MDMA Psychotherapy: An Annotated Bibliography
of Late 20th Century English-language Literature
Oct 29, 2000
Master's Thesis, John F. Kennedy University
Adamson, S. (Ed.). (1985). Through the gateway of the heart: Accounts of experiences with MDMA and other empathogenic substances. San Francisco: Four Trees Publications.
This book is a collection of about 50 first-person accounts of experiences with MDMA, occasionally in combination with 2C-B, Ketamine, or LSD. The reports were both from therapy sessions, and from informal sessions supervised by friends or relatives.
Of particular interest in an account by the rape victim who was treated with MDMA by Downing (pp. 37-38). This case was described in Downing's (1985) written testimony at the scheduling hearing, and was widely quoted in the press and in other secondary sources. For the purpose of comparison, the following excerpt is an account by a schoolteacher whose session was supervised by friends at home. While under the influence of LSD, this woman relived scenes from having been raped eight years beforehand. She then was given 65 mg. of MDMA, which she refers to as "Adam". (Adam was the term used by the original MDMA psychotherapists.)
By talking about it I was able to face the fear of the experience and to understand what it had done to my life. It was frightening to think that I had tried to ignore that day to the point where I didn't know where the pain had come from, nor could I remember what had happened. I had gone through life having nightmares and feeling guilty, telling myself that it was not normal to be affected by something that has occurred such a long time ago.
The most destructive feeling that resulted from the rape was a feeling of inner emptiness: I didn't feel love or hate for the people who had hurt me; I didn't feel anything toward myself and even less for life itself. . ..
About two hours after taking the LSD, my friend asked me whether I wanted to take Adam. At this point I would have tried anything, and I thought that the Adam would help me cope with this pain, so I said yes. It didn't ease the pain but it helped to open up the emotions that were bottled up inside. Once I opened to my memory of the past, the room seemed to fill up with people from my past who had hurt me, and with people who had tried to help me. My friend's eyes seemed to be calling out to me, but then all of a sudden he changed and became transformed into the rapist. His toes and legs were those of the rapist but I knew that the figure was my friend. It was horrifying to see him as the man who had caused me so much pain. The only reason I could deal with it was because my friend was so strong in being himself that even though his body seemed to be that of the rapist, the rapist could not take over his mind, and I could turn to him for support.
I started to feel the horror of that day and I started vomiting. Getting sick was more than just a physical illness. I was vomiting from my soul, getting rid of pain, of an evil that had been destroying me. I felt then the need to tell my friend what the rapist had done to me, having always kept it to myself because I thought that by not speaking about it that eventually it would be erased from reality, and that all of it would become a horrible dream, a part of my imagination.
I felt that it was too late to pretend that it hadn't been real, and I feared that my friend would hate me. I don't know why, maybe it was that I hated my own body, it being a reminder of evil and corruption. But he didn't feel disgust towards my body, he didn't see it as changed by the experience. I then tried to see my body through his eyes, to understand that it was not impure, that it didn't have to be a reminder of cruelty.
I felt that I was becoming stronger with my friend's help. The rapist was grabbing me inside and wouldn't let go. I wanted to vomit so badly, feeling that if I did I could be rid of the rapist--at least he would be outside and longer a part of me.
Later I felt I had got rid of so much, but I still felt nauseous, there was still a burning lump in my stomach. But no matter how hard I tried I couldn't get it out. It seemed to be the only part of the rapist that remained. Maybe it will always be there and I will have to learn to live with it. But it doesn't have to dominate my life.
My physical discomfort interfered with the peaceful movements that were also a part of this experience. They seemed trivial compared with the pain, but now I hold them close to me and they help me cope.
I felt that it was so painful to love that knowing that I could still love was what caused most of my suffering. But the emptiness and pain of not loving was so much greater--without love we cannot experience the beauty of living. I felt that I had to hold on to the love instead of fighting it, and that I had to try to deal with the pain that it caused me, because facing it is better than the emptiness.
It seems hard to do, but perhaps there is a chance that I can fill the emptiness with new life. It scares me and I feel very lonely. But this experience has made me realize that death is not necessarily the right answer, or the most peaceful alternative. Realizing this has given me the courage to at least try to find meaning and reason (pp. 52-54).
This non-clinical session involved the same healing dynamics as a formal psychotherapeutic intervention.
anonymous. (1995). MDMA: a catalyst for healing my fears and depression. Newsletter of the Multidisciplinary Association for Psychedelic Studies [Online], 6 (1). Available: http://www.maps.org/news-letters/v06n1/06114per.html [2000, Aug. 19].
This testimonial was written by a 33-year-old woman who had suffered from depression for 12 years. Anti-psychotic medication controlled her delusions, but the depression and anxiety persisted despite various medications, two hospitalizations, and out-patient treatment by four psychiatrist and two psychologists. This woman decided to use MDMA, which she had never had before, to relieve her fear and depression at work. She took the medicine in her apartment under the supervision of two friends. During her session, she talked about her childhood emotional neglect and its consequences for her adult life. She greatly relishing the attentive interest that she received from her friend. After the session, she initiated positive changes at work by becoming more assertive. The objective improvements in her emotional health can be surmised by the reactions of her therapist:
A week and a half after the MDMA episode I saw my therapist. I did not tell him that I had taken an illegal drug. I knew he would strongly disapprove. About 20 minutes into the session, he seemed a little disconcerted. He said something about how he had been gone for two weeks and instead of me getting worse while he was away, which would have been normal for me, I seemed better. He said that there was some new quality about me that he couldn't quite put his finger on, but I seemed stronger. It was hard for me not to share with him. I only commented that I had evolved. . .. My therapist told me two weeks ago that I don't seem to be very open with him anymore and maybe that was a sign that I didn't need him and that I am strong enough to go "solo" (for the first time in 11 years). I am still open with my boyfriend and my close friends. I feel less alone than I've ever felt in my life. I'm still on low doses of Sinne-quan and Novane, but they are the next to go.
I plan to take MDMA again, but only if I can talk my boyfriend or a close friend into taking it with me. I thank my friends for changing my life. (online)
This sort of account shows that, if approached with the proper intention, MDMA can have a therapeutic effect even when taken in an informal non-clinical setting.
anonymous. (1986). MDMA: A multidisciplinary conference.
This conference was sponsored by the Institute for Addiction Studies (a joint venture between John F. Kennedy University and the Merritt Peralta Institute Chemical Dependency Recovery Hospital) and the Haight Ashbury Training & Education Project. It was held in May 1986 in Oakland, CA. The event was documented by three pieces of promotional literature plus a six-question multiple-choice test. The post test was used so nurses could get licensure credit for seminar hours. The Revised Program listed twenty-six discussions, seven of which were directly related to MDMA psychotherapy:
1) Bakalar, James B. "The Past and Present State of Psychedelic Drug Therapy".
2) Greer, George, M.D. "What Does MDMA Do, and what Doesn't It Do?".
3) Greer, George, M.D. (moderator) "Panel of Morning Speakers, including Leo Zeff, Ph.D."
4) Harlow, Debbie, M.A. "MDMA Research & Practice: A Survey of Physicians and Healers in the United States."
5) Ingrasci, Rick, M.D., M.P.H. "MDMA an Adjunct in Psychotherapy with Couples and Cancer Patients".
6) Riedlinger, June E., R.Ph. "Implications of MDMA Research for Suicide Prevention".
7) Wolfson, Philip E., M.D. `Encountering "Adam" at the Edge: A Man for All Seasons'.
Possibly, tape recordings of the actual lectures may exist somewhere. Papers by some of these speakers were published in the MDMA: Proceedings of the Conference theme issue of Journal of Psychoactive Drugs, 18 (4). Harlow repeated her presentation to psychiatrists in Prague. Harlow and Beck also presented the same information as Survey of the clinical use of MDMA at the MAPS International Conference on Psycholytic Psychotherapy, Bern, Switzerland, November 29, 1999. Harlow never published the results of her survey and did not preserve any copies of it.
MDMA was a 137-page paperback by Seymour (1986), Director of the Haight-Ashbury Training and Education Project. This book was produced for distribution at the Oakland MDMA conference. Chapter 4 "MDMA in the Therapist's Office" was just a quick general review of the work by Greer and Ingrasci.
anonymous. (probably circa 1985-86). MDMA: A year later.
This small typewritten poster advertises a one-hour video about six people who underwent MDMA psychotherapy. A handwritten inscription indicates that the poster was typed for a particular screening at an institutional cafeteria, probably a university or medical center. It has not been possible to locate a surviving copy of the actual videotape. The following text from the poster, with typographical errors corrected, summarizes this documentary film:
Tony - A very successful businessman, in therapy for nine years with little change in his life, but with great insight, finally begins to make changes that lead to fulfillment. He finds totally new feelings that allow him to relate to his family and employees with compassion and intimacy; he gains the self-confidence to change careers, something he has been wanting to do for years, and he discovers that by reducing his stress level his physician finds him to be healthier than he has ever been.
Joy - A fifty-four-year-old school librarian, and minister in her church, discovers an entirely new life and claims it as her own when she becomes aware through MDMA that she has been "tied to her mother's apron strings" but has been totally unaware of it even though she has previously been in therapy.
Nick - Pulitzer Prize winner, but unable to write for ten years in the wake of his success with `A Chorus Line' finds that MDMA releases blocks in his sexuality and creativity.
Elly - Successful singing star finds her work and her ability to relate greatly improved with one session of MDMA therapy. By becoming aware of her underlying feeling of helplessness, Elly is in the process of changing her life.
Paul - After one session of MDMA therapy Paul thought that his problems were solved. Five months later he concluded that he needed some help and entered therapy on a once a week basis. He is now rebuilding his personality based on insights that came as a result of his first MDMA session.
Jeff - Dramatically changed his life after one session of MDMA: he gave up drugs, coffee and an unhealthy lifestyle.
Cohen, R. (1998). MDMA and drug-assisted psychotherapy. In The Love Drug: Marching to the Beat of Ecstasy (uncorrected prepublication galleys pp. 51-63). New York, London: The Haworth Medical Press.
The Love Drug is included here as an example of the numerous popular books about Ecstasy that have a section on MDMA psychotherapy. Cohen condensed the professional and technical literature into a form that is accessible to the interested lay person. His style was one of continuous compromise, deftly trying to present all viewpoints without offending anybody. For instance, Chapter 4 "MDMA and Drug-Assisted Psychotherapy" reviewed much of the clinical work in a sympathetic tone (pp. 51-63). However, the author did not want to be perceived as an advocate. Therefore, he maintained his objectivity by retreating to the safety zone: he compared MDMA psychotherapy to permitting the client to get drunk, and presented the highly original idea that insights from MDMA may be state-bound so that they will not be remembered afterward. Having proven himself a nonpartisan by these remarks, Cohen then ventured out of complete neutrality so far as to actually endorse MDMA psychotherapy for the terminally ill.
