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PTSD, Grief, and Transformational Psychedelic Healing: A Deep Dive into Identity, Trauma, and Therapeutic Innovation

The intertwining paths of post-traumatic stress disorder (PTSD) treatment, facilitated grief work, and the use of psychedelic-assisted therapy presents a compelling narrative for innovative treatments in mental health care. Central to this discussion is the concept of identity and how therapists, particularly those using MDMA as an adjunct, navigate the nuances of a patient’s self-perception and experiences of grief. Drawing from Judith Herman’s perspective on healing from trauma, as well as recent research on MDMA-assisted therapy, Beckley Academy’s approach to transformational, trauma-informed education and care explores the complex relationship between trauma, grief, and identity, with particular consideration for how transformational psychedelic healing can offer a profound sense of renewal amidst an inevitable sense of loss.

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Understanding the Interplay: Trauma, Grief, and Identity

Trauma disrupts the very essence of a person’s identity, often embedding feelings of shame and a distorted self-concept within the individual’s psyche. Herman (1992) describes this disruption as a core challenge to a person’s fundamental sense of safety and trust in the world. Traumatic experiences can shatter one’s sense of control, leading to profound psychological distress. This disruption often manifests in symptoms such as flashbacks, nightmares, and dissociation– leading to a PTSD diagnosis when symptoms become debilitating.

Herman describes people who have endured trauma as “trauma survivors,” whom she portrays as individuals struggling to make sense of their experiences while grappling with intense emotions and a fractured sense of self. She emphasizes the importance of bearing witness to survivors’ stories and validating their experiences as a crucial step in the healing process. An essential takeaway from Herman’s work on trauma is her discussion of feelings of shame, guilt, and worthlessness in trauma survivors as they relate to the degradation of agency and identity. This understanding of trauma symptomatology is essential when looking at strategies for recovery, particularly when we consider how MDMA-assisted therapy may factor into treatment. In discussing recovery, Herman emphasizes the importance of establishing safety, rebuilding trust, and reclaiming agency– each of which factors heavily into the preparation and integration of a therapeutic psychedelic experience.

In addition to illustrating the role that fractured identity plays in the psychological impact of trauma, Herman also acknowledges grief as a fundamental aspect of the experience of trauma. Grief arises from the loss that trauma brings, not only the loss of loved ones in cases of violence but also the loss of safety, trust, and a sense of control over one’s life. Throughout her discussion of trauma, Herman identifies four key areas grief may arise in those that experience trauma.

  • Loss of Safety and Trust: Trauma shatters the fundamental belief in safety and trust. Survivors may mourn the loss of the world they once believed in, where they felt secure and protected. This loss can lead to profound feelings of grief and vulnerability.

  • Loss of Identity: Traumatic experiences can disrupt a person’s sense of self, leading to feelings of confusion, disconnection, and alienation. Herman highlights how survivors may mourn the loss of their pre-trauma identity and struggle to reconcile who they were with who they have become in the aftermath of trauma.

  • Loss of Relationships: Trauma can strain or sever relationships with family, friends, and communities. Survivors may experience grief over the loss of these connections, whether due to betrayal, abandonment, or the inability of others to understand their experiences.

  • Grieving Unresolved Trauma: Herman discusses how survivors often grapple with unresolved trauma, including unprocessed emotions, memories, and experiences. Grief may arise from the ongoing struggle to make sense of the trauma and integrate it into one’s life narrative.

While grief is a painful and challenging aspect of trauma recovery, Herman emphasizes its importance in the healing process. By acknowledging and processing their grief, survivors can gradually begin to make meaning of their experiences, reconcile their losses, and move forward with their lives. With this in mind, it is incumbent on a PAT facilitator to cultivate a deep understanding of a patient’s identity– encompassing their history, cultural, ethnic, and racial background, and personal values– as well as provide a safe container to acknowledge and process grief, to facilitate a meaningful therapeutic process.

The Role of MDMA-Assisted Therapy

Existing treatments for post-traumatic stress disorder (PTSD) often fall short of providing relief for many individuals grappling with this debilitating condition. Despite the availability of various therapeutic approaches, including psychotherapy and pharmacotherapy, a significant proportion of patients continue to struggle with persistent symptoms that impact their quality of life. PTSD is a widespread and devastating issue, affecting millions of people worldwide, with a wide array of consequences, including profound emotional distress, functional impairment, and increased risk of comorbid mental health disorders (Kessler, R., et al., 2005).

