[We] took 120 mg of MDMA in the early afternoon[...] At about the
half-hour point, the usual "awareness" time, 'Janice' gave
no indication of effects, nor were there any changes at the 40 minute,
nor at the
50 minute point. A few off-hand comments were offered:
"My throat is dry."
"I'll get you a glass of water." Which
I did. It did no good.
"I'm having trouble breathing."
"So, breathe as best you can." I noticed
by the reflection in the window where we were, at the back of the
house, that she had no difficulty breathing when I wasn't watching
We walked up the hill, to an area
I had leased out to the condominium builders on the neighboring land
for the storage of lumber. There were several 'no smoking' signs
around as fire warnings.
"Do you think I smoke too much?"
"Do you think you smoke
"I don't think so."
"Then the answer is: probably not."
It was now an hour into the experiment,
and still no acknowledgement of any activity from the MDMA. Then
came the unexpected question, the "off the wall" question.
"Is it all right to be alive?"
"You bet your sweet ass it's all right to
be alive! It's a grace to be alive!"
That was it. She plunged into the MDMA state,
and started running down the hill, calling out that it was all right
to be alive. All the greens became living greens and all the sticks
and stones became vital sticks and stones. I caught up with her and
her face was radiant. She told me some of her personal history which
she knew well, and which I knew well, but with which she had never
come to peace.
She had come into the world by an
unexpected Caesarean section and her mother had died during the delivery.
And for fifty years she had lived in the guilt of having had her
life given at the cost of her mother's life. She had been in therapy
with her family physician for about three years, largely addressing
this problem, and apparently what she needed was the acknowledgement
that it was all right to be alive.
I didn't hear from her for a couple
of months. When she did call, she volunteered that she still felt
very much at peace, and had discontinued her therapy.
This story represents one of the
earliest reports of MDMA having therapeutic benefits. In spite of
the striking, almost mystical qualities of the case, such responses
to MDMA are not unusual. What would eventually become "ecstasy" first
entered the medical community's
awareness not as a new
new tool for
personal growth. For people familiar with psychedelic drugs the
idea of drugs as a catalyst for growth hardly seems surprising, but
to a general public who's idea of recreational drugs means the
drooling stupidity of alcohol abuse the idea takes some explaining.
What does MDMA do that
could be beneficial to a patient? First, it powerfully suppresses
emotional fear, to such an extent that people under the influence
are often able to openly discuss deeply traumatic events, such as
rape, suicide attempts, etc. MDMA produces complete emotional honesty
with yourself. Second, it is a moderately powerful stimulant, not
simply allowing the patient
to sit there indifferently, but prodding them to examine and discuss
their lives. Animal experiments also indicate that MDMA enhances
learning, allowing what is discovered and experienced during the
to strongly affect and stay with the patient long after
net result is
a patient who, for a few hours, is almost perfectly primed to grow
as a person. Their fears are gone. They feel strong, at peace,
and able to handle almost anything emotionally. They're also hyperactive
and extremely talkative, eager to explore ideas and issues and share
their thoughts. The 'hyper-focused' MDMA state can also allow the
therapist to steer the conversation into otherwise highly charged
topics...they don't have to tease the story
out of them; the patient is truly ready to talk about what's on their
mind. And finally, the experience seems to allow a high degree
of incorporation of what they learn about themselves back into their
Many classic elements of a
cathartic MDMA experience appear in the above case, including Janice's
anxiety/difficulty in letting go and embracing the experience. Once
she entered the MDMA state, she became euphoric, talkative, and emotionally
open, bringing herself to face what was truly bothering her. Equally
important, however, was that the experience stayed with her. She
didn't simply revert to her prior emotional state upon sobering up.
Although her long-term prognosis is unknown, several months of relief
a few hours of treatment is nothing to sneeze at.
Granted, an anecdote is not proof
of efficacy. But when the anecdotes become as striking, as numerous,
and as tantalizing in their promise as those surrounding MDMA are,
it becomes difficult to discount them all as placebo effects or sudden
improvements for unrelated reasons. The thousands of therapists
that originally spread the use of MDMA certainly believed their
were benefiting. The scientists that fought tooth and nail against
its prohibition certainly thought it had value. The therapists that
have continued to use it after it was outlawed, risking prison in
order to be able to provide this form of treatment to suffering patients
certainly believe. And indeed, the US government is sufficiently
intrigued by the evidence that
the FDA has given permission to test MDMA under controlled circumstances
in the treatment of people with post-traumatic stress disorder.
