Summary: Playboy features MDMA research conducted by MAPS. Underground MDMA-assisted psychotherapy patient Seven McDonald of Playboy speaks to MAPS Founder Rick Doblin, Ph.D., MAPS-sponsored researchers Michael Mithoefer, M.D., and Annie Mithoefer, B.S.N., and study participant CJ Hardin about current clinical trials of MDMA-assisted psychotherapy for PTSD. “People ask all the time if this is a cure,” explains Michael Mithoefer. “I think a better term is maybe durable remission, because we don’t know. People can make so much progress and be free of symptoms that were debilitating before, yet if they get a strong enough trigger, it can happen that the symptoms come back.”
Originally appearing here.
My first MDMA-assisted psychotherapy session took place in my apartment on a sunny winter morning. I bought fresh-cut flowers, filled the fridge with vegetables, made hot tea from my garden and listened to Exile on Main Street. My months-long search to find a male-female therapy team who would agree to do the illegal treatment with me had led me underground. Meanwhile, my symptoms had grown extreme. My post-traumatic stress disorder had me suicidal, anxious, almost housebound. I had become obsessed with the cutting-edge therapy while researching an article on the Multidisciplinary Association for Psychedelic Studies, or MAPS, an organization that conducts Food and Drug Administration–approved clinical studies on treating PTSD with MDMA. Preliminary findings show that, combined with psychotherapy, the drug—more commonly known as ecstasy—can help people overcome chronic PTSD in just a few eight-hour sessions. A tantalizing thought, especially since nothing else had worked on me.
The therapists arrived around 10 a.m. They suggested I lie on the sofa. They sat on the rug in front of me; my dog lay down beside them. My female therapist handed me two capsules of pharmaceutical-grade MDMA. At 125 milligrams, my dose fell on the light end of the recreational-use spectrum, which can range up to 200 milligrams.
It didn’t take long. I got quiet, stopped talking mid-thought. After some time, they asked how I was feeling. I put my head down and told them I was “understanding something.” Inside, I felt as if a dark spell was lifting. I felt light and free.
Later, I regressed to the age of seven. That’s how old I was when I followed my mother from my hometown of Berkeley, California to Los Angeles. I didn’t want to move, I told them, but I did it for my mom, who was an actress and wanted to become a star. The seven-year-old me was smart, playful, intuitive. She had a funny way of talking; I had never heard myself talk in that voice before. She liked the therapists, and also a sock monkey that happened to be sitting on the sofa and that quickly proved to be a faithful servant, helping seven-year-old me say things I didn’t want to say.
Soon I became overwhelmed with grief. I was sad about my mother and all the times she left me alone. Once, I whispered as my breath grew labored, I was locked out of my house in the rain. “You guys,” I said in my strange new voice, “do you know what? I stayed there all night.” I started remembering something. “Oh no, this is so sad. You guys, she didn’t come home until the morning, until the sun came out. When she got home she just opened the door, irritated, and told me to go inside. She never said sorry or anything. Isn’t that sad?”
One of the therapists suggested that we pull the grief out of me. Making motions in the air with her hands, she helped me drag it out. I joined her and we pulled until my arms grew tired. I said it might take a very long time to get it all out.
Full disclosure: I was molested when I was a preverbal infant. I didn’t remember that until much later, after I was date-raped at the age of 20 by a man I’d met in Narcotics Anonymous. Four years after that, a stranger broke into my apartment in the middle of the night and attempted to rape me in my bed. These and other traumatic incidents contribute to my PTSD, which lay dormant for decades but a few years ago began to emerge.
Before the session was over, the female therapist asked if I would like to see what kind of agreement I had with my mother. She called it “a contract.” I excitedly told them I knew how to read and write contracts. She offered to take dictation. As we discussed the terms of my relationship with my mother, from whom I’ve been estranged most of my life, it became clear that the contract wasn’t mutually beneficial. I was sacrificing things, such as my own happiness, to avoid upsetting her. So we made some changes. I put my head down and thought about it.
The medicine was wearing off. They made a light vegetable soup. We sat at my kitchen table together. I wasn’t hungry, but I enjoyed being there with them. A friend came over, and we took the dog for a walk.
I’ve always liked psychedelics. I did a lot of them as a teenager in northern California—LSD, mushrooms, mescaline, ecstasy. But before the MDMA therapy, I hadn’t done any psychedelics in decades; as a member of Alcoholics Anonymous, I practiced total sobriety. In the name of health, I’ve done a lot of “work” on myself. I eat locally grown organic food and was a vegetarian for 30 years. I practice yoga and meditate. I’ve been in and out of traditional and nontraditional talk therapy for most of my life. I lived in an ashram in the Bahamas for more than a year. I’ve read the Bible cover to cover twice and have studied Sanskrit and Buddhism, Vedanta and Hinduism. I’ve been rebirthed and given two spiritual names by two different gurus. I’ve done countless hours of deep body work, acupuncture, energy healing and eye movement desensitization reprocessing. I’ve practiced both silence and celibacy. All these things provided rich experiences and deep understandings, but none of them helped me locate and integrate the different parts of myself that trauma, meteorlike, had splintered off. None gave me the perspective that started to come to me that day in my apartment.