Doblin, R. (1994). MDMA in the Treatment of Post Traumatic Stress Disorder (PTSD): Status Report on the Nicaraguan Project. Newsletter of the Multidisciplinary Association for Psychedelic Studies [Online], 5 (1). Available: http://www.maps.org/news-letters/v05n1/05126pts.html [2000, Aug. 19]
The Nicaraguan civil war produced an abundance of soldiers and civilian suffering from post-traumatic stress disorder. In 1988, Madriz conducted a pilot study using MDMA to treat twenty soldiers suffering from combat-induced PTSD. This is the most detailed published account of Madriz's proposed follow-up project. Due to political turmoil in Russia, Krupitsky had to cancel his investigation using MDMA to treat alcoholism and neurosis at the St. Petersburg Regional Dispensary of Narcology. Krupitsky graciously permitted his MAPS funding to be given to Madriz. Official permission was received to transfer MDMA from Perdue University to the Military Hospital in Managua. Madriz set up equipment and developed a protocol using North American scientific data and psychometric instruments, some of which had to be translated for the project. The research team (three psychiatrists, two psychologists, several graduate psychology students, and other hospital staff) attended a four-day seminar conducted by a renown PTSD expert. Greer and Yensen planned to conduct another seminar on MDMA later in the year. This seminar was to have included theoretical discussion of psychotherapy, and supervised MDMA sessions for the Nicaraguan research team. The protocol design, which was still under development, anticipated using a three-week in-patient treatment program:
There will be two experimental groups, an MDMA group and a randomized matched control group that will not receive MDMA. Those patients who receive MDMA during their treatment will probably be administered two sessions, the first at the end of the first week and the second at the end of the second week. This schedule will give the patients a week to get comfortable with the therapeutic team before their first MDMA session, a week between MDMA sessions, and a week to integrate their experiences before leaving the hospital. The two groups will receive the same sort of overall treatment, with the control group receiving two special therapeutic sessions of the same length of time as the MDMA sessions but without any drug. Music might be substituted, or perhaps more talk therapy (online).
MAPS hoped this study would generate data that would convince the FDA to allow MDMA psychotherapy in the United States. Therefore, the methodology had to use a control group. This conventional design has been criticized as applying a paradigm that is inappropriate for this sort of mind-altering drug. Although politically advantageous, the concession of having a control group had a scientific weakness in that there was no way to account for such factors as unconscious differential treatment of the patients due to a desire of the research staff to succeed in demonstrating the advantages of using MDMA. (In fact, such enthusiastic motivation is an essential element in the success of MDMA treatment). While such elusive effects as experimenter expectations are difficult to document in ordinary circumstances, the problem is magnified with pharmacological agents that amplify the subjects' suggestibility to subtle non-verbal cues. Of course, because the US government generally refuses to acknowledge that psychoactive drugs produce any mental effect other than toxic psychosis, such details were probably the last criticism that was likely to come from the North American federal regulators.
Two years later, despite time-consuming and expensive preparations, this project was canceled due to the many crises in Nicaragua and the limited resources of the military hospital (MAPS, 1995-96b). Consequently, MAPS developed two other projects. In February 2000, the Spanish Ministry of Health approved a revised protocol submitted by Bouso, Sopelana and Corral. This was to be the world's first controlled experiment with MDMA psychotherapy. MAPS committed to funding $54,000 for this two-year PTSD study of female survivors of sexual assault. 21 patients would be divided into five groups that would receive MDMA in doses of 50 mg, 75 mg, 100 mg, 125 mg, or 150 mg. Some members of each group would receive a placebo as the control. Meanwhile at University of Ben-Gurion of the Negev, Kotler was designing a protocol for submission to the Israeli Ministry of Health (MAPS, 2000). This was for a MAPS-funded study of MDMA-psychotherapy to treat Post-Traumatic Stress Disorder, a condition widespread in Israel due to war and car accidents. Kotler hoped that MDMA might "help those patients to bring up painful repressed memories in the therapeutic encounter and also help them through the process of coping with traumatic memories." (MAPS, 1998, online).
Donahue, P. (1985) The Phil Donahue Show. videotape privately recorded on April 25, 1985.
This hour-long episode of the popular television talk show was dedicated to Ecstasy. The guest speakers discussed their ideas, answered questions from the audience, and the camera broadcast a close-up shot of a pair of MDMA capsules in the palm of Donahue's hand.
Riddile was regional director of a drug abuse treatment organization called Straight, Inc. He scornfully insisted that MDMA caused many young people to become psychotic, having delusions and hallucinations for up to three weeks after a single dose. In contrast, Seymour, director of the Haight-Ashbury Training and Education Project, characterized MDMA as possessing medical value, and having a low abuse potential among recreational users of the type who came to the Haight Ashbury Free Clinics. Haislip, deputy assistant administrator of the DEA, portrayed MDMA as being a dangerous menace similar to LSD in the 1960s. Donahue had a confrontational stance toward Haislip. On a previous episode about designer drugs, Donahue advocated legalization, expressed open contempt for the Reagan's Drug War, and directly criticized a DEA agent who was a guest on the show. On this program, Donahue again cautioned against anti-drug hysteria, and scolded the Reagan Administration for having a deceptive "moral loftiness" in its drug policy. He bluntly told Haislip to "at least be open to a dialog about the possibility of decriminalization rather than bringing this stern fatherly approach, hardball approach that your not going to solve [drug abuse] that way. (Donahue, 1985, video)"
Talk shows thrive on polarized conflicts. While other guests expressed opposing viewpoints, the role of mediator was briefly performed by Schuster of the University of Chicago Drug Abuse Research Center. Schuster was the most charming and eloquent panelist. He articulated a broad overarching perspective that embraced the best of what everybody else was saying. He exhibited an independence of mind in arguing against Haislip's contention that Schedule I status would not impede research, yet expressed his honest reservations about MDMA's possible neurotoxicity. While advocating some sort of scheduling, he nevertheless supported research and development for MDMA's potential clinical applications. He misrepresented Ingrasci's perspective by implying that therapists were only using MDMA for human potential development rather that in treating actual disorders:
Dr. Ingrasci says he wishes to have this drug available for appropriate therapeutic use. Gene Haislip is saying it is being abused on the street. I don't think there is any disagreement that it should be regulated; there is no question about that. But, the question really is whether or not the society is willing to accept therapeutic agents which are not there to correct deficits, that is we're not curing schizophrenia, we're not curing manic depressive disorders, but rather we're improving people in some ways. Now, the question is whether or not society wants to have those kinds of substances available through physicians. . . (cited in Donahue, 1985, online)
Ingrasci tried to convey that MDMA was not a panacea, but was rather a useful tool in helping people to look inward and express their emotions in a supervised situation. He voiced the opinion that MDMA should be regulated, but not in a way that would prevent administration by psychiatrists. Four of his patients told their stories. Littlehale & Littlehale, who were also interviewed in magazines during this period, told how MDMA psychotherapy had fostered lasting improvements in their marital relationship. Littlehale originally came into therapy to deal with her multiple sclerosis. She now believed that her illness had manifested because of emotional issues that she had uncovered in psychotherapy. Watson said that one MDMA session had opened up meaningful communication with her family after she contracted terminal cancer that had spread from her colon to her liver. Her prognosis had extended from having six months more to live to having a projected longevity of a year-and-a-half. She believed this was due to a "renewed hopefulness to fight her cancer". She hoped that, if she did die, then her 17-year-old daughter would be able to have a supervised MDMA session. Livermore said that the frightening negative emotions that she experienced under the influence of MDMA had given her access to her innermost feelings about childhood traumas, leading to a better quality of life once she removed self-imposed barriers to sharing love. She attributed her complete remission from cancer as being due to this therapy. The audience is left to wonder to what extent these intriguing anecdotal reports are actual cases of emotional pre-disposition to physical illness, or whether this interpretation merely an artifact of Ingrasci's own belief system which he may have somehow conveyed to his patients during therapy.
The show ended with a brief statement by Doblin. With his characteristic optimism, he predicted that the FDA would approve clinical MDMA research "within the next month. (cited in Donahue, 1985)" Now fifteen years later, Doblin is hoping to broadcast a digital version of this episode of the Donahue Show from the MAPS web site.
Downing, J. (1986). Individual revitalization training: Counselors manual. Therapeutic Instructional and Medical Experiments.
There is apparently only one extant copy of this rare unpublished typewritten manual. Although no author is listed, internal references indicate that it was produced by Downing. After serving as an Air Force captain in Berlin, Downing spent five years as director and psychiatric epidemiologist with the Community Mental Health Research Unit of the New York State Department of Mental Hygiene in Syracuse. From 1958 to 1968, he was director of the Community Mental Health Services of San Mateo County CA, where he supervised a LSD psychotherapy program for alcoholics that was the subject of a favorable television documentary. Downing stated "Briefly, we instituted an outpatient treatment program that achieved some good results: about one third of our chronic desocialized patients showed definite improvement. Based on this experience, we would have continued this program except for the social furor that arose around LSD" (1985, pp. 1-2). During this time, he was also an associate professor at Stanford University. He served as a trustee and scholar-in-residence with the Esalen Institute, and was president of the Gestalt Institute of San Francisco.
Downing decided to make productive use of the brief window of opportunity that existed in 1986 after the domestic MDMA scheduling, before the advent of international regulation by the World Health Organization. He established the Exuma Island Institute in the Bahamas. This offshore MDMA stress-relaxation clinic was situated in the most scenic beach resort on this small tropical paradise in the Caribbean. The goal of the program was to help people remove as much stress as possible. The clinic's staff supervised groups of clients recovering from physical, occupational, and emotional stress. This "psychocatalytic" program included MDMA sessions devoted to personal introspection and interpersonal communication. In much of the text, MDMA is referred to by the code name "TME-2000". This program's initial popularity promised such success that Downing wanted to open an office in Miami as an intake center to screen potential clients. The local officials on Exuma were enthusiastic about the influx of tourist revenue generated by the clinic's affluent clientele. Then, apparently under pressure from federal authorities in the United States, the government of the Bahamas suddenly became uncooperative. After a brief period of activity in 1986, the Exuma Island Institute was forced to close.
The manual described candidate selection, the psychocatalytic experience, follow-up, and advanced training. Candidate selection dealt with screening out individuals with certain physical and mental health problems. Contraindications were heart disease and high blood pressure, diabetes and hypoglycemia (these not being a proven contraindication but rather a precaution), people on medications that might have an adverse interaction, pregnancy, and psychosis. A therapist's approval was required for anybody currently in psychotherapy. The screening also examined motivation for wanting to participate by inquiring about why the person was applying to the clinic and what personal goals they wished to accomplish. Once accepted, the participants signed an informed consent statement that reviewed the nature of the program and contraindications. Additionally, this form included a commitment to the four agreements. These agreements were to remain on the premises until the counselors concurred that it was safe to leave, to abstain from sexual activity with the facilitators, to refrain from property destruction and violence against self or others, and to follow any instructions from the facilitators which were part of the structure of the program. The participants were grouped into 10-person "Life Groups". This was originally intended be a month-long program with two "psychocatalytic" MDMA sessions after a week of orientation. However, it appears that the actual schedules used in May 1986 involved groups that stayed only four, five, or eight days. The orientation instructed the participants about what to expect, explained that they would be supported if they encountered any negative emotions, and encouraged them to surrender to the experience without having preconceptions about where it would lead. This preparation emphasized the desirability of incorporating new understandings into everyday life following completion of the session. After a 24-hour fast, they would take 1000 mg of l-tyrosine (an amino acid believed to enhance the drug effect). Then they would take MDMA with the expectation of the experience being an immensely powerful learning tool which could produce potentially life-changing benefits. The sessions were conducted in a comfortable attractive setting under the supervision of two staff members. Towards the end of the session, participants would be offered another 500 mg of l-tyrosine, a dose of vitamin B-3 (to prolong the session), and up to 500 mg of tryptophan (an amino acid thought to reduce any feelings of energy depletion following return to baseline). After the sessions, there was the "follow-up" which included anti-stress evaluations and creative activities to process the subjective experience of the session.