However, emerging research on MDMA-assisted therapy presents a promising breakthrough in the treatment of PTSD. MDMA, when used in conjunction with psychotherapy under controlled settings, has demonstrated remarkable efficacy in reducing PTSD symptoms and supporting long-term recovery. MDMA-assisted therapy has been shown to reduce the fear response associated with traumatic memories and increase feelings of trust and empathy (Mithoefer, M., et al., 2011). Below is a basic overview of how MDMA-assisted therapy can help patients with trauma, drawing from recent scientific work:

  • Enhanced Therapeutic Alliance: MDMA has been found to enhance the therapeutic alliance between the patient and therapist. It promotes feelings of trust, safety, and openness, which can facilitate deeper exploration of traumatic memories and emotions during therapy sessions (Mithoefer et al., 2018).

  • Reduced Fear and Anxiety: MDMA has anxiolytic properties, meaning it can reduce fear and anxiety in individuals with PTSD. By lowering anxiety levels, MDMA can help patients approach traumatic memories and experiences with greater ease, allowing for more effective processing and integration (Oehen et al., 2013).

  • Increased Emotional Processing: MDMA-assisted therapy can promote emotional processing by enhancing empathy, compassion, and emotional insight. It can allow patients to access and explore difficult emotions associated with trauma in a supportive and non-threatening environment, leading to greater emotional resolution and healing (Feduccia & Mithoefer, 2018).

  • Facilitated Memory Reconsolidation: MDMA may facilitate the process of memory reconsolidation, whereby traumatic memories are reactivated and then updated with new, adaptive information. This can lead to a reduction in the emotional intensity and distress associated with traumatic memories, promoting healing and integration (Carhart-Harris et al., 2014).

  • Promotion of Neuroplasticity: MDMA has been shown to increase levels of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), which play a crucial role in promoting neuroplasticity and neuronal growth. This may facilitate the rewiring of neural circuits involved in fear and stress responses, contributing to long-term therapeutic benefits (Burke & Miczek, 2014).

  • Sustained Symptom Reduction: Research suggests that the benefits of MDMA-assisted therapy for PTSD may be sustained over the long term. Follow-up studies have demonstrated lasting reductions in PTSD symptoms and improvements in overall well-being, even after the completion of treatment (Mithoefer et al., 2019).

MDMA-assisted therapy offers a unique space for patients to explore painful memories and the associated grief with reduced psychological defenses. A therapy facilitator attuned to the nuances of a patient’s identity can guide them more effectively through their past experiences, recognizing the layers of grief that may manifest as mourning for lost safety, time, relationships, or even parts of the self.

Trauma and Patient Shame

Shame can be a significant barrier to seeking treatment for mental health conditions, particularly PTSD. Individuals often experience shame related to their traumatic experiences, believing they are somehow responsible for what happened to them. This internalized shame can lead to a reluctance to seek help, as individuals may fear judgment, rejection, or further stigmatization. The traumatic events themselves often leave individuals feeling powerless and degraded, enhancing the association between shame and PTSD symptomology (Lee, D. A., Scragg, P., & Turner, S., 2001). The social stigma associated with both trauma and the act of seeking help can exacerbate this shame, making the therapeutic challenge even greater.

Therapists and care providers must proactively address shame with empathy in order to create a safe and supportive environment for healing. This involves validating the individual’s experiences, normalizing their emotional responses, and fostering a nonjudgmental atmosphere where they can feel accepted and understood. Some clients will benefit from the reframing of their trauma responses as survival resources that helped protect them in the moment (Ogden & Fisher, 2015). Therapists can help clients explore and reframe their shame-based beliefs, encouraging self-compassion and self-forgiveness.

By addressing shame in therapy, therapists can help clients recognize that their experiences are not their fault and that seeking help is a courageous and empowering choice. This can pave the way for greater engagement in treatment, deeper emotional processing, and ultimately, healing and recovery from PTSD.

