MDMA and the Future of Psychotherapy

MDMA, methylenedioxyphenethylamine, otherwise known as Ecstasy, criminalized in 1985 during the Reagan administration is currently in the midst of a well deserved renaissance. We can likely attribute this to a combination of the recent legal success of the marijuana activists, as well as the escalating rates of Post-Traumatic Stress Disorder, (otherwise known as PTSD). The explosion of trauma pathology in the U.S. has sent researchers and clinicians scrambling for new alternatives, effectively softening public perception and media scrutiny towards the once maligned substance. Clinical trials for MDMA-assisted psychotherapy, funded by the likes of Rick Doblin and the Multidisciplinary Association for Psychedelic Studies (MAPS) have shown nigh miraculous results in helping people recover from PTSD. In several cases, patients reported experiencing a phenomenon known in positive psychology as Post-Traumatic Growth (PTG), a transcendent psychological state in which traumatic experiences are put to rest, resulting in a heightened sense of self-awareness and a greater capacity for emotional and psychological autonomy.

The history of Post-Traumatic Stress Disorder in the West unofficially began with the First World War. A historic meeting of old and new world brutality, it was a conflict which (particularly in todays cultural climate) does not get the recognition it deserves for both its impact on the 20th century and its barbarism. Without exaggeration, there were quite literally countries whose military consisted of sword wielding horsemen, while other nations had mounted machine guns. In short, it was a horrific introduction to modern warfare. Such never before witnessed battle conditions included trench warfare, where combatants burrowed underground to find save haven from the maelstrom of bullets and bombs. This presented unique challenges of its own, not the least of which included camping out in your own filth. Mortars and grenades would make their way past whatever makeshift defenses could be cobbled together, decimating troops. It was not uncommon for soldiers to be lying in the trench surrounded by the body parts of their comrades. At the time, military and medical professionals had taken to calling the resulting psychological damage caused by such conditions ‘Shell Shock’. By the second World War it had come to be known as ‘Battle Fatigue’. Fast forward to the Gulf War of the 1990s, the American Psychological Association had officially termed the condition Post-Traumatic Stress Disorder.

As I mentioned before, Rick Doblin, the founder of MAPS, has been instrumental in debunking the quarter-century long propaganda campaign against MDMA. He campaigned for the better part of two decades for the decriminalization and legalization of MDMA for therapeutic use. While his work is currently enjoying much attention, it hasn’t always been this way. MDMA was used clandestinely by the military in the mid-1990s as a treatment for active soldiers struggling with PTSD. Their findings were mostly positive; MDMA proved to be highly effective in aiding people suffering from unintegrated traumatic experiences. However, the military got more than they bargained for; after their treatment, patients very strongly resisted returning to combat. Displeased by this turn of events, the U.S military terminated these experimental treatments.

To this day, the conversation around PTSD figures mainly around combat veterans. But the unfortunate truth is that traumatic events are part of the human experience. I’m taking an extreme liberty in saying this, but it is my opinion that that a lot more people suffer from the stress protocols associated with PTSD than the official data would lead us to believe. That isn’t to say everyone has clinical PTSD, but rather that we are all to some degree victims of trauma. Certainly the military, law enforcement, firefighters, and other high risk professions are most at risk for PTSD and are therefore obvious candidates for MDMA-assisted psychotherapy. However, that is not sufficient reason to deny treatment to other at risk populations that could benefit from new treatment models.

As many professionals in the overburdened mental health fields learned in the middle part of the 20th century, talk therapy (traditional psychoanalysis) has shown to be woefully inadequate when it comes to resolving emotional anguish. Whether this can be blamed on incompetent therapists or a faulty method is a different question altogether. For psychotherapy to be effective at all, it requires the patient to have a skill set that promotes change. The capacity to self-reflect, detach oneself from thought and emotion, and the willingness to implement new lifestyle strategies are in very rare supply. Most people do not regularly examine their life experiences, decisions, and beliefs. A very small percentage of the population is capable of doing this with any regularity. The reason for this is two-fold: firstly, it is DIFFICULT to do these things. I don’t mean to overstate this – it requires a great deal of mental fortitude and emotional resiliency to look at oneself in an unbiased way. The ability to take a perspective on your life that is not your own is rare. Secondly, life is too demanding. It is simply not practical for one to spend the kind of time necessary in self-examination. From an evolutionary perspective, these kinds of behaviors do not further the gene pool compared to other more immediate coping strategies.

Enter Ecstasy: MDMA removes the emotional and cognitive barriers to growth. It’s not exactly a quick fix per say, but it enables people without these skills to experience their emotions without triggering a trauma response. For people with these skills, they can make the kinds of progress that would take 5 to 10 years of traditional talk therapy. Talk therapy itself is woefully inadequate; in training, would-be therapists are taught that they cannot actually help their clients. The client must desire change and must have the ethic to do the work required for change. In this new model, the therapist acts more as a facilitator, or a ‘sitter’ while the patient works through the experience. A particularly skilled and intuitive psychotherapist can intervene where appropriate and apply their knowledge of the mind and behavior to lead the patient along the therapeutic path.

Sigmund Freud, the famed progenitor of psychotherapy was no stranger to substance-assisted psychotherapy. He wrote about and often praised the effectiveness of cocaine as a therapeutic agent. As was common for scientists and innovators before the 20th century, Freud experimented on himself and detailed his observations. He felt that the drug allowed him to talk freely about his own internal experience in a way that he couldn’t without the aid of cocaine. While he later abandoned the drug altogether, it left a great impression on him. Now here we are over a century later, on the precipice of a new medical breakthrough: the legalization of MDMA for therapeutic use.


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