Between MDMA sessions, the program required daily meditations emphasizing visualization of colors associated with the planets of the solar system. There was a regimen of "Psychocalisthentics®". In order to harmoniously integrate the functioning of mind and body and emotions, these psychocalisthentic exercises emphasized mental concentration, proper breathing, and stretching movements which seem partially derived from hatha yoga. Participants kept a daily journal, writing about a list of topics devoted to introspective self-examination. After the completion of the program, a counselor might keep in contact with the participants to monitor their progress.
Downing, J.J. (1985). Testimony of Joseph J. Downing, M.D. In the Matter of MDMA Scheduling. Docket No. 84-48. United States Department of Justice, Drug Enforcement Administration.
Downing's testimony outlined his professional experience, the development in his interest in psychoactive drugs, and his personal experience with MDMA. In addition to stating his opinion that MDMA had a low abuse potential, he included an abstract of the summary of his preliminary psychophysiological study of MDMA, which had indicated that normal dosages produced no acute detectable toxicity in healthy subjects. He stated that he had used MDMA with eight of his patients. Two had pleasant experiences but showed no change. Five responded favorably, with acceleration of their therapeutic progress. One of these was presented as the case history of F.R. This successful entrepreneur suffered from depression, stress, and suicidal ideation:
We arranged a day long session, which produced a flood of repressed material that emerged into consciousness; he and a younger sister were very badly battered and traumatized for many years by their father who was repeatedly jailed, placed in psychiatric hospitals, then returned home until he repeated his psychotic behavior. The tragic cycle ended only when the father ended his life with carbon monoxide when the boy was seven. I have rarely heard more vicious details from persons who have survived physically intact and sane. The man is still in treatment, making good progress with the prospect of having a normal emotional life in a few years. I can say, and I firmly believe, that this absolutely central historical material would never have emerged without the use of MDMA in the proper setting. He had seen three therapists without any hint emerging of this underlying chaos. Not until he was in the proper setting, with a therapist he trusted, and with the effect of MDMA, was he able to acknowledge this previously repressed history of abuse. (p. 7)
The final case was that of K.T. This woman had been kidnapped, tortured, and sexually terrorized. Her panic attacks and other symptoms were so incapacitating that she was only able to recover her sanity by having four MDMA sessions. Downing noted "The MDMA was very helpful, enabling her to approach and recall the rape in detail. In fact she was able to supply the police with descriptions they had not had before" (p. 6). The appendix to the testimony includes a statement by the patient that concluded "It has seemed that the MDMA allowed me to move into. . . trauma and come out of it in an open, loving way rather than leaving me with more memory of assault" (p. 13).
Eisner, B. (1989). Ecstasy: The MDMA story (1st edition). Berkeley: Ronin Publishing, Inc.
This book contains photographs of various MDMA advocates, including therapists Ingrasci, Downing, Wolfson, Greer & Tolbert. The text contains very little original material about MDMA psychotherapy, other than a previously unpublished case history from Downing's written testimony at the scheduling hearings.
Greer, G. (1983) MDMA: A new psychotropic compound and its effects in humans. Santa Fe: Self-published.
This eventually became the show-piece article for MDMA psychotherapy. All of the early MDMA therapists concurred that the best policy was to be discrete, avoiding publicity about their practice. They were so successful at maintaining a low profile that, when the Federal Register announced the proposed scheduling, DEA was genuinely surprised to receive 15 letters informing the agency that Ecstasy had a medical use. Greer had begun conducting this study on the psychological effects of MDMA in preparation for that inevitable day when the authorities would demand scientific proof of MDMA's safety and efficacy. Although he had considered publishing the study in France in order to delay any sensationalistic response in America, the paper was still unpublished when it was submitted as an exhibit attached to Greer's written testimony at the scheduling hearings. A detailed discussion of the contents of this paper is included under "Subjective Reports of the Effects of MDMA in a Clinical Setting" because presumably the minor differences in wording reflect what the author considered to be a more polished presentation.
Greer, G. (circa 1983). The legal, safe, and effective use of MDMA. Santa Fe: Self-published.
This undated five-page typewritten document is an early version of "Recommended Protocol for MDMA Sessions". It lacks some details about how to conduct sessions which were included in the later revision, such as information about physical contraindications (ie. heart problems or liver disease) which were previously mentioned in Greer's 1983 paper.
Before the 1985 prohibition, MDMA was always distributed along with promotional literature describing its effects and giving instructions for use. There is an entire genre of anonymous pamphlets that paraphrased much of Greer's advice in this seminal handout. Other brochures were designed for distinct user groups. First, a short anonymous 1984 paper entitled "General Information: MDMA" was distributed along with a companion paper about 2C-B. This brief, anonymously written by Ann Shulgin, describes how to organize group MDMA sessions for human potential purposes. Later pamphlets by unknown authors targeted the New Age audience. These pamphlets promoted MDMA for personal introspection or spiritual purposes, often referring to MDMA's propensity to open the heart chakra. When MDMA became mass-marketed to the general public in Texas, other pamphlets explained how to host Ecstasy parties in one's home.
Greer, G. (1985). Recommended protocol for MDMA sessions. Anonymously self-published.
Photocopies of this typewritten five-page document were distributed to psychotherapists attending workshops on how to conduct individual MDMA sessions. It discussed legal, safety, and efficacy issues. It explained that MDMA is neither a prescription drug nor a controlled substance. It stated that in California a licensed physician could legally manufacture and dispense any experimental substance not in Schedule I to patients who give informed consent; laws in other states may vary. Furthermore, the physician was advised to have peer review and some supporting scientific literature. Safety issues discussed physical contraindications and side-effects. In mentioning the possibility of experiencing some unpleasant emotions while under the influence of MDMA, it noted that such "psychological reaction can be utilized beneficially if both parties are committed to that endeavor" (p. 2).
The section on efficacy issues gave detailed instructions on how to conduct sessions. The client's psychological preparation and goal-directed motivation were posited as the most important factors in determining productive outcome. The client's mental set was framed by the "four agreements". The setting had to be comfortable and secure. The MDMA was ingested on an empty stomach. The discussion on dosage noted "Many people feel they learn more from lower doses than higher ones. This could be because their state is only slightly altered so that the insights gained are more realistic and applicable to their usual state of consciousness" (p. 4). To facilitate an internalized exploration, the client was encouraged to recline wearing eyeshades and listening to instrumental music through headphones. This emulated the procedure developed at Spring Grove and the Maryland Psychiatric Research Center, with input from music therapist Helen Bonny. To provide time for physical recovery and psychological integration, the client was not to have occupational or social obligations for at least the following day. Follow-up contact with the client was provided by the facilitator as necessary. The paper concluded:
This protocol is not to be seen as a do-it-yourself manual on giving MDMA sessions. Every facilitator should be trained by someone who has had experience giving many sessions successfully. All facilitators should also have had a few MDMA sessions at different doses themselves to understand the range of effects and to work through any psychological issues that arise during the sessions. All such issues should be fully resolved before taking MDMA with a client, or else the psychological issues of the client may be confused with those of the facilitator. (p. 5)
A one-page "MDMA Session Questionnaire" was attached so that facilitators could collect follow-up information from their clients. This data about the effects of MDMA was intended for "research and socio-political" purposes.
Greer, G. (1985). Using MDMA in psychotherapy. Advances: Journal of the Institute for the Advancement of Health, 2 (2), 57-59.
The MDMA psychotherapists had been discreet, hoping to avoid media exposure that might result in controversial publicity. Then by early 1985, the DEA's threat to put MDMA into Schedule I hung overhead like an albatross, and behind it loomed the specter of international regulation by the World Health Organization. In response, the Earth Metabolic Design Foundation and ARUPA organized five meetings at the Esalen Institute to promote the practice of MDMA psychotherapy. Greer's article about one of these meetings was written to bolster MDMA's credibility by having at least something published that documented psychotherapeutic benefits.
On March 10-15, 1985, 35 participants gathered to discuss MDMA psychotherapy. These including five veteran researchers on psychoactive drugs: Grof, Naranjo, Yensen, Lynch, and DiLeo. Four psychiatrists who used MDMA in their clinical practice also attended: Greer, Downing, Wolfson, and Ingrasci. The meeting included an experiential component, with 13 participants using MDMA while individually monitored by a physician or psychotherapist. Greer describes some of the discussion:
The reports on the benefits of MDMA, although anecdotal, were uniformly positive. In the discussion of MDMA's effects, the clinicians using it felt it possessed a unique action that enhanced communication, especially in couples in therapy. The drug reduced defensiveness and fear of emotional injury, thereby facilitating more direct expression of feelings and opinions, and enabling people to receive both praise and criticism with more acceptance than usual.
Reports on MDMA's facilitation of individual psychotherapy were also favorable. Many subjects experienced the classic retrieval of lost traumatic memories, followed by the relief of emotional symptoms. Victims of child abuse and sexual attack experienced the most dramatic benefits. Wolfson also reported having multiple MDMA sessions with psychotic individuals and their natal families, leading to improvements in the patients' functioning and ego integration. In two of the cases, year-long trials with antipsychotics and lithium had proved unsuccessful in significantly ameliorating the patients' symptoms. . .
Rich Ingrasci, M.D., reported using MDMA with patients suffering from terminal cancer, to help them deal with feelings of hopelessness and helplessness. He noted that many of them were outliving their prognosis. . ..
Integrating MDMA sessions within a format of psychotherapy, family support, or conjoint therapy were deemed essential components of the healing process. Though explanations for the drug's effects were highly speculative, it was agreed that in the experience of the therapists, its capacity to reduce or temporarily eliminate fear and anxiety from a subject's consciousness, allowing an acceleration and deepening of the therapeutic process, was unique. . .. (p. 58)
Toward the end of the meeting the participants discussed research ideas for studying the use of MDMA to treat drug abuse and psychosomatic disease and as a motivational tool in vocational rehabilitation. (p. 59)
Greer, G. (1985). Testimony of George Greer, M.D. in DEA Hearing on Scheduling MDMA Under the Controlled Substances Act. In the Matter of MDMA Scheduling. Docket No. 84-48. United States Department of Justice, Drug Enforcement Administration.
Greer opened his testimony with a description of his qualifications. He had a private psychiatric practice, and also treated inmates at the Penitentiary of New Mexico. He became interested in using altered states of consciousness in psychotherapy while attending a seminar at the Esalen Institute conducted by Grof. Greer subsequently administered MDMA to 76 patients and Ketamine to about 40 patients.
As to why some of his original 29 subjects were healthy normal volunteers rather than psychiatric patients, Greer noted:
I have never recommended MDMA as a treatment to any of my private patients, unless they have been referred to me for that purpose, because those patients have not specifically requested an experience to open their minds to repressed feelings or thoughts. Most of the patients I see who do not know of my work with MDMA are in crisis and seek relief from their symptoms. If there were an inpatient facility available with a staff trained in the use of MDMA, then I would offer its use for more distressed patients. (p. 4)
Greer testified that he was unsuccessful in getting funding from both the government and the pharmaceutical industry, and "Though my data are anecdotal, I cannot see that the research design can be improve without a funded study" (p. 6). Therefore his unfunded project was an open-ended phenomenological investigation, with a comparison of pre-session and follow-up questionnaires. He intended his paper to encourage funding for a formal study with independent evaluations of therapeutic change, extensive psychological testing, and remuneration for research subjects.
Greer also presented evidence that MDMA was safe when used under medical supervision, and had a low abuse potential.
Greer, G., & Tolbert, R. (1986). Subjective reports of the effects of MDMA in a clinical setting. Journal of Psychoactive Drugs, 18 (4), 319-327.