According to the National Center for PTSD, 8 million adults suffer from the disorder in any given year. Not everyone who experiences trauma will develop PTSD; in fact, only 10 percent of women and four percent of men experience PTSD after a traumatic event. Some groups—minorities, the impoverished, the less educated and those with other mental health issues such as anxiety, depression and alcoholism—are more prone to PTSD than others. And those with PTSD are significantly more likely to suffer from addiction, as well as suicidal tendencies.
This summer, MAPS will begin phase III of its study, treating hundreds of subjects with PTSD stemming from various forms of trauma. Although the subjects for the newest round have not yet been selected, they will most likely include individuals who have suffered trauma linked to childhood abuse, sexual assault, combat, working as a first responder, loss, natural disasters, hate crimes and other causes. If all continues to go well, MAPS founder and executive director Rick Doblin estimates that MDMA will be an FDA-approved prescription medicine by the year 2021.
Psychedelic drugs are making a comeback in the world of neuroscience and medicine. Clinical tests are being conducted across the globe, using LSD, MDMA, psilocybin, ayahuasca, ibogaine and ketamine to treat illnesses and conditions as common as cluster headaches and nicotine addiction. Micro-dosing LSD has also become popular, thanks in part to high-profile supporters such as author Ayelet Waldman, whose book A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage and My Life came out earlier thi
s year.
MDMA, or 3,4-methylenedioxymethamphetamine, was developed by German pharmaceutical company Merck in 1912. The drug existed with little fanfare until 1976, when American chemist Alexander “Sasha” Shulgin synthesized a batch in his Berkeley backyard laboratory. Recognizing its therapeutic potential, Shulgin shared it with his friend Leo Zeff, a psychologist who had previously used LSD legally in his practice. As the story goes, Zeff was so inspired by the new psychedelic, which he nicknamed ADAM after the original man, that he decided to postpone retirement and incorporate it into his work. He also made it a point to spread the word to as many people as possible, so much so that he’s often referred to as the Johnny Appleseed of MDMA. By 1984 an estimated 4,000 therapists were using the drug in their practice.
MDMA simultaneously became a popular street drug or, more aptly, club drug, thanks in no small part to a Texan seminary student named Michael Clegg, who had started selling it, under the name ecstasy, through a booming mail-order business. Clegg was making a fortune before the Drug Enforcement Administration stepped in, classifying MDMA as a Schedule I drug in 1985. (Clarification: Drugs commonly sold on the street under the name molly or ecstasy frequently contain unknown and dangerous adulterants and may contain no MDMA at all.)
Today’s psychedelic renaissance began in 1989 with a restructuring at the FDA, when the newly formed Pilot Drug Evaluation Staff decided to reopen the doors to both psychedelic and marijuana research—exactly what many enthusiasts, including Doblin, had been waiting for. Some of the current psychedelic research is funded by governmental agencies, though most is sponsored by nonprofit organizations such as MAPS, the Heffter Research Institute and the U.K.’s Beckley Foundation.
According to Doblin, pure MDMA is good for “a million things,” including assisting in couples therapy and treating eating disorders, anxiety associated with life-threatening diseases and possibly even schizophrenia. The correlation between what MDMA and PTSD do to the brain is particularly remarkable. PTSD increases activity in the amygdala, the brain’s fear center, and decreases activity in the prefrontal cortex, the part responsible for high-level processing. MDMA, on the other hand, decreases activity in the amygdala while increasing activity in the prefrontal cortex. MDMA also activates the hippocampus, the part of the brain that deals with memory, so it can help dislodge what its users have repressed. At the same time, the drug creates a feeling of extreme well-being, or even love, by flooding the system with the neurotransmitters serotonin, oxytocin and dopamine, as well as the hormone prolactin. What this means is that subjects who have been traumatized, in some cases for decades, can suddenly relax and trust other human beings. In the case of MAPS therapy, those trusted human beings are a male-female therapy team who are there with patients as they revisit the trauma, allowing them to finally process and integrate the experiences that are at the root of their condition.