This research (overseen by MAPS)
should begin in 2004.
Only the research can say how useful
MDMA will be in objective terms, but there is no doubt in my mind
that there will, in fact, be a significant and measurable benefit
to the experimental patients. Where we go from there is the real
unknown. MAPS intends to seek full FDA approval, which would allow
doctors to have (legal) access to MDMA again. (That would hardly
make it easily available; methamphetamine is available by prescription
well, but good luck getting any that way.) However, it is likely
that there will be mortal opposition to gaining FDA approval, since
it would mean admitting what the science has already proven: That
all things considered, the demon-drug "ecstasy" is actually
fairly safe. Granting MDMA prescription status would also be seen
as a threat to another piece of prohibitionist dogma: That no good
can come from psychedelic experiences. In part I think this latter
perceived cultural threat; the
law didn't really go after psychedelics until they became associated
with the Hippie/anti-war/socialist movements of the sixties and seventies.
Regardless of the specific motivation,
however, there is likely to be a long and bitter battle over getting
full FDA approval as the dark forces of politics rise up to oppose
science and medicine once more.
Some explanation of the exact role
of psychedelics in therapy is needed. These drugs do not solve problems
per say. Getting high isn't inherently going to make your life better
or make sense. Rather, drugs offer us a change in perspective that
can allow us to better understand and come to terms with ourselves.
What MDMA has to offer is the chance to examine your own life with
an emotional moment of grace; a chance to forgive yourself for
your own mistakes and pain. In the MDMA state, you can stop repressing
issues and face them. Ultimately, what MDMA offers is a chance for
closure...to pour out everything that is weighing on your soul, face
it...and give yourself permission to let it go.
Pharmacologically, therapeutic use of MDMA
probably works because the drug provides a rather exotic mix of stimulant,
anxiolytic, and dopaminergic effects. The massive serotonin release
neutralizes anxiety and emotional defense mechanisms. The large noradrenaline
release prods the patient to high levels of mental activity, thinking
about themselves and their lives (instead of simply sitting on the
couch feeling cheerfully indifferent as would occur with other anxiolytics.) The
dopamine release enhances conditioning/reinforcement. This
mechanism appears to be central to drug addiction, but in this context
it has a much more interesting role: It allows the patient
to essentially re-write their conditioning, over-riding the initial
memory of trauma and fear (such as from a violent crime) with a newer
memory of being able to calmly examine, cope with and move past the
experience. The net result is an extremely promising
tool for the treatment of psychological trauma of all sorts. MDMA
assisted psychotherapy is not some sort of mystical Hippie mumbo-jumbo. It
is very real science, with perfectly rational neurological mechanisms
behind its effects.
Although the current research on MDMA in
psychotherapy targets Post Traumatic Stress Disorder (victims of
sexual assault and other violent events) the drug also seems to have
a great deal of potential for couples therapy, since it can break
down the defensiveness and lack of trust that prevent open, honest
and compassionate communication between many couples. If MDMA is
approved for PTSD, doctors will be able to use it for other forms
of therapy as well ("off-label use"); although the FDA issues approval
of drugs for specific conditions, long tradition (and court rulings)
have established that once a drug is approved, doctors may prescribe
it for other conditions that they believe it may help.
Guidelines for MDMA use in therapy:
Just as there are considerations of
company, environment, etc. for recreational use of MDMA, there are
guidelines for safe and effective therapeutic use. In the course
of pursuing human MDMA research, MAPS has
prepared a detailed treatment manual. It was written by medical doctors,
psychiatrists and therapists
MDMA to treat patients.
• Read the MAPS
Treatment Manual for MDMA-Assisted Psychotherapy
The MAPS protocol is
extremely conservative, as is only appropriate for human research.
This document doesn't specify a dosage of MDMA to be used; I believe
a dose of about 1.5-1.7 mg/kg would be appropriate (about 120-135
mg for a 175 pound person.) A person who is relatively uncomfortable
the idea of altering their state of mind may prefer a lower dose
(1 mg/kg) for their first time, although it would be considereably
less effective in my opinion.