Meanjin Quarterly: Pinging off the Wars

Summary: Meanjin Quarterly publishes a first-hand account from Australian Jesse Noakes about overcoming depression and anxiety through underground MDMA therapy sessions. Noakes details how the MDMA sessions with their therapist followed the treatment protocol developed by MAPS, highlighting MAPS’ ongoing international MDMA-assisted psychotherapy research. Noakes discusses the bureaucratic barriers to starting an MDMA-assisted psychotherapy clinical trial in Australia, explaining that “MAPS have been pushing for an Australian arm of their trials for over five years, and getting nowhere.” MAPS Founder Rick Doblin, Ph.D., says, “Australia’s been really difficult. You have the dubious distinction of being with Jordan as one of the two countries we couldn’t get approval.”

Originally appearing here.

On MDMA Therapy

One morning a few weeks ago I walked through the cool air around Rushcutters Bay and buzzed myself up to my therapist’s apartment nearby. I hugged him when he opened the door and we chatted while he made me some green tea and put more in the fridge to chill for later. Making myself comfortable on his long sofa, I lined up my accessories on the coffee table beside me: headphones, a padded eyemask, a notebook, my water bottle, and a capsule containing 125mg of pure MDMA.

When I was ready, I handed him three handwritten pages of bullet point topics for discussion, and swallowed the capsule. For the next seven hours, when I wasn’t lying back on the couch with Tame Impala or Hindu chants in my headphones, I talked with him about the early childhood roots of my crippling depression and the blind terror that underpins it.

This was the fourth time I had taken MDMA with a therapist. Last year, giving up on finding someone to work with in Australia, I travelled first to Europe, and had two day-long sessions with a doctor in Switzerland. Then, in New York, on a sweating August evening, with the sirens and the music and a thunderstorm coming in through the skylight, I found the breakthrough that a decade of CBT and SSRIs and a bunch of other acronyms had never come close to granting.

For the first time in years, I relaxed. I could feel my body. I felt calm and open, eager to connect with the guy sitting across from me. ‘Has it worked, this time?’ he asked, amused, and with an ironic laugh I indicated that it had. It was the most profound relief.

I didn’t feel like I was tripping, or blissfully euphoric. With the depressive sludge gone from my system, I felt lucid and enthusiastic. I felt a warmth towards myself and my therapist, wondrous and poignant in its novelty—this was how it is supposed to be. Earlier that afternoon I had avoided his eye contact and felt hobbled in conversation—now, the intimate vulnerability in moving closer to delicate feelings was delicious and rewarding.

I massaged my thighs, discovering an intricate palette of tension and sensitivity in each of my feet. Taut coils seemed to be rippling loose across my body. Each time I remembered to breathe deeply was an opportunity to soften and relax more, exploring this vivid bodily awareness. I knew the theory well enough from years of meditation and yoga classes, but could never apply it. Now, without thinking, without effort, I welcomed the renewed sensation that lapped in as the paralysing tension dissolved.

And gradually I appreciated that my fear was gone. Its background static was so normal that I found the new intensity of thought and emotion startling. The grey veil lifted from my brain to reveal a subjective experience in high definition. I saw patterns, tracing the way family dynamics from early childhood had trapped me in a way of relating to the world and other people that was defensive and restrictive.

Previous therapy had often seemed like an exercise in grazing up against a thick stone wall. A therapist would inquire and prompt, and I’d talk, but a layer of ice in my brain would prevent me from connecting my searching words with any bedrock of emotion or meaning. I’d skate in frustrating circles without penetrating. In these few humid hours in New York, I approached close to my traumas and realised that it was safe to do so. I came to understand how, ultimately, it all comes down to trust—a feeling of safety that lets things in, or a contractive fear that excludes and represses. By surrendering, I opened to find a powerful stream of experience that had been blocked for a long time. I reconnected with early memories and understood how they still shaped me. I came home.

A few days later, I looked at my hands and noticed I had fingernails, for the first time ever. After a lifetime of compulsive, incessant nail-biting, I had stopped without trying or even realising. It was visible evidence of some knot releasing deep in my mind.

In my MDMA sessions, as well as in the regular therapy sessions that precede and follow them, I followed a treatment protocol developed by the US-based Multidisciplinary Association for Psychedelic Studies (MAPS). Over the past decade, MAPS has coordinated and funded six clinical trials to investigate the efficacy of MDMA-assisted psychotherapy as a treatment for post-traumatic stress disorder (PTSD). In the first trial, a Phase 1 pilot study in South Carolina published in 2011, they treated 20 survivors of war and sexual abuse, whose resulting PTSD had been diagnosed as ‘treatment-resistant’. After three MDMA sessions interspersed over a three-month period with another half-dozen non-drug therapy sessions, 83% no longer qualified for a PTSD diagnosis.

Last December, the US Food & Drugs Administration (FDA) approved the third and final phase of trials, intended to treat over 250 participants at a dozen sites in the US, Canada and Europe. This approval was informed by the results from MAPS’ Phase 2 double-blind control trials, following the same protocol as Phase 1. A further 107 participants with chronic PTSD were treated—53% of those who received three MDMA therapy sessions experienced full remission of symptoms, compared to 23% of those who received the therapy with a placebo instead of MDMA. A year down the track, 68% of MDMA recipients no longer had PTSD, suggesting that not only do the benefits last, they actually compound with time.