This paper was virtually identical to "MDMA: A New Psychotropic Compound and its Effects in Humans". It lacked a chart entitled "Appendix: Tabulation of Subjects' Responses" that was at the end of that unpublished version. This article was published in the 1986 MDMA theme issue of the Journal of Psychoactive Drugs. Coming just a few months after the DEA overruled the Administrative Law Judge's decision (thus ending all legal use of MDMA), this journal's collection of articles seemed like a series of eulogies at a memorial service.
Like most (if not all) other MDMA therapists, Greer was a clinician - not a researcher. This was an unfunded exploratory pilot study of the phenomenological descriptions obtained from the therapists' observations and the subjects' experiences. Greer never pretended that this was a double-blind placebo-controlled investigation with psychological evaluations by independent observers and laboratory examination of organ and metabolic functions. While the DEA lawyers had a feast ripping apart the methodology during cross-examination at the hearings, an objective reader can appreciate the valuable aspects of Greer's work within the limitations that he himself frankly addressed.
The article explained that the subjects were volunteers recruited by word of mouth, not from Greer's private practice. He outlined his screening criteria, the lengthy informed consent, and the "four agreements" that defined the psychological set of the therapeutic container. The individual (solo) sessions aimed for an internalized experience. Instrumental music was played, with headphones and eyeshades optional. The interpersonal (group or couples) sessions used lower doses and had music playing in the background. The attentive therapists, available throughout the session, offered a 50-75 mg booster to prolong the MDMA effects when they began to subside. The sessions lasted five- to eight-hours. Afterward, there was verbal and written follow-up. In explaining the results of the study, Greer discussed the benefits, undesirable side-effects, the degrees to which the subjects' goals for the session were realized, and the progress of the nine subjects who had DSM-III disorders. He also reports on changes in mood, attitude, beliefs, relationships, occupation, activity, spiritual practices and physical exercise, drug use, life goals, experiences being avoided, and attitudes preventing self-actualization.
This summary report presents data from the study's first 29 people administered MDMA in a clinical setting. MDMA was deemed to be physically safe for subjects screened for vascular disease and the standard contraindications for sympathomimetic drugs. MDMA was presented as possibly predisposing people to a recurrence of previous psychological disabilities, although with ongoing support such a recurrence was seen as offering the possibility of accelerated resolution of the underlying problem. Greer said "It is also recommended that people who want MDMA to cure their problems should be excluded, whereas people who want to use it to learn about themselves should make good candidates." (p. 326)
MDMA seemed efficacious for clinical improvement of DSM-III diagnoses. It relieved low self-esteem, and increasing self-acceptance and self-confidence. It was mentioned as possibly valuable in treating psychosomatic complaints. It caused some reduction of craving for addictive drugs. It proved useful for creative writing. Greer surmised:
In general, it is reasonable to conclude that the single best use of MDMA is to facilitate more direct communication between people involved in a significant emotional relationship. Not only is communication enhanced during the session, but afterward as well. Once a therapeutically motivated person has experienced the lack of true risk involved in direct and open communication, it can be practiced without the assistance of MDMA. This ability can not only help resolve existing conflicts, but it can also prevent future ones from occurring due to unexpressed fears or misunderstandings. Regardless of the mechanism, most subjects expressed a greater sense of ease in relating to their partners, friends and co-workers for days to months after their sessions.
MDMA's use as an adjunct to insight-oriented psychotherapy was specifically recommended by six subjects. Many felt that MDMA enhanced self-understanding and was useful in their personal and spiritual growth. . ..
Providing the reports of these 29 subjects' experiences will hopefully encourage further research into the beneficial effects of MDMA. Presenting evidence establishing the limits of its usefulness should discourage any movement to promote it as a social or psychological panacea. (p. 326)
Greer, G., & Tolbert, R. (1990). The therapeutic use of MDMA. In S.J. Peroutka (Ed.), Ecstasy: The clinical, pharmacological and neurotoxicological effects of the drug MDMA (pp. 21-36). Boston: Kluver Academic Publishers.
"The Therapeutic Use of MDMA" includes data from 80 patients with a two-year follow-up. The authors maintain the same conclusions they presented in the previous article with their original 29 subjects. Greer elaborated:
. . .we saw a need both to offer sessions and to document the results so that the research community would learn about the potential of MDMA as a pharmacological catalyst for psychotherapy. We began conducting sessions and recording information about patients both before and after their sessions. This information gathering was more in the spirit of a descriptive "medical anthropology" study than a rigorously controlled experiment designed to determine the efficacy of MDMA-assisted therapy." (p. 23)
This paper also reviewed Greer's method to screen and prepare the clients, and how to conduct sessions. There is discussion of informed consent. Five particularly successful case histories were presented. These described the treatment of a cancer patient, a Vietnam veteran, a Holocaust survivor, and a married couple.
Greer, G., & Tolbert, R. (1998). A method of conducting therapeutic sessions with MDMA. The Journal of Psychoactive Drugs, 30 (4), 371-379.
Because Greer's work was halted by the scheduling, he was not permitted to gather new data about MDMA psychotherapy. Therefore it is understandable that this paper recycled some material previously used in "Subjective Reports of the Effects of MDMA in a Clinical Setting" and "MDMA: A New Psychotropic Compound and its Effects in Humans". However, while those papers were intended to present the findings from Greer's study, this one was formatted more as an instructional piece on the procedures for conducting MDMA sessions. Rather than catalog subject responses into various categories, Greer included reworded versions of the case histories of the cancer patient and Holocaust survivor formerly presented in "The Therapeutic Use of MDMA".
Grinspoon, L., & Bakalar, J. (1986). Can drugs be used to enhance the psychotherapeutic process? American Journal of Psychotherapy, XL, 393-404.
Dr. Grinspoon was an associate professor of psychiatry at Harvard. Bakalar was a lawyer who lectured at the Department of Psychiatry at Harvard Medical School. Together they authored Marijuana Reconsidered (1971, Psychedelic Drugs Reconsidered (1979), Psychedelic Reflections (1983), and Marijuana, The Forbidden Medicine (1993). Aside from both authors' long-standing academic criticism of the excesses of the drug war, Grinspoon had a personal objection to Schedule I regulation of recreational drugs which also had valid medical uses. In 1971, his 10-year-old son was terminally-ill with lymphatic leukemia. The boy illegally used marijuana because it was the only medicine that improved his appetite and which alleviated the eight-hour vomiting episodes that followed each chemotherapy treatment. The MDMA Scheduling Hearings were to set a legal precedent that impacted upcoming cases involving medical marijuana. Both Grinspoon and Bakalar submitted written testimony at the hearings, where it was evident that the lack of previously published data about MDMA strengthened the DEA's case. Apparently, "Can Drugs Be Used to Enhance the Psychotherapeutic Process?" was published in a professional journal both to educate therapists who were uninformed about the topic, and to bolster the medical credibility of mind-expanding substances should there ever again be a reconsideration of their legal status.
The first half of the article covers LSD psychotherapy. The second part reviewed MDMA, offering enthusiastic quotes from the patients of Greer & Tolbert and Ingrasci:
Among these is MDMA, a relatively mild, short-acting drug that is said to give a heightened capacity for introspection and intimacy along with temporary freedom from anxiety and depression, and without distracting changes in perception, body image, and the sense of self. . .. As compared with the more familiar psychedelic drugs, it evokes a gentler, subtler, highly controllable experience which invites rather than compels intensification of feelings and self-exploration. The user is not forced onto any mental or emotional path that is frightening or even uncomfortable.
One patient described it this way: "I felt that my cognitive powers were unaffected. That is, except on the few occasions where the affective experiences were very strong (a minute or two, it seemed, at most), I could guide my thoughts to and away from whatever areas I chose." (p. 399)
. . .One patient described his experience as "primarily an intense warmth and security about myself and other people." He added, "MDMA breaks down inhibitions about communication, making it easy to give or receive criticism or compliments that under normal circumstances are embarrassing."
Another patient put it this way: "I believe the most beneficial aspect of how I felt during the session was that I felt very little defensiveness. On my own and to myself during the session, I thought about things in myself that I didn't like. I was able to accomplish this without feeling guilty or defensive."
Another MDMA patient wrote "One of the major `differences' [from a non-MDMA-assisted psychotherapy session] was the feeling of security and tranquility [sic]. I had the feeling of being safe. Nothing could threaten me. I briefly tried to fantasize natural catastrophies [sic], like an earthquake. I did not feel anxious or threatened." This patient also suggested that the effects of MDMA-assisted therapy may endure. Eighteen months after her third and last MDMA session, when she was asked whether she thought there was a lasting benefit, she replied, "I have been able to experience myself more fully ... to feel my feelings ... to be totally with myself ... to experience the ease of expressing myself when I am in touch with myself. The sessions enabled me to break through my defenses (rationalizing, analyzing, intellectualizing, etc.) that I used to win approval of myself and others ... to break through my facade and to go to the truth underneath.... At various times [that truth] meant grief, love, sadness, fear, humor."
MDMA might also help in working through loss or trauma. One patient described the effect as follows: "After a [MDMA assisted therapy] session where I grieved the loss of [boyfriend] in my life, it surprised me that I felt so good about myself for having grieved so deeply ... for having been so deeply into my real self, crying my heart out, and how healthy it felt to know that I had really been there for those feelings rather than the facade I was living with - trying to be strong and get on with my life and unconsciously to avoid the pain, disappointment and sadness ... as well as my fear of being alone."
Another patient said: "I think that I experienced a more solid adjustment to my father's death about a year previously and to the breakup of my engagement about three months previously. [During the session and since then they have] seemed to recede into the distant past, as if they had happened longer ago and I had less emotional attachment to them. This was helpful, as I feel less emotionally attached to those events, but have integrated them into my personal history."
It is also said to help patients experience closeness and empathy. Nine months after his MDMA-assisted therapy session, a patient noticed "feelings of closeness and sharing with others--evaporation of the usual barriers to intimate communication." Another said "I would say this is a heart drug, but not in the way I would have expected. I did not feel romantic love, strong feelings. I felt attention toward [the therapist and his co-therapist wife] and a concern for them and how they were. This feeling was one of compassion for their needs... this feeling I have been able to carry over after the immediate MDMA effects have gone."
Many MDMA patients have claimed a lasting improvement in their capacity for communication with others. For example, one man who was asked about enduring effects five months after his sessions answered: "Communication is improved with [wife], less defensiveness between us, more leeway for diversity, desires, etc."
Interest in and capacity for insight is also said to be enhanced. Five months after one MDMA-assisted therapy session a patient reported: "Insights into problems have proven accurate and helpful in planning my private and personal life." Later he added, "I have a broader perspective on my life and activities; that carries on."
Many report heightened self-esteem. Two and one-half months after his MDMA experience a man wrote: "A long-lasting effect is an enhancement of self-esteem. I really feel better about who I am and what I have to offer." A woman who had two MDMA-assisted therapy sessions wrote four and one-half months later: "I feel the sessions allowed me to experience my `higher centers'- I expanded my boundaries, grew in dimensions, and in general feel I have more awareness of what it is to be alive. I also literally got rid of a lot of negative material I carried around with me forever. This has resulted in more energy, a greater feeling of freedom and strength, deeper joy, less pain."
Many patients report strengthening of trust and increased capacity for intimacy. As one patient stated: "It was characterized by warmth ... although I was intellectually lucid and clear, the chief impact of the experience for me was in the heart, and not in the head. Fundamentally it seemed to facilitate intimacy. I found I could give and receive at very intimate levels without embarrassment or defensiveness."