Of course other drugs, namely benzodiazepines, also reduce anxiety. The problem with those drugs is they interfere with memory and act as sedatives, whereas MDMA effectively reduces anxiety in a manner that still allows subjects to connect to their emotions without being overwhelmed by them. According to Dr. Michael Mithoefer, Doblin’s partner in the study, MDMA also provides subjects and therapists four to six hours of what is considered an “optimal arousal zone.” The idea here is if subjects are too anxious or over-aroused during therapy, they won’t be able to process it effectively; the anxiety hijacks the experience, and they may even become retraumatized. Conversely, if a subject is too shut down or numb while discussing trauma, it is also not therapeutic.
In addition to those who’ve experienced sexual trauma—the National Sexual Violence Resource Center has found that one in four girls and one in six boys will be sexually abused before they turn 18—another large and vulnerable group makes this research all the more urgent. A 2008 RAND study found that nearly 20 percent of military veterans returning from Iraq and Afghanistan suffer from PTSD. As of September 2014, veterans from the wars in Iraq and Afghanistan alone number some 2.7 million. About 22 U.S. military veterans commit suicide each day, and though not all of them would fit the criteria for PTSD, many would—and a veteran named James Hardin might have been one of them.
James “CJ” Hardin, 37, served for more than seven years in the U.S. Army, half that time in heavy combat zones: a year at Qayyarah Airfield West and a year at Camp Speicher, both in northern Iraq, and another year at Bagram Airfield in Afghanistan. It goes without saying that he saw a lot of death, both in combat and while working in a mortuary in Iraq.
Hardin was one of 24 veterans and first responders accepted into the second MAPS MDMA study for PTSD in 2013. (The first study treated 20 victims of sexual assault and childhood sexual abuse.) Multiple tours and some trauma he experienced before entering the military left him with “treatment-resistant” PTSD, meaning he hadn’t responded to medication or therapy, just as I hadn’t. He had opted for an early administrative discharge, leaving behind a military career he’d been planning since he was a 13-year-old Air Force cadet.
Sipping a mimosa at a creek-side restaurant in Mount Pleasant, South Carolina, Hardin is polite and personable. He looks you in the eye when he talks and smiles whenever he mentions his wife, Erin, an accountant for a coastal-conservation organization who belly-dances and volunteers for a local sea-turtle rescue organization in her spare time; Hardin calls her Shine. They live 20 minutes away in a rental with a backyard garden and two cats and two dogs, one of which he rescued while stationed in Korea.
Thanks to the GI Bill, he has an associate’s degree in avionics, a field he has dreamed about since he first saw the film Top Gun as a boy. Down the line, when he and Shine are making more money, they might adopt a child. Right now they’re just enjoying spending time together, seeing friends, eating good food and being out in nature.
Prior to the study, Hardin spent almost a year hardly ever leaving an eight-by-10-foot Shasta camper he shared with his dog, and another year in a cabin with spotty heating and running water, three miles off the nearest road. He moved there after the lights from passing cars and some run-ins with the Ku Klux Klan made living closer to town difficult. Most days he drank a full bottle of vodka and smoked two packs of American Spirits and a lot of pot. If he did go out, he couldn’t look people in the eye. He was suicidal and suffering from a dissociative phenomenon called depersonalization, which caused him to experience himself in the third person.
The Veterans Administration had misdiagnosed Hardin as bipolar and denied him disability benefits. He had tried Alcoholics Anonymous as well as the VA’s group therapy and spent close to five years on an assortment of prescribed drugs: Ambien, Effexor, Ritalin and a blood pressure medicine to stop the nightmares. None of them helped.
During his first MDMA session, Hardin felt safe for the first time in years, perhaps in his life. He tells me that he had resigned himself to never feeling safe again. By the time he had completed his third MDMA session, he and Shine had started talking about the future: relocating to Mount Pleasant and maybe even getting married (both of which they have since done).
Today Hardin is off all prescription medication. He has quit smoking, and if he does drink he keeps to a two-drink maximum. He says the PTSD is gone. None of this would have been possible if he hadn’t partici
pated in a study conducted less than a mile away in the homey offices of Dr. Michael Mithoefer.
Michael Mithoefer and his wife, Annie Mithoefer, who conduct and oversee MDMA-assisted psychotherapy for PTSD in Mount Pleasant, might be the ideal co-therapy team. He’s a psychiatrist specializing in PTSD and trained in eye movement desensitization reprocessing; he is also board certified in emergency medicine and was previously a clinical assistant professor at the Medical University of South Carolina. She’s a psychiatric and cardiac nurse. Michael Mithoefer maintains a small private practice specializing in PTSD while monitoring all MAPS-sponsored clinical trials.
Married 43 years, the Mithoefers have raised a family together, and both studied with Stanislav Grof, an early psychedelic pioneer and one of the founders of transpersonal psychology. Compassionate, intelligent, respectful of each other, they’re not the people you think of when you think of MDMA; they’re who you think of when you imagine ideal parents. That’s no accident: In a nod to the early researchers into psychedelics, many of them married couples—including Alexander and Ann Shulgin and Grof and his wife, Christina—MAPS MDMA-assisted psychotherapy calls for a male-female co-therapy team. The reason for this is that it allows the subject to feel safe at all times. It also allows those who may regress during sessions to have corrective experiences with both of their “parents.”