MAPS will begin enrolling Phase 3 participants later this year. They plan that MDMA will be a prescription medicine in the US by 2021. It won’t simply be a case of seeing a doctor and going home with your pills, though. MDMA is often described as an empathogen, which means that it facilitates interpersonal openness and a relaxing of psychological defence mechanisms. That’s when traumatic or emotionally painful material can surface, and be discussed with the therapist. Marcela Ot’alora is lead clinician in one of the MAPS trials in Colorado, and she emphasises that ‘it’s about MDMA-assisted psychotherapy. The MDMA does a lot of the work, but people can’t treat themselves.’

This is why there’s a difference between taking MDMA at a festival or club, and the explicitly therapeutic use of the drug to deliberately address trauma. Ot’alora acknowledges that someone taking MDMA recreationally can experience psychological benefits, but says maintaining those benefits after coming down is the hard part. ‘My experience is that you can have a very profound experience and that it’s difficult to integrate it on your own.’

Roxxann Murphy will attest to that. Roxxann’s husband David died in her arms by the side of an Oklahoma highway, as she breastfed their baby daughter and waited for an ambulance that came too late. When I spoke to her last year, Roxxann was warm, energetic, exuding curiosity and care. But in the aftermath of David’s accident, the trauma stole all her vitality. &l
squo;During the PTSD, I was bad. I was really bad. I raged out, I broke things, I wailed, I cried at the grocery store.’ Worst was the effect on her daughter. ‘She’s got a dead dad and a fucked-up mum—and she’s not two yet. If I was going, she was going with me. It’s a horrible feeling to want death for you and your daughter. But I was just sick, sick, sick.’

Desperate after two years of fruitless therapy, she found Ot’alora’s trial, and talked her way in. ‘It’s the kind of desperation that hopefully speaks to people. You really don’t have many options left. I just got very, very lucky, I think.’ She’d taken MDMA before, with friends, ‘and I always got a lot from it.’ But with Ot’alora and her co-therapist Bruce Poulter (therapists in MAPS trials work in teams of two), ‘it was a very different experience. Since I was so traumatised and I wanted to die and kill, it was different. At the scene [of David’s accident], I was unable to physically react in certain ways, and it stayed with me, physically and emotionally.’

Now, on a couch in Ot’alora’s cosy office, ‘it was like having your best friend there, but a best friend who knew a lot about psychology. It was imperative. If I had just done it with myself, or my best friend, I don’t even think I would have got that far. It would have been too terrifying.’ It’s not what you’d call recreational drug use. ‘A lot of that last session was me going to the scene of losing David. I was able to see how I can incorporate him into my life now even though he’s not physically here. It was a really big job that I didn’t think I’d be able to handle, and the MDMA sessions showed me that I can.’

Evidently, this was a transformative shift. ‘The proof is in the pudding. I am living my life, I’m happy, I’m travelling, I’ve fallen in love again. You think, finally, I’m back to normal, I’ll be ok. I am better than normal.’ This last emphasised with an emotion-charged deepening to her tone—a joy, a disbelief, and a poignancy. ‘I can’t believe it’s illegal. I really can’t. For the next year after the therapy, it was the most exponential growth of my entire life. The only thing that gives me pain is that people don’t have access and they are screaming for it at the top of their lungs.’

And here is the crux. Roxxann found her freedom in a regulator-approved trial, but so far barely 150 people have been accepted into MAPS studies, across North America, Israel and Europe. I had to travel overseas, following months of online investigation, to find underground therapists to work with, before I finally found my friend in Sydney. MAPS have been pushing for an Australian arm of their trials for over five years, and getting nowhere. As their Executive Director Rick Doblin told me, ‘Australia’s been really difficult. You have the dubious distinction of being with Jordan as one of the two countries we couldn’t get approval.’

A local non-profit, PRISM, was established in 2011 to advocate for increased Australian research, and MAPS has agreed to partially fund an MDMA study that would be affiliated with their FDA trials. PRISM have been shopping the concept to universities ever since, to a stony reception. Last year, an application at one sandstone university was rejected after the personal intervention of a deputy vice-chancellor.

PRISM’s secretary, Steve McDonald, gave me the gist of it: ‘What we’ve found is that Australia’s a very conservative place, particularly the academic and medical professions. They’re worried about the social stigma of MDMA as an illicit drug. It’s not about the science, in the same way our drug laws are not about the science, they’re about the social attitudes and the taboos. Same thing with the academic world. It’s about the fears.’

In the meantime, I’m not super fussed about the legal status. I’m interested in evidence-based medicine. The science is in on the MAPS research, and my own empirical findings replicate theirs.  In the year since New York, I have had more periods of calm, connected clarity than in the 28 years before. I still have numbly depressive periods, where the lights are off and I’m fumbling desperately in the dark—but now, after a few days, or a week, the light comes back, and it’s warmer and stronger each time. MDMA therapy is no magic bullet, the New York therapist cautioned me before I flew. Perhaps not, but the change it catalysed is alchemic.

Roxxann feels the same way. ‘I got all my special powers back, as a human being. And they really do feel like magic powers, when you don’t have access to them.’