Another patient put it this way: "I found it to be uncanny how easy it was to speak freely ... about feelings. I'm generally not very good at that but the MDMA apparently enabled me to let down the defenses and open up the offenses--but all in a gentle, matter-of-fact sort of way." And still another observed: "It breaks down the walls--relieves inhibitions--free thoughts escape--under a euphoric cloud that makes it okay to say anything and everything."
These features of the MDMA experience may account for the common observation that an MDMA-assisted therapy session can greatly enhance the therapeutic alliance. Many patients report how much more they trust the therapist and how much closer they feel to the therapist after one such session. . ..Therapists who have used the drug claim that it can enhance the therapeutic alliance by inviting self-disclosure and promoting trust. Whether MDMA fulfills this promise or not, other drugs may eventually prove useful in psychotherapy. Research on their potential should not be curtailed because of fear that they will be subject to illicit abuse." (p. 401-403)
Grob, C., Bravo, G., McQuade, J., & Doblin, R. (1991). Analgesic efficacy of 3,4-methylenedioxymethamphetamine (MDMA) in modification of pain and distress of end-stage cancer: FDA IND application.
As PI for this proposed project, Grob has spent the past decade in continuous struggle. His IND Application has probably been rejected more times than any other that has ever been submitted to the FDA. He has rewritten about 8 drafts of his protocol for a Phase II trial with incurable terminally-ill cancer patients. During that length of time, a pharmaceutical company would have long ago received their Investigational New Drug permit and already gone on to market a patented product. Yet year after discouraging year, Grob keeps returning for more abuse. The FDA may never allow him to administer MDMA to people who are about to die, supposedly because the medicine might eventually cause some sort of long-term brain damage.
MAPS initiated this investigation in 1986, and committed to fund the $70,000 cost of this year-long experiment involving 12 subjects. In a detailed discussion of protocol design of the Phase 2 study, Cullen (1994) summarized her recommendations on the appropriateness of various psychometric instruments, and emphasized the need for flexibility in administering tests to patients with this debilitating illness. The MAPS newsletter publishes periodic updates on this project, one of which explained:
After the FDA completes its review of the Phase 1 safety data, Dr. Grob plans to submit a Phase 2 protocol for FDA review. This Phase 2 study will gather preliminary data on the safety and efficacy of MDMA and guided imagery when used as an analgesic in cancer pain and as a psychotherapeutic adjunct for the treatment of anxiety and depression related to terminal illness. The study will also seek to determine the physiological effect of MDMA on the immune system as well as whether the combination of MDMA and guided imagery could be used as an effective tool to facilitate psychoneuroimmunological (mind/body) stimulation of the immune system. The population of end-stage cancer patients was selected because of the desperate life circumstance they encounter, for which conventional psychotherapeutic and pain reduction treatments often offer limited relief. (MAPS, 1995-96a, online)
Admittedly, the FDA did allow Grob's team at the Harbor Hospital-UCLA Medical Center to administer MDMA to healthy volunteers for a Phase I trial to determine potential health hazards (Grob, Poland, Chang, & Ernst, 1996). This was the first government-approved administration of MDMA to human subjects. That accomplishment paved the way for other human pharmacokinetic research with MDMA at places like the Drug Dependence Research Center at UCSF Medical Center and Wayne State University School of Medicine. However, the FDA will not permit MDMA to actually be used as a medicine. Therefore, they have stonewalled Grob for 9 years.
Commenting on the Federal restrictions prohibiting physicians from harnessing the healing potential of MDMA, Grob (2000) recently stated "It's unfortunate that we are practicing our craft with one hand tied behind our back. The FDA is very uncomfortable with the notion that a drug like this could be used in a therapeutic context. So far, we're not close to a bona fide approval. . .. Knowing the pressures the regulators are under, if I were in their position, I might feel the same way."
The position that MDMA may have benefits for patients is supported by reports from people who used MDMA to help relatives dying of cancer or other causes. When these sessions were not supervised by clinicians, the participants always took the trouble to educate themselves about MDMA therapy for the terminally ill. These anecdotal accounts indicate that if informed nonprofessionals are able to successfully use MDMA for such purposes, then perhaps licensed psychotherapists could also somehow figure out how to achieve similar results.
MAPS published a series of letters about a man who was dying of pancreatic cancer. He and his family took MDMA together twice so they could share some last "few precious hours of pain-free `quality time'" (MAPS, 1999, online). His daughter wrote:
In looking back, I find that the two MDMA sessions we had were two of the most joyous memories during his final weeks of existence. . .. I will never forget it, and know that a major part of the reason for his improvement was the MDMA session.
Our two sessions will undoubtedly stick out in my memory as time passes and I can begin to mellow the memories of agony and cherish the ones of quality time spent together. I wish you continued success in getting the status of MDMA changed through research, to allow for others to participate in such beautiful experiences. (cited in MAPS, 1999, online)
George was a man who was dying at age 92. Analgesics and hypnosis offered only partial respite from physical pain due to strokes and falls. The medical hypnotist suggested that George might benefit from MDMA. During the session, George released sorrow over the deaths of his wives and the trauma of his physical injuries. George's grandchild explained:
To permit these feelings to emerge was very cathartic. He was lifted out of the body to experience complete pain relief and association with those he held dear. It was a glorious experience for him. With this experience to draw on, I found that I could hypnotize him and have him leave his body at will. This permitted him to leave any pain, but without narcotic stupor...
There is no way I can say how grateful I am for MDMA for opening up a way to help George with his emotional and physical pain. It was the first time this stiff necked, fearful old man had let go. Nobody had ever seen before that hidden, beautiful, lovely soul. (anonymous, 1994 online)
Shane was a 25-year-old terminal cancer patient. Sue was his 28-year-old spouse. They were in the midst of a heart-wrenching struggle against the disease. A few MDMA sessions relieved much of their torment during this agonizing period of their lives. Sue recounts their last MDMA session which occurred shortly before Shane's death:
Within an hour we felt the effects. The thought of this brings the largest smile to my face in remembrance. It was an unbelievable night that I wish every government official could view. Every person who is skeptical of the legalization of MDMA to help people with cancer pain needs to view the miraculous events that began to unfold. . .. We enjoyed approximately 5-6 hours free of physical and mental pain. We joked, we loved fully, we talked like we hadn't seen each other in years and had much catching up to do. We would suddenly stop talking just to look at each other and feel... cancer free.
. . .What I do believe fully and have seen and lived first hand is that while MDMA will not cure cancer, it can cure the emotional pain that accompanies it if used correctly. This entire fight [for legalization of MDMA psychotherapy] makes me cry more than Shane's passing. I am appalled that it is not available to those who need it.. . . everyone facing terminal cancer should have the feelings of acceptance brought on by MDMA made available to them when it is so desperately needed. (Sue, 1999-2000, online)
At Shane's funeral, Sue distributed pamphlets to 100 relatives and friends requesting that, instead of sending flowers, people donate money to support MDMA research for cancer patients. Sue (1999-2000, online) believed that taking MDMA together "was the best decision we could have ever made in regards to the cancer." She hoped that the "wonderful research" with MDMA would be legalized so that people in the future would not have to break the law to help their anguish. This case was later described in a cover story of Time magazine (Cloud, 2000, p. 68).
For 14 years, Grob and his colleagues have wanted to explore the following issues: Is it possible that MDMA could reduce acute and chronic pain in end-stage cancer patients, thus reducing dependency on addictive narcotics? Might MDMA bolster the functioning of the immune system by reducing systemic stress and discharging unexpressed negative emotions? Could it be that the emotional anguish of the patient (and loved ones) could be ameliorated by MDMA psychotherapy? Apparently, Washington bureaucrats are determined to prevent these questions from ever being answered.
Hastings, A. (1994). Some observations on MDMA experiences induced through posthypnotic suggestion. Journal of Psychoactive Drugs, 26 (1), 77-83.
Hastings described a classroom experiment in which four of his graduate students were successful in using hypnosis to re-experience the effects of MDMA.
This preceded Farber's (1999) self-experimentation using
"hypnotic anchoring" to re-experience states achieved by practicing yoga
under the influence of MDMA, and the publication of his account in Psychedelic Monographs and Essays
1994 (which can be found here). Hasting's discussion of the history of experimentation with hypnotic recreation of drug states was limited to an incomplete review of the literature regarding LSD, overlooking work by Erikson and Huxley (Rossi, 1980), and also that by Masters & Houston (1972). There was also no mention of Greer's success with teaching a cancer patient to use self-hypnosis to extend and "re-anchor" the analgesic effects first experienced with MDMA, although Hasting cited a paper by Greer (1990) which presented this case history. With regard to therapeutic applications of hypnotically-induced MDMA experiences:
These cases suggest that it is possible to use hypnotic suggestion to create a state quite similar to that produced by MDMA in persons who have previously experienced it. In such a case it may be possible to use the hypnotic procedure for therapy sessions, counseling, and other clinical work by beginning with MDMA experiences, and then using hypnosis to continue with similar work without using the drug itself. One of the participants in this study had only two previous MDMA sessions; this would appear to be sufficient for the effects to be reproduced. Perhaps one previous experience would also suffice. Though MDMA is not legal now, this technique could be used with clients who have used it in the past. As noted, MDMA sessions have advantages for therapy, and the hypnotic procedure could produce those qualities without physical side effects (or aftereffects), and could shape the state to facilitate therapeutic process. For example, the time frame could be varied for shorter or longer sessions.
It is not clear if the hypnotically induced condition as a discrete state of consciousness will hold sufficiently stable for sustained psychological work in the face of habits and dynamics of the personality. A drug can shape the state chemically and hold the parameters in a biological way until it has run its course. One would expect hypnosis to vary in its ability to do this, depending on the strength of the effect and whatever limitations are inherent in the process. . ..
It is possible that this hypnotic procedure could be utilized in recovery and rehabilitation work with substance abusers. It may be that an MDMA-like experience, via posthypnotic suggestion, could be utilized in treatment and therapy for substance abuse. The reproduction of other drug states in the absence of the drug, and indeed with qualities that could be shaped or directed, could be of value in a substance abuse treatment program. (p. 82)
Hastings (2000) later published a condensed version of this paper, reiterating the same information which was based on experiments with a total of 8 subjects.
Future MDMA researchers might consider the possibility of constructing therapeutic adaptations derived from Copley's (1962, pp. 15-16) pioneering experiments. Unfortunately, his published account did not detail precisely how he successfully implanted posthypnotic suggestions while the subject was under the influence of a massive quantity of LSD.
Ingrasci, R. (1985). Testimony for MDMA Hearing Submitted by Richard Ingrasci, M.D., M.P.H. In the Matter of MDMA Scheduling. Docket No. 84-48. United States Department of Justice, Drug Enforcement Administration.
Although Ingrasci was the most widely quoted MDMA therapist in the media, this testimony was his only written statement about his work. He described the procedure which he used in conducting approximately 150 MDMA sessions with 100 patients, 11 of them cancer patients. Two thirds of these sessions were with individuals and one third were with couples. Ingrasci included some case histories. Despite minor differences in the presentation of one woman, these seem to be the same patients who appeared with him on the Phil Donahue Show.
Mrs. W. is a 37 year old white married female with colon cancer which has metastasized to her liver. Her prognosis is poor. She has always found it difficult to express her feelings and tends to hide her feelings behind a frozen smile.