MDMA-assisted therapy can help bridge this gap by fostering a non-judgmental, accepting environment where patients can confront and reframe their traumatic experiences without the overwhelming burden of shame. Because MDMA itself can strengthen the therapeutic alliance and increase emotional processing while also reducing patient anxiety, recipients of MDMA-assisted therapy are often able to temporarily shed much of the shame they hold. Translating the healing breakthrough a therapeutic MDMA session can provide to sustained, long-term relief relies on thorough and consistent integration work prior to the medicine experience. MDMA-assisted therapy facilitators are presented the opportunity to extend a patient’s secession from shame, should they have the therapeutic tools in place to work through a patient’s grief and fractured sense of self in the integration sessions following a medicine experience.

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The Grief Inherent in Psychedelic Transformation: Long-Term Healing

Grief is often an inherent part of psychedelic transformation, as psychedelic experiences have the potential to catalyze deep emotional healing and growth through profound introspection. Psychedelics, particularly MDMA, have the potential to unlock deeply buried emotions and facilitate the release of emotional blockages– resulting in a cathartic release of pent-up grief and sorrow, which can be a key part of a psychedelic healing journey. The heightened emotional sensitivity and ability to tap into transpersonal or collective grief induced by psychedelic experiences can create a space for individuals to explore the depths of their grief and engage with it in a profound and transformative way.

Grief can create feelings of isolation and disconnection, exacerbating the symptoms of PTSD. MDMA’s ability to enhance feelings of connection, trust, and intimacy can provide a healing antidote to the loneliness and isolation often experienced by trauma survivors (Nielson et al., 2018). Through the therapeutic use of MDMA, patients may experience a profound sense of connection with themselves, others, and the world around them, facilitating healing and integration. Additionally, MDMA-assisted therapy can help patients approach their grief with greater ease and openness, allowing for deeper exploration and resolution of unresolved emotions (Mithoefer et al., 2019). By creating a safe and supportive environment, therapists can guide patients through the process of grieving and healing.

The transformative potential of psychedelic-assisted therapy not only lies in the alleviation of symptoms but also in the broader reconfiguration of a patient’s identity and life narrative. This transformation often comes with a dual sense of gain and loss. As patients integrate their traumatic experiences, they might mourn the loss of their previous selves, even as they journey towards a renewed identity. Adequate therapeutic preparation and integration are essential to ensure that these shifts lead to long-term healing and personal growth.

Herman’s framework posits that recovery from trauma involves the re-establishment of safety, remembrance and mourning, and reconnection with community (Herman, 1992). Each stage of recovery, while healing, also involves its own type of grief. The loss of what could have been, or the grief of acknowledging what happened, is a crucial part of the healing journey. For some people, their identity has been inexorably linked with their experience of trauma, and when healing happens, they experience a loss of their sense of self. In MDMA-assisted therapy, patients often experience intense emotional releases that can be both healing and painful, reflecting the loss of their former, trauma-bound identities. Long-term integration of medicine sessions may involve helping clients to navigate the grief associated with healing and establish a new sense of self

The integration of identity-focused considerations within MDMA-assisted therapy offers a nuanced approach to treating PTSD and associated grief. Inspired by Judith Herman’s insights, therapists are encouraged to remain deeply attuned to the identities and experiences of their patients, facilitating a therapeutic process that respects both the pain of the past and the potential for future transformation. This approach underlines the profound impact of therapeutic innovation in healing psychological trauma, emphasizing a journey that is as much about mourning and loss as it is about recovery and renewal.


Carhart-Harris RL, et al. (2014). The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Front Hum Neurosci. 8:20.

Feduccia AA, Mithoefer MC. (2018). MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Prog Neuropsychopharmacol Biol Psychiatry. 84(Pt A):221-228.

Herman, J. (1992). Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror. New York: Basic Books.

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.

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Mithoefer MC, et al. (2019). Long-term follow-up of a randomized controlled trial of MDMA-assisted psychotherapy for PTSD. J Psychopharmacol. 33(8): 1-10.

Nielson EM, et al. (2018). The enduring effects of psychedelic drugs on biomarkers of stress and inflammation: A systematic review and meta-analysis. Psychopharmacology (Berl). 235(2): 347-357.

Oehen P, et al. (2013). A randomized, controlled pilot study of MDMA (±3,4-methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic post-traumatic stress disorder (PTSD). J Psychopharmacol. 27(1):40-52.

Ogden, P., & Fisher, J. (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment. (D. Del Hierro & A. Del Hierro, Illustrators). W W Norton & Co.

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