When I was in college, I took MDMA with a few friends. It was 2002, and we thought of the drug as Ecstasy, or Molly, and associated it with raves. We weren’t really rave people, so we piled into a dorm-room bathroom and sat together on the floor. We were blissed out on one another’s company, deeply appreciating the cool, smooth nature of the wall, when John, the roommate of one of my friends, opened the door. He seemed unfazed to find us staring up at him with the big pupils you’d expect from an anime character. But something about his demeanor made us think that he was upset. When we asked him what was going on, he told us only that he’d been hanging out with some friends. On an ordinary day, we probably wouldn’t have inquired further. But we were on MDMA, which has been called an “empathogen,” because it intensifies feelings of empathy and connection, and we were curious to the point of pushiness. Was he sure that everything was fine? Did he want to tell us what had happened?
John closed the toilet lid, sat down, and began to talk. He was a serious musician who played in both an orchestra and a rock band; he said that, earlier that day, a friend of his had asked why he bothered with the band. As he told us about it, he started to tear up. Her comment, I sensed, had pricked a tender spot in his idea of himself. At the time, I thought of John as a friend but not necessarily a close confidante—but I was on empathy overdrive, and it felt intolerable to see him hurting. We got to work trying to help him sort things out, reminding him what a talented musician we knew him to be.
John’s dorm-room bathroom didn’t have much in common with a therapist’s office. Still, I’ve always thought of our encounter as a sort of informal therapy session. Some key elements of therapy were involved: we listened, with focussed attention, while John told us what was bothering him, and we asked why the remark had hurt so much. When he confessed his anxieties, we tried to validate and reassure him. In my memory, John left the bathroom feeling better, and so did I; I remember that conversation as a turning point in our friendship. Strangely, a chemical seemed to facilitate this connection. If not for MDMA, we might not have been so invested, or have invited John so earnestly to open up.
In recent years, growing numbers of scientists have been asking whether MDMA could become a recognized, official part of psychotherapy. Rachel Yehuda, who runs a lab at Mount Sinai focussed on post-traumatic stress disorder, or P.T.S.D., says that MDMA “produces a substantial change in mental state that increases people’s ability to engage with traumatic material in psychotherapy.” Although the drug has been illegal since the eighties, the F.D.A. considers MDMA one component of a “breakthrough therapy” for the treatment of P.T.S.D., and could soon consider an application for its prescription use during therapy sessions. Such a development would force us to change our idea of the drug. Many people still think of MDMA as a chemical that makes you feel good when you go out dancing all night long. But what if its greatest power is an ability to inspire empathetic conversations? The meaning of MDMA is changing. What kind of a drug is it going to be?
MDMA takes its name from its chemical formula: 3,4-methylenedioxymethamphetamine. In “I