I did one MDMA session with Mrs. W. in which she said that she became more relaxed than she had ever felt in her entire life. She opened up emotionally and was able to discuss her feelings about dying in a deeply-felt, meaningful way. Even more significant was the discussion that took place with her husband, mother, and 17-year-old daughter following the therapy session itself. The family spent the entire evening talking about things that the patient had always wanted to say but never quite could. Many unresolved feelings and family issues were dealt with openly and honestly in one evening. Mrs. W. says that that was one of the most important days of her life, and she continues to make progress in her ability to communicate her feelings without fear. (pp. 2-3)
Couples therapy: Mr. and Mrs. L. have been married for 22 years and were considering divorce when they began couples therapy with me one year ago. Four months into the therapy they took MDMA for the first time. Their level of defensiveness and anger, as well as their tendancy [sic] to blame the other for causing each other's hurt and pain, dramatically decreased both during and after this session. They continued couples therapy, and six months later took MDMA for the second time. In this session, the deeper, spiritual aspects of their marriage were acknowledged and discussed very openly, and as a result they made the decision to stay together and work through their difficulties.
I have seen MDMA help meny [sic] couples break through longstanding communication blocks because of the safety that emerges in the session as a result of the drug. It is difficult to convey in words how deeply moving it is to watch couples heal in this way with the help of MDMA. (p. 3)
Mrs. B. is a 40-year-old mother of two who had been sexually molested by a male cousin when she was nine years old. She had always been too afraid to talk about the incident in detail or to express the feelings that she had about it. She had developed a negative attitude toward all men and was experiencing sexual difficulties with her husband. After three months of therapy, Mrs. B. did one session with MDMA as a way of helping her deal with her sexual abuse. Her experience during the MDMA session was unpleasant and upsetting. She talked about what happened to her as a child, shed many tears, but handled the feelings quite well. Two days following the MDMA session she realized that a major shift in her attitude toward her abuser and toward men in general had taken place, and she no longer felt the need to "push love away," as she put it. She considers the MDMA session to be a major turning point in her life. (p. 4).
Ingrasci believed that MDMA had a low abuse potential, and was a very safe therapeutic agent with little potential for chronic abuse (p. 5).
Kueny, S. (1980). Report on a Study to Examine the Feasibility of Using 3,4-methylenedioxymethamphetamine (MDMA) to Facilitate Psychotherapy: Submitted in Partial Fulfillment of Requirements for Psychopharmacology 641 to Alexander Shulgin, Ph.D. Pacific Graduate School of Psychology.
This was the first paper written about MDMA's psychotherapeutic potential. It preceded the unpublished 1983 student paper about the therapeutic benefits of MDMA which Forte wrote while attending divinity school in Chicago. Kueny's project was probably suggested by her instructor, who was instrumental in catalyzing the MDMA psychotherapy movement. Kueny administered MDMA to nine normal adults in a non-clinical setting for the purpose of assessing the feasibility of using MDMA to accelerate the development of the "therapeutic alliance". The report included a review of the research protocol, a summary of the participants' first MDMA session, a nine-month follow-up, and observations on the research design. No adverse effects were reported. The report noted:
This study, whose protocol included two more MDMA experiences for each subject, was interrupted after the completion of the first cycle. Due to the concern on the part of some students in attendance at the institution which sponsored this project that minor technicalities related to research on human subjects had not been met, the study was discontinued. Although additional experiences on the part of the subjects would have yielded firmer observations on which to comment, several points may be made on the basis of this single session.
First, all nine reported that their sessions were beneficial and non-threatening, and all were eager to proceed to the second session. . ..
To return to the question of the applicability of MDMA in a psychotherapeutic setting, the researcher believes that this brief experiment yields enough provocative data to justify further research on that issue. Although the sessions in this study were not defined as therapeutic encounters, even without the facilitating intervention of a clinician, the participants experienced what may be termed therapeutic changes. It would appear that, in this cross-section of subjects at least, MDMA allows ordinary defenses against communication and closeness to relax, and permits those involved in its effects to deal with substantive issues. The researcher believes that the implications for using this apparently non-injurious, yet potently catalytic, agent in the therapeutic setting are enormous. (pp. 8, 16)
Liester, M., Grob, C., Bravo, G., Walsh, R. (1992). Phenomenology and sequelae of 3,4-methylenedioxymethamphetamine use. The Journal of Nervous and Mental Disease, 180 (6), No.1315, 345-352.
This report summarized semi-structured interviews with twenty psychiatrists who had previously themselves taken MDMA. Over half of the subjects stated that they believed MDMA had a high or very high potential as an adjunct to psychotherapy. Such an article is also thought-provoking in that it documented that personal MDMA use was viewed favorably by a number of psychiatrists.
Riedlinger, J. (1985). The scheduling of MDMA: A pharmacist's perspective. Journal of Psychoactive Drugs, 17 (3), 167-171.
This paper was adapted from the author's 1984 letter to the DEA protesting the proposed scheduling of MDMA, and from her written testimony submitted to the scheduling hearings. After countering various claims by the DEA regarding MDMA's abuse potential and putative addictiveness, the article discussed MDMA's therapeutic value in a format worded to foil the legalistic prongs of the federal regulators.
It is here that Riedlinger first published her theory that the pharmacological action of MDMA's "S" isomer could relieve depression by releasing serotonin. Actually, Shulgin previously recommended MDMA as a possible antidepressant when describing it to the first therapist who later used it with patients, although this was not documented until after Riedlinger's article. Sferios reports that some young people who use MDMA weekly at raves are unconsciously self-medicating for undiagnosed depression (Lindesmith Forum, 2000). Ongoing ingestion of Prozac and other SSRIs supposedly inhibits the euphoric effects of MDMA. Nevertheless, once these young people are prescribed an SSRI, they are unwilling to go off it in order to occasionally use MDMA because they feel better with the daily doses of their medication. Due to tolerance MDMA's desirable effects quickly diminish with frequent use, so MDMA is not a viable substitute for SSRIs or other prescription antidepressants, at least for patients whose endogenous depression is caused by 5-HT disorders. Of course, depression can also be a reaction to unfortunate life circumstances, and unexpressed negative emotions. MDMA psychotherapy might alleviate these causes of this reactive depression by providing emotional catharsis and offering insights in how to more effectively combat untoward external conditions.
Riedlinger also suggested that MDMA might mitigate autism because it improves the "flow" of serotonin (p. 170). She emphasized that the "interpersonal element" would be important for MDMA sessions with autistic children (p. 170). This paralleled the recommendation Grof made at this same time, that such sessions include lots of affectionate physical contact between the autistic children and the treatment staff. Asserting that MDMA is a safe effective tool with an established medical use, Riedlinger concluded:
MDMA does not belong in Schedule I of the Controlled Substances Act, as recommended by the DEA. Furthermore, it probably should not be placed in Schedule II either. To place MDMA in either category would sharply curtail research on this promising drug and its use in the field by practicing psychotherapists and other mental health professionals. In light of the fact that MDMA seems to constitute one of a new class of drugs, it would seem most efficacious that MDMA not be scheduled until such time as a consensus of the medical community determines in which schedule it properly belongs. Its uniqueness may warrant the creation of a whole new scheduling category. (p. 170)
Reidlinger, T., & Reidlinger, J.E. (1994). Psychedelic and entactogenic drugs in the treatment of depression. Journal of Psychoactive Drugs, 26 (1), 41-55.
This article could be useful as an introductory piece for readers not familiar with the field. It also probably served as an inspirational tract attempting to generate interest in psychotherapy utilizing mind-expanding substances. The theme "treatment of depression" seemed to be included primarily to bolster the secondary author's claim to being the first person to publish the notion that MDMA could be used to treat this condition.
The introduction explained that some depressed patients have serotonin deficiencies, and many drugs prescribed to treat depression elevate serotonin levels. Noting that psychedelics such as LSD mediate serotonin levels, the authors suggested that perhaps they too might be useful for treating depression. The paper's first section was Psychedelic Psychotherapy. This discussed Grof's contradicting (and more plausible) theory that any influence which psychedelics might have on depression is mediated through psychodynamic rather than pharmacologic means. The second section of this article is entitled Entactogentic Psychotherapy. There was no mention of the well-known clinical explorations with other entactogens (Naranjo, Shulgin, & Sargent, 1967; Naranjo, 1973; Turek, Soskin, & Kurland, 1974; Yensen, Di Leo, Rhead, Richards, Soskin, Turek, & Kurland, 1976; DiLeo, 1981) such as MMDA or MDE, and MDA was discussed only in the context of a 1958 experiment to test its efficacy in treating depression. The bulk of this section was a general overview of all aspects of MDMA. The Riedlingers cited a few examples from other publications that described how MDMA psychotherapy benefited clients by alleviating various symptoms, including depression. However, the authors did not present new case histories or give detailed instructions about specific treatment approaches designed especially for depressed patients.
The following passage probably reiterated ideas from June Riedlinger's May 1986 lecture "Implications of MDMA Research for Suicide Prevention" in Oakland at MDMA: A Multidisciplinary Conference":
The particular value of MDMA for suicidal patients and, by extension, for patients with less severe forms of depression is basically twofold. First, it might be useful as an intervention drug. By providing immediate relief from overwhelming dark emotions, it seems likely that MDMA could help forestall the act of suicide or otherwise alleviate a patient's sense of hopelessness. This buys time for the drug's second major effect. It facilitates psychotherapy by helping to enhance the patient's trust and by inviting self-disclosure. As previously noted, the result is to fortify the "therapeutic alliance" between patients and their therapists. (p. 52)
Saunders, N., & Doblin, R. (1996). Psychotherapy. In Ecstasy: Dance, trance & transformation (pp. 123-134). Oakland: Quick American Archives.
This book was an updated version of Ecstasy and the Dance Culture (1995) and E for Ecstasy (1993). It was primarily a sociological study of MDMA, emphasizing recreational use at raves. There were some personal accounts of MDMA being used to treat pain from cancer (pp. 197-198) and stroke (pp. 209-210). Chapter 12 contained some pertinent first-hand reports by Saunders. These included an anonymous interview with a psychiatrist who administered MDMA (pp.126-127). Saunders also described the work of Madriz, chief psychiatrist of a Nicaraguan military hospital, who used MDMA to treat twenty cases of "depression or anxiety disorders" (pp. 127-128). Saunders interviewed the Swiss psychotherapist Bloch (pp. 129-131). Bloch mainly treated "people with unusually hard character armor. . .. women with bulimia, some compulsive characters, and depressive patients" (p. 129). She ran a group MDMA session twice a year. Meeting at 8 A.M., the clients gathered in a circle and discussed how they were feeling. After meditating and doing breathing exercises, they each took 125 mg of MDMA. They lay down with eyes closed, listening to music. Bloch then monitored her feelings as she interacted with the patients. She was alert for ones that were trying to draw too much attention to themselves, ones who experienced anxiety due to unfamiliar feelings of intimacy, or ones who relived childhood memories and who had other experiences. At the end of the session, everybody drew a picture of their experience, and had a discussion. Bloch related MDMA to her understanding of body therapy:
When you have a block in the body, it is because it is too painful to allow the feelings to flow. MDMA is able to open up the blocks because it also releases the feelings--or releases the feelings and then the blocks open; you can say it either way. But I also use MDMA because of its spiritual value. MDMA is the drug that really opens up the heart, and in normal therapy I also work with opening up the heart. That, for me, is the main goal. For me it's not important that people are totally de-armored, but that they get in contact with love--love for themselves. That is why I really like to work with MDMA. (p. 131)
Shulgin, Ann. (1995). The new psychotherapy: MDMA and the shadow. Eleusis, 3, 3-11. SISSC (Italian Society for Study of States of Consciousness).
