MDMA - a drug for healing relationships?

Nicholas Albery

The following article was published in the Guardian and looks at some of the implications of the drug Ecstasy.

'A good MDMA session is comparable to two years' traditional therapy;' 'it produces that vital and transforming factor in psychiatric sessions, honesty;' 'it invites self-disclosure and self-exploration' - these are quotes from some of the several hundred psychotherapists and psychiatrists in America who have made use in their practices of the psychedelic amphetamine drug MDMA. In the UK, MDMA has been illegal since 1977, and in the States since 1985. But under its street name of 'Ecstasy' or 'Adam', it continues to be consumed illegally by hundreds of thousands of users in the Western world.

The literature is beginning to accumulate as to its potential dangers and benefits - there are a handful of reports to date of deaths resulting directly or indirectly from MDMA use (one of a healthy woman in her early thirties taking only two to three times the 'average' dose); and one published report of a near-fatality concerning a healthy 33 year old female publishing editor whose second MDMA experience, with an average dose, led to hallucinations and delirium, and to treatment in a hospital critical care unit for hypothermia, regulatory distress and pulmonary oedema. There are also anecdotal reports of seizures and that MDMA may reduce resistance to infections. Rats given high doses of MDMA suffered degeneration of serotonergic nerve endings in the brain - in humans the serotonergic system helps regulate sleep, mood, sexual activity and sensitivity to stimuli. Monkeys have proved susceptible to MDMA damage at lower levels than rats, in fact at levels only two to three times higher than the average human dose (there is however evidence of subsequent recovery - serotonin levels that had fallen 80-90 per cent showed only a 30-40 per cent depletion ten weeks later); the preliminary findings from research on 34 long-term human users is that they too have 'persistent alteration in the serotonin system', although this study is now to be repeated with better controls.

Add to these warning signs, the fact that only two out of five street samples tested by Face magazine turned out to be MDMA, and the conclusion seems to be that it is not a suitable drug to take casually. But since many people will inevitably continue to use it, there is an urgent need to put MDMA through all the trials that any new drug would undergo - to gather further data, for instance, on its toxicity and carcinogenicity.

'Perhaps MDMA's greatest potential in therapy is non-verbal, in somatic therapy, to remove the blocks that prevent contact with the life force within the body, the blocks that hinder the 'elan vital' from flowing'

Promosing research is now under way at Dr David Nichols' laboratory at Purdue University, Indiana. He is investigating how MDMA neurotoxicity is produced. 'It now seems likely,' writes his supporter Rick Dobin, 'that the therapeutic properties of MDMA can be separated from the toxic properties.' If this proves true, and once the contra-indications are more firmly established, it may be possible to recommend the drug or a variant of it for its therapeutic potential as a relatively mild psychedelic normally without the hallucinations and loss of ego that LSD can cause (although positive results using LSD in the treatment of prisoners, alcoholics and terminal cancer patients were reported in the days before LSD was made illegal). The overwhelming majority of MDMA users report good experiences, and do so more consistently than LSD users in the past, with only mild side effects such as nausea, jaw tension and tiredness afterwards. One of the attractions of the drug for recreational users is that it tends to make them feel more sensual and increases the pleasure of physical contact. In one study, for instance, 32% of users reported an increased desire for sex while under the drug's influence, although 84% reported a decreased ability to attain orgasm. This leads Robert Leverant of Sebastopol, California, to suggest that 'perhaps MDMA's greatest potential in therapy is non-verbal, in somatic therapy, to remove the blocks that prevent contact with the life force within the body, the blocks that hinder the 'elan vital' from flowing.' Certainly people seem to fall in love more readily under its influence - it can promote inappropriate 'pair bonding.' In California they sell T-shirts which say 'Don't marry for six months after Ecstasy.'

San Francisco psychotherapist Dr Philip Wolfson argues that there is 'a volume of experience indicating that MDMA is effective in the treatment of depression, marital discord and couple therapy.' His work also leads him to believe that the drug offers 'unique possibilities in the treatment of psychosis.' Whereas the traditionally used neuroleptic drugs create a zombie-like effect and a profound loss of identity, with the possibility of Neuroleptic Malignant Syndrome, permanent brain damage and death, research into potentially less dangerous drugs of the MDMA variety is constrained 'by the spectre of abuse' and by the necessity for an 'absence of pleasurable or energy-giving properties' in psychiatric drugs. 'If a substance is desired by a human being,' writes Dr Wolfson, 'it is taboo to the psychiatric and governmental bureaucrats.'

Dr Wolfson believes that drugs such as MDMA could help maintain or increase a sense of non-psychotic identity, reduce aggression and paranoia and improve communication and empathy. He envisages such a drug being used on a voluntary basis for five-hour sessions once every five days, with daily psychotherapy in between. He is excited by the prospect: 'No new clinical agent of importance has been placed in psychiatry's hands since the introduction of haloperidol almost twenty years ago.'

Dr George Greer, a psychotherapist in Santa Fe, New Mexico, who has studied the effects of the drug on 69 patients, is equally enthusiastic: 'We have not heard of any long-lasting problems following MDMA sessions supervised by professional psychotherapists. Because of this fact, we have not been overly concerned by the reports of neurotoxicity in animals. We currently believe that, for all but extremely rare cases, there is a significant gap between the highest therapeutic doses and clinically significant toxic doses.' One of his clients was a terminal cancer patient in his early seventies. He had had four MDMA sessions in a nine-month period, and these were the first times he had been really pain-free in four years. In his first session, he experienced 'being inside his vertebrae, straightening out the nerves, and 'gluing' fractured splinters back together.' In between sessions, he had 'greater success in controlling painful episodes by returning himself to an approximation of the MDMA state. He noted in particular that the feelings of 'cosmic love' and especially forgiveness of himself and others, would usually precede the relief of physical pain.'

'It made me feel how all of us would like to feel we are anyway'

The Scottish psychiatrist and author, the late Dr R.D. Laing, has been quoted in a similar vein: 'It is a shame that MDMA has been criminalised, because it could take its place in the pharmacopoeia.' It is a drug that enhances feelings of self-esteem. 'It made me feel,' said Laing, 'how all of us would like to feel we are anyway.'

In Switzerland, with permission from the government - possibly out of deference to its powerful pharmaceutical companies, Switzerland is not a signatory to the 1971 International Convention on Psychotropic Drugs - six doctors are using MDMA and other psychedelics in the treatment of patients suffering from reactive depression, addictive disorders, character neuroses, phobias, obsessive-compulsions and anorexia nervosa. Their preliminary reports are encouraging.

- Serious researchers can gain access to the literature on MDMA at the Institute for the Study of Drug Dependence's library in London. For details phone 071 430 1993. There is also a sizeable file in the Institute for Social Inventions' library (tel 081 208 2853).
- Rick Doblin, 23A Shaler Lane, Cambridge, Mass. 01238, USA (tel 617 547 7271). Doblin runs a centre for research into MDMA and the psychedelic drugs, and publishes a newsletter. He is the author and publisher of a paper entitled 'Regulation or Prohibition? MDMA Research in Switzerland and the United States'.
- An aubiographical book by the chemist who (legally) synthesised (and researched the effects of) a hundred or more drugs in the MDMA family has been published, entitled 'Pihkal (Phenethylamines I Have Known And Loved) - A Chemical Love Story' by Alexander and Ann Shulgin (published by Transform Press, Box 13675,Berkeley, CA 94701, USA, $18-95; also available from Rick Doblin, address above).

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