目的可以是個人成長、

for couples therapy

夫妻婚姻治療，

or for spiritual, mystical experiences.

或靈性、神秘體驗。

Humanity now is in a race between catastrophe and consciousness.

人類現在陷於大災難和意識之爭。

The psychedelic renaissance is here to help consciousness triumph.

迷幻藥復興能夠 協助意識獲得勝利。

And now, if you all just look under your seats ...

現在請各位看一下 你們的椅子底下……

Just joking!

開玩笑的啦！

(Laughter)

（笑聲）

Thank you.

謝謝。

(Applause)

（掌聲）

(Laughter)

（笑聲）

(Applause)

（掌聲）

Thank you.

謝謝。

(Applause)

（掌聲）

Corey Hajim: You've got to stay up here for a minute.

柯蕊•哈金：請你留在台上一會兒。

Thank you so much, Rick.

非常謝謝你，瑞克。

I guess it's a supportive audience.

這些觀眾挺支持你的。

Rick Doblin: Yes, very.

瑞克•杜布林：是的，非常支持。

Many of them have also been to Burning Man.

當中許多人也去過火人祭。

(Laughter)

（笑聲）

CH: There's some synergy.

柯：效果加倍。

RD: (Laughs)

瑞：（笑聲）

CH: So, in your talk, you talked about using these drugs

柯：在你的演說中， 你談到使用這些藥物

to address some pretty serious traumas.

來處理一些很嚴重的創傷。

So what about some more common mental illnesses

那麼比較常見的心理疾病呢，

like anxiety and depression,

比如焦慮症和憂鬱症，

and is that where microdosing comes in?

微量用藥是不是就可以用在這裡？

RD: Well, microdosing can be helpful for depression,

瑞：嗯，微量用藥 是可以幫助憂鬱症，

I do know someone that has been using it.

我確實知道有人在用。

But in general, for therapeutic purposes,

但一般來說，針對治療的目的，

we prefer macro-dosing rather than microdosing,

我們會偏好大量用藥 而非微量用藥，

in order to really help people deal with the root causes.

這樣才能真正協助病人 處理根本原因。

Microdosing is more for creativity,

微量用藥比較是用在創意、

for artistic inspiration,

藝術靈感、

for focus ...

專注力上……

And it also does have a mood-elevation lift.

它還有提升心情的功能。

But I think for serious illnesses,

但，我認為，對嚴重的疾病，

we'd rather not get people thinking that they need a daily drug,

我比較希望病人不要覺得 他們需要每日用藥，

but do more deeper, intense work.

而是去做更深入、更強的治療。

CH: And what about outside the United States and North America,

柯：那麼，在美國和北美以外呢，

is this research being done there?

也有相關研究在進行嗎？

RD: Oh yeah, we're globalizing.

瑞：有的，我們在全球化。

Our Phase 3 studies are actually being done

我們的第三階段研究其實就在

in Israel, Canada and the United States.

以色列、加拿大，和美國進行。

So once we get approval in FDA,

一旦食品及藥物管理局核准，

it will also become approved in Israel and in Canada.

在以色列和加拿大就會核准。

We're just starting research in Europe.

我們剛開始在歐洲的研究。

And we're actually going to be training some therapists from China.

我們也即將要訓練 一些中國來的治療師。

CH: That's great.

柯：那很好。我們 本來要請觀眾來投票，

We were going to do an audience vote

to see if people felt like this was a good idea

看看他們是否覺得這是個好主意，

to move forward with this research or not,

是否該讓這項研究向前邁進，

but I have a feeling I know the answer to that, so ...

但我覺得我知道答案會是什麼， 所以……非常謝謝你，瑞克。

Thank you so much, Rick.

RD: Thank you. Thank you all.

瑞：謝謝你。謝謝大家。

(Applause)

（掌聲）