“We’re happy there are other treatments available,” says Michael Mithoefer, seated in the warmly lit office that doubles as his test site. “We’re not claiming this is the only treatment. It’s clear that a substantial proportion of people don’t respond to existing treatments, and that’s why we need more choice.”
Beyond the various therapeutic approaches, including eye movement desensitization reprocessing, cognitive behavioral therapy and prolonged exposure, the most common pharmaceutical treatments for PTSD are the antidepressants Zoloft and Prozac. Although they’re effective in decreasing suicidal thoughts, they appear to address only the symptoms and not the underlying causes of PTSD. As Doblin points out, the medications result in only about a six- to 10-point drop in the Clinical-Administered PTSD Scale for DSM-5, the VA’s standard for assessing the illness. MDMA-assisted psychotherapy has shown a 50-point drop on average. (The scale ranges from zero to 136.)
“People ask all the time if this is a cure,” says Michael Mithoefer. “I think a better term is maybe durable remission, because we don’t know. People can make so much progress and be free of symptoms that were debilitating before, yet if they get a strong enough trigger, it can happen that the symptoms come back.”
By the time I met the Mithoefers, I had been researching PTSD for months but had yet to begin my illicit sessions. My personal identification with the study’s subjects had become overwhelming. My anxiety was interfering with my cognitive abilities, something I hadn’t experienced before. I was having panic attacks and was also having trouble writing.
I arrived at Michael Mithoefer’s office on a muggy afternoon. Sinking into the sofa, I felt confident his glowing reputation was well earned. When Annie explained that many sexual-assault and childhood-abuse victims suffer for decades, whereas veterans often find help sooner, usually after a decade, my heart dropped. I continued to interview them for my article, wanting to be professional. I never asked if they could help me because I didn’t want to jeopardize their practice.
The MAPS psychotherapy treatment includes three sessions with MDMA; the rest of the sessions involve 90 minutes of integrative talk therapy. Because it’s a double-blind clinical study, some subjects are initially administered a placebo and later given the option of participating again with full-dose (125 milligrams) MDMA sessions.
An MDMA-assisted psychotherapy session lasts eight hours. The therapeutic approach is nondirective; the idea is to let the subject’s unconscious lead the way, without therapists forcing any particular issue.
Subjects stay overnight with an attendant in case they need anything. The next day, they spend a few hours with the therapists, discussing what came up for them the day before. As Doblin explains—and I can attest—the initial integration process that takes place on that second day is essential to the subjects’ overall progress. Afterward, they return home, or to a nearby hotel if they’ve traveled for the study, and for a week they receive a daily call from the therapy team. Then they shift to weekly talk sessions until the next MDMA session is scheduled.
One of the reasons Doblin and Michael Mithoefer settled on MDMA for PTSD was the existence of extensive clinical research showing that, when taken in moderate doses and in limited sessions, MDMA is sufficiently safe. Doblin estimates that governments all over the world have conducted $300 million worth of research on the safety of the drug—including investigations into neurotoxicity, serotonin levels, driving under the influence and emotional processing, the findings of which are now all in the public domain.
Organized opposition to the research is all but nonexistent. In fact, marijuana research is far more contested. The biggest hurdle seems to be the enduring stigma that surrounds MDMA because of the cultural associations with being a Schedule I “drug of abuse.” Brad Burge, MAPS director of communications, hopes that as people learn more about PTSD they will come to understand the importance of finding an effective additional treatment.
The work of making a drug into a medicine is scientific, but everything else—from the subjects you select to whom you choose to build alliances with—is political, not to mention part of a fraught cultural landscape that must be navigated with care. Ironically, some of the greatest roadblocks the treatment faces en route to the mainstream were laid down by Timothy Leary, whose pioneering work in the field of psychedelics was colored by his devotion to fighting the system.
“One of the big mistakes of the 1960s was people identifying as the counterculture,” Doblin says. “When the crackdown happened, psychedelics got wrapped up with Timothy Leary and the cultural revolution. When you self-identify as part of the counterculture, you check yourself out of things; you kind of marginalize yourself. You don’t ask the system to grow and change.”
It has been a year since I completed my MDMA-assisted psychotherapy. Like Hardin, I have experienced relief from my PTSD. I often think about the afternoon I spent with him, and my mind is still blown by the extent of his transformation. Now that I too am transformed, I know that MDMA-assisted psychotherapy is not an escape from reality. I believe it’s the opposite. It’s a reentry.