This article, printed in English and Italian, was a revised and edited version of a talk given at the "Psychoactive Sacraments Conference Retreat" sponsored in 1995 by the Chicago Theological Seminary and the Council on Spiritual Practices. It reviewed some of the highlights of the author's previous writing in TIHKAL. Shulgin described how, in 1972, her husband introduced MDMA to the first psychotherapist who used it with patients. This psychologist devoted the next 12 years to administering MDMA to about 4000 people, specializing in training other therapists who needed personal experience so that they would understand how to conduct sessions with patients. Then there was an unusual version of the "four agreements. Rather than the customary agreement that the client stay remain on the premises until the end of the session, there is an agreement that the client not voluntarily allow their consciousness to abandon their body in such a manner that would cause physical death. Shulgin noted that sometimes significant progress is made during the end of a session just as the effects are wearing off. The therapist must have the stamina to continue to support the client if this occurs.
The rest of the article discussed a topic the author previously explored in TIHKAL. This was the dark side of human nature, which Jung called the "Shadow". Before taking MDMA or other insight drugs, clients should be prepared for the fact that they may encounter this closed off, long denied, aspect of the self. The client has to be instructed that this shadow is not the whole truth of their inner nature, that this is only a part of the self that split off to protect the person from unacceptable aspects of their unconscious. There should be a great deal of preliminary discussion about the client's childhood, to understand the survival value of developing certain behaviors and emotional responses. The therapist who had already personally been through this repressed core of their own self would be able to speak with believability and authority about how to struggle through one's deepest fears. The therapist must approach the client with as few theoretical preconceptions as possible, staying receptive to clues that might reveal the unique inner structure of this particular individual. The therapist should have sincere heartfelt caring about the client in order for MDMA therapy to work. If this concern is not present, or if countertransference issues can not be overcome, the therapist should refer out rather than try to fake it. A therapist who has sufficient personal training with MDMA and psychedelics will have had what Eliade referred to as the "participation mystique", which is the direct experience of kinship with all lifeforms, plant and animal and human. This will enable the therapist to identify with and care about the client. When the client's unconscious anticipates the destruction of a needed and long-nurtured good self-image, it may refuse to have any response to the MDMA in order to prevent access to the shadow. Shulgin's Jungian interpretion of MDMA psychotherapy was undoubtedly inspired by her first husband, Perry, who was the last surviving psychiatrist who was personally trained by Jung:
A Jungian analyst will encourage his client to see his Shadow as clearly as he can - see what shape it takes, sense what its qualities are--and then to continue working on understanding its origins and its functions. Eventually, it will transform into an ally of the whole, integrated, conscious Self.
This may not sound like a dramatically important difference, but a therapist working with MDMA or a psychedelic drug will gently help his client to take one additional step, when he has full view of his Shadow, which--by the way--usually, but not always, takes the form of a large, powerful animal. He will urge the client to first face, then enter into, the dark figure he is meeting; he must work to get inside the beast's skin and look out through its eyes. It is here, at this point, that a battle may have to be fought, because not only does the conscious man have to fight his own revulsion, shame and fear of this forbidden aspect of this psyche; the mind may project upon the Shadow an equal resistance to being seen or touched.
Some people seem to be able, once they have acknowledged the Shadow, to step right into it. Others must fight to get there, with strong, patient, loving support and encouragement from the therapist.
The first response to successful merging is usually astonishment at an unaccustomed absence of fear of any kind. The second is a growing appreciation and then frank exhilaration at the sensation of power--immense, fearless power--which characterizes this creature.
This stage of getting to know the Shadow from the inside may take more than one session, but I have--many times--seen the work completed in one day. As the client learns to accept and understand his Shadow and its primary goal, a transformation will begin.
Ultimately, the Shadow will take its place as a devoted ally and protector, available--when needed--to the whole Self, respected and validated by the conscious mind, even though it will never be entirely housebroken or have good table manners. In other words, the final goal is identical to that of the Jungians.
The author concluded by assigning culpability for the prohibition of this type of therapy:
You might blame an almost universal ignorance on the part of lawmakers, as well as most of the general public, about the psychedelics and their appropriate uses.
I blame something else: an intense unconscious fear of the hidden depths of the human psyche, and an unacknowledged certainty that the Shadow is, indeed, the final terrible, rockbottom truth about the nature of man. This belief, in most of us, has been nurtured in a thousand ways by family and culture, and too often by religion.
It will be up to us--and others who feel as strongly as we do--to find out how turn this around, in our own nation. In many other countries, in Europe and South America, a change in attitude seems already to have begun.
Shulgin, A., & Shulgin, A. (1997). The intensive. In TIHKAL: The Continuation (pp.209-245). Berkeley: Transform Press.
This discussion of the author's experience with MDMA psychotherapy uses pseudonyms to maintain the anonymity of the people involved. The chapter begins with Ann describing how she developed a partnership with a licensed psychotherapist. Ann supervised MDMA sessions for this therapist, who concurrently used self-hypnosis to process intrapsychic material which the Jungians would call the "Shadow". Later they worked together to administer MDMA to some of the psychotherapist's patients.
Even though MDMA was legal at the time they treated clients, their method of working involved security precautions designed to minimize the risk of harassment. The licensed therapist would select particular patients with whom she had already been working for at least six months, preferably a year. Before the subject of MDMA was brought up, the patients would have already have done the basic work of psychotherapy. Only trustworthy patients who seemed like they would be able to grow from the experience would be offered the opportunity to take MDMA. The patient would be instructed never to discuss the use of MDMA on the telephone. Before a client arrived, the single dose of MDMA was brought out in the home where the sessions were conducted. The MDMA was then mixed into a glass of orange juice before the client arrived. The client would drink the juice without being allowed to remove the glass from the room. Then the glass would be washed. The idea was to prevent anybody from knowing where it was kept, and to eliminate any evidence of it having been consumed on the premises. An additional rule was that the therapists had to agree to continue working with the client if an important breakthrough occurred at the end of a session. Usually the sessions were over within six hours, but there was the understanding that, regardless of how tired the therapists might be, they would be committed to continue for however long the patient needed their help. The patient would be encouraged to drink fluids during the session to avoid dehydration. The client would not be allowed to leave the premises until they had "returned to baseline". If necessary the patient could stay for the night. The patient had to arrive alone either in their own vehicle or by taxi; being dropped off by a friend or relative was not permitted because that would involve another person in knowing the location of the sessions. The patient would have already agreed not to discuss their involvement with MDMA psychotherapy with anybody. However, after the course of treatment was completed they would be permitted to discuss it with people who were close to them, provided that no identifying information was shared2yp about where, when, or with whom they had this experience.
The patient would also have to recite aloud a version of the "four agreements". This chapter implies that three of the agreements were originally developed by a hypnotherapist, and were later adopted as a standard practice of most MDMA therapists. The intention of reciting the agreements was that presumably the patient's unconscious mind would pay more attention if the words were repeated aloud. The first rule was not to allow any hostile feelings to be expressed in aggressive action toward people or property. A patient who needs to express rage would be given an old sheet to tear up and a pillow to beat. The second rule was no sexual activity during the session. The third rule is that if the patient gains the ability to terminate the functioning of their physiological processes, that they would abstain from causing the disruption of dying during the session. The fourth rule, the agreement about not leaving the premises until the end of the session, would have already been discussed. By establishing this structure, the patient would feel freer to express various emotions, knowing that the expression had to be contained within safe limits.
An interesting case history was presented about a man who had psychosomatic leg pains. During his MDMA session, he remembered a forgotten childhood trauma of having his legs crushed by a roof that collapsed. His mother had explicitly instructed him to forget the incident. For years afterwards, he periodically had uncanny accidents involving his legs, as if the repressed memory inexplicably attracted further damage to the site of his original injury. After remembering the childhood trauma, he had no further problems with his legs.
The chapter concluded with a discussion of the attitudes necessary to be an effective therapist. The therapist should set aside preconceptions, and approach each patient's mind as a new world with its own language of imagery and symbols. The therapist would try to activate the internal healing abilities that are latent within each patient. In order to be effective, the therapist must have genuine caring, a feeling "something very close to love for the person". If the therapist disliked the patient, it was necessary to refer them elsewhere. One of the advantages of the therapist having extensive personal experience with altered states of consciousness was that they would hopefully have experienced a unitary sensibility that would foster a feeling of relatedness in cases where it might otherwise be difficult to identify with the patient.
Stolaroff, M.J., & Wells, C.W. (1993). Preliminary results with new psychoactive agents 2C-T-2 and 2C-T-7. Yearbook for Ethnomedicine and the Study of Consciousness, 2, 99-117. Berlin: VBD - Verlag fur Wissenschaft und Bildung.
The purpose of this experiment was to screen two of Shulgin's new insight-generating phenethylamines for possible therapeutic use by comparing their effects to those of MDMA. Healthy normal adult subjects were used. All other scientific papers have either tried to prove or disprove the validity of MDMA psychotherapy. This article is interesting because it just assumes that MDMA is an accepted standard against which to compare other drugs.
Stolaroff, M.J. (1997). The secret chief: Conversations with a pioneer of the underground psychedelic therapy movement. Charlotte: Multidisciplinary Association for Psychedelic Studies (MAPS).
Stolaroff is best known for his projects at the International Foundation for Advanced Study and at San Francisco State University, where he administered mescaline for creativity enhancement and technical problem-solving. This book is a transcript of interviews which he conducted with the psychologist who founded the field of MDMA psychotherapy. This former Lieutenant Colonel, who is now deceased, was one of the few licensed mental health practitioners in the United States who continued administering Schedule I substances to clients after they became illegal. Therefore, he is presented in this book under the alias "Jacob". This is apparently the only alteration to the taped interviews--unfortunately not even expletives were edited out. In addition to Stolaroff's introduction, there are laudatory prologues about Jacob by Grof, Hofmann, and the Shulgins. The book recounted how Jacob became involved in therapy using psychoactive substances, including MDMA. It described the dosages and effects for various materials, giving case histories of subjects who experienced varying degrees of benefit. Jacob honestly admits how his various mistakes were refined through trial-and-error into standardized approaches for both individual and group sessions. He trained about 150 therapists in America and Europe, and probably introduced various mind-expanding substances to between 3000 and 4000 people. He used LSD, mescaline, psilocybin, ibogaine, harmaline, MDA, and to a limited extent 2C-B. Toward the end of his career, when introduced to MDMA by Shulgin, he began enthusiasically administering MDMA to his clients. However, MDMA was only given after the client had considerable experience with other compounds. By the time Jacob began using MDMA, he was conducting sessions that were less for the purpose of therapy, and more for personal and spiritual development. Nevertheless, Jacob's style of running individual sessions will be reviewed because it formed the basis of Greer's clinical use of MDMA.
Potential new clients were referred by word-of-mouth from his established clientele. Therefore, there was a pre-screening process going on. Screening was based on intuition, which comes from experience rather than being something that can be taught. When Jacob suspected that the candidate was unsuitable, he got an unsettling feeling in his stomach, and a vague anxiety that lingered after he had talked to the person. He preferred to work with growth-oriented clients who had an established interest in self-actualization, and who were engaged in socially productive lines of employment. At least 80% of his clients had been in therapy, and those currently in therapy had to get permission from their therapists.
Clients had their first session in a private setting, preferably in their own home. Jacob arrived in the morning. He set up a tape recorder to record conversation during the session. He also set up a cassette player with headphones for the person to listen to music. A bucket and Kleenex were available in case the client later became nauseous or cried. Jacob had the client agree to "the four agreements" plus a security clause that the client would not reveal identifying information about the session which might jeopardize Jacob's practice. Then they said a prayer. The client ingested the medicine, and drank water from Jacob's special cup which he explained was a symbol of transformation that went back before the Holy Grail. The client would have brought family photos and pictures from various stages of their life. After taking their medicine, the client arranged their photographs chronologically. Jacob explained that if they felt fear or discomfort during the transition to the altered state of consciousness, then they could hold out their hand to request physical support. Then Jacob had them go to the bathroom before reclining with eyeshades and headphones. The client was able to request that a particular piece of music to be repeated, that dissonant music to be switched to something else, or for there to be silence. The client would be offered a booster if the initial dose had not produced adequate results. The therapist intervened in the client's process as little as possible, unless assistance was requested. Sometimes clients encountered anxiety-provoking internal conflicts. These conflicts were generally accumulated negative energy around all their unfaced fears. They would then be encouraged to just look at the problem, holding it in the mind's eye. Without actively doing anything other than visualizing the conflict, it would tend to be transformed and to loose its charge. If they need to go to the bathroom during the experience, Jacob instructed them to look deeply at their image in the nearby mirror, and report later what they saw. They were not supposed to talk until the experience was ending. As the effects subsided, Jacob handed them their photographs one by one. The client examined the pictures and processed any emotions that were evoked. After the session, a trusted friend or family member came to spend the night with the client. Preferably, this person had experience with mind-expanding substances so that they would not ask "a whole bunch of stupid questions". Jacob would then leave, saying that--if the person felt the need to talk about anything--"Don't hesitate at all, call me any time" (p. 75).
Tatar, A., & Naranjo, C. (1985). MDMA in der gruppenpsychotherapie. Symposium in Hirschhorn/Neckar, Germany: "Uber den derzeitigen Stand der Forschung auf dem Gebiet der psychoaktiven Substanzen."
This presentation was described in "The World Wide Web Psychedelic Bibliography: Dr. Shulgin's MDMA bibliography: Clinical Studies":
Two independent reports of clinical utility are presented. Both investigators report MDMA use in group settings. The groups consisted mainly of psychosomatic patients involving problems such as allergies, eczema, sexual dysfunction, troublesome urination, cardiac irregularities, and cancer. There were some positive changes reported, and in some cases there were no improvements. No details are presented. (Shulgin, 1990s, URL not currently functioning and online citation non-retrievable)
Widmer, S. (1997). Listening into the heart of things: The awakening of love: On MDMA and LSD: The undesired psychotherapy. Gerolfingen: Basic Editions.
The original German version of this book was:
Widmer, S. (1989). Ins herz der dinge lauschen, vom erwachen der liebe. Solothurn: Nachtschatten Verlag.
In the 1990s, the Swiss Association for Psycholytic Therapy (SAEPT) claimed success in treating over 600 psychiatric patients with MDMA, LSD, and similar substances. Widmer was a member of this a small cadre of Swiss clinicians. The only English-language descriptions about what was actually going on over in Switzerland were a few brief blurbs in the MAPS newsletter. Therefore, the international audience would have been fascinated to finally have access to a detailed description of any distinctive methods which the Swiss may have evolved. Also of value would have been an updated objective historical analysis of their political struggles, such that researchers in other countries could emulate their successes and avoid repeating their mistakes. Of particular relevance to North Americans would have been a full account of the mandatory experiential training of the therapists, since the US government still considers it taboo for its scientists to have personal experience with any psychoactive substances they may dispense, despite compelling well-known arguments favoring this sort of instruction. Such a valuable contribution to the literature would have naturally emphasized the important and largely undocumented differences between the classic psychedelics (such as LSD) and the feeling-enhancing communication tools such as MDMA, particularly with regard to clinical indications, treatment strategies, and healing dynamics.
These hopes were only partially gratified by Listening into the heart of things. Although case histories of MDMA treatment were interspersed throughout the book, general descriptions about the actual practice were confined to the final section. This information was often treated in a superficial manner, leaving the reader wishing for a more in-depth analysis. Widmer considered MDMA particularly suited for phobias and paranoia (p. 249), and for exploring relationships and conducting group therapy (p. 257). Widmer emphasized that the MDMA session is always part of a conventional therapeutic framework involving a trusting relationship with the therapist and individual talk therapy sessions (p. 258). He gave a concise description of how the actual group MDMA sessions are conducted (pp.259-262). There was also discussion of follow-up after the session, the therapists influence, body work, the use of music, indications and contraindications (pp. 262-297).
A book review written by Bravo used tactful understatement when noting "Widmer's devotional odes to the qualities of Love are interspersed throughout the book and take some getting used to, as does his verbose prose and poetry, which seem to be roughly translated at times" (1998, online). Indeed, a good editor could have cut out Widmer's rambling impressionistic musings, as well as the Zen parables and diagrams of mental states, distilling these 302 pages into a concise 50-page booklet.
Widmer began using MDMA because he was not allowed to practice LSD psychotherapy. The Swiss Department of Health was reluctant to grant him special consent to administer LSD:
I hoped that after I had completed my training in psychiatry and psychotherapy, my request for special consent would be considered in accordance with the basic regulations given by the Swiss Department of Health. Knowing what a tiresome procedure this could turn out to be, however, I launched the initial inquiries years before I was ready to practice. What I experienced exceeded the darkest of my expectations and confirmed to a large extent just how undesirable the whole thing was. It wasn't merely a question of waiting months for a response in each case. On one occasion, after a nine-month wait, I managed to wrest a complaint from the highest authorities (the Confederation of the Home Office) and had to furnish plenty of additional information and ideas. In spite of my fulfilling these conditions, they did not comply with my request. On the contrary, they continued to shy away from discussion, feeding me instead with the opinions of anonymous experts who had no medical arguments whatsoever with which to back their opposition, apart from which they happened to be the directors of clinics who knew of the work only through hearsay. They pointed out slickly, that my work had to be checked on political grounds. They tried to frighten me off with complicated demands and to undermine my thinking with vague arguments. After I had managed once again to sort out the problem, they simply changed the level of argument without ever getting to the point we were discussing.
The approval had not been granted to me at the time I set up my practice but that did not stop me from going ahead with my work. MDMA at the time was not banned and suited me perfectly for a start. Later as it entered the list of banned drugs, we found other substances too. . .. (pp. 23-24)
(Eventually, with the assistance of a single sympathetic government official, Widmer and his colleagues were able to secure permission to administer LSD and MDMA to patients.)
Also, the joy of the prospective sanction accorded to a small group of psychiatrists ought not to obscure the fact that basically nothing has changed with regard to the unwanted therapy. The grant is an exception, and as such, it is an attempt to control the use of such methods. The potential danger, even if it can't quite be suppressed, or so the thinking seems to be, ought at least to be left in charge of a qualified elite who will watch over it so that, like before, the majority of those whom it could possibly help have no access to it. (p. 25)
Wolfson, P.E. (1986). Meetings at the edge with adam: A man for all seasons? Journal of Psychoactive Drugs, 18 (4), 329-333.
This paper was a condensed version of the author's written testimony at the MDMA Scheduling Hearings. He was the only psychiatrist to go on record as having administered MDMA to psychotics and their families. This article included a case history of a patient who had suffered increasing decompensation as his family had him undergo numerous conventional and unconventional treatment strategies covering the spectrum of theoretical orientations. Several MDMA sessions with various configurations of family members were interspersed throughout a year of family therapy. Despite short-term gains in intimacy and understanding, often periods of closeness were soon followed by painful rebounds into isolation and alienation. Wolfson stated "In the warm afterglow of an MDMA session, new possibilities for love, relationships and self-appreciation emerge. To achieve these possibilities, the forgiving, less judgmental, reduced defensive state that MDMA provides has to be learned, at least partially, as an everyday way of life" (p. 331). There was no proof of long-term benefit from the use of MDMA in this case.
Perhaps new approaches could be developed to improve the track record of MDMA therapy for psychosis, yet some cases will always remain refractory to any and all treatment methods. Wolfson not only chose subjects who were in acute episodes involving desperate circumstances, but also chronic cases that, being already unresponsive to every other available treatment, had little to lose by using MDMA as a last resort. While such caution was justified by the preliminary nature of his exploratory investigation, it my also someday be found that MDMA-assisted psychotherapy might have more success with reactive schizophrenics and other patients who have a more optimistic prognosis. After discussing the limitations and drawbacks of neuroleptics for many such cases, Wolfson's paper concludes with this suggestion:
Imagine a setting in which individuals and their families would on a voluntary basis be in psychotherapy for a psychotic crisis and in which MDMA might be used. It would be in a secure outpatient environment or in the home. There would be ongoing support for the duration of the crisis. MDMA would be used once per five-day basis, with psychotherapy continuing daily. There would be space and time for dedifferentiation and privacy. Exploration of anger, distance and negativity would be possible and such states accepted rather than condemned. A family focus would enable exploration of the communication matrix and embedded injustice in the structure. Long-term availability for programs that would enable vocational and personal growth would be component parts.
This is a possibility that MDMA's availability would facilitate. Is there any doubt that this is an opportunity to be explored with the utmost seriousness? (p. 333)
This article also illustrated that not everybody responds to MDMA in an identical manner. Some people may have "ideopathic, severe and potentially fatal reactions". In particular, there was "no established record of safety in those who have cardiovascular disease", and "Whether or not there is a lowering of the seizure threshold is an open question." Wolfson stated "MDMA may reduce resistance to infection. An increase in viral respiratory infections seems related to use in some individuals." This lent credence to the hitherto unpublished anecdotal claims that MDMA can aggravate infections, particularly vaginal infections. In contrast, Grob, et al, (1991) suggested that MDMA might bolster immunity by lowering stress and reducing emotional conflict. It has not yet been determined if these contrasting responses are a matter of genetic variability, or have to do with the frequency and style of use. For example, is the bolstering of immunity more likely to occur with infrequent internalized introspective sessions? Is the increase of infections more likely to result when the person engages in outwardly-oriented physical exertion (such as dancing every weekend at raves)? Finally, Wolfson noted during the day after the session, some people feel energized and others have a hangover. Actually, some MDMA users report feeling normal after some sessions and having "bodyload" after others. All of these variables need further scrutiny, with regard to both straightforward pharmacology and to mind/body interaction.
Wolfson, P.E. (1985). Testimony of Philip E. Wolfson, M.D. In the Matter of MDMA Scheduling. Docket No. 84-48. United States Department of Justice, Drug Enforcement Administration.
Wolfson testified because he was "extremely concerned that this promising new psychotherapeutic agent will be lost to the medical profession" (p. 1). This testimony provided details about the 3 psychotic patients who were given MDMA in the context of family therapy. Wolfson recommended that MDMA might be most useful when the identified patient was treated in family therapy. He concluded:
In conclusion, it is my experience that MDMA is a potentially valuable therapeutic agent that should not be lost to the psychiatric profession or to human beings. Its uses and value as a psychotherapeutic agent demand exploration in the interests of all of those people who are doomed to a life of chronicity. In sophisticated psychotherapeutic hands, within an overall program of psychotherapy, I believe MDMA will prove to be a boon to those of us interested in helping individuals going through terrible states of mind. The cost to society, and the level of misery of the family and of the individual should focus our attention on the search for a new means to help those in torment. MDMA is such a path, and I would urge its exploration. A Schedule III or lower designation would enable this to occur. Support for this research should be made available, potentially through the National Institute of Mental Health with the cooperation of the Food and Drug Administration. I would be happy to participate in such an endeavor. (pp. 13-14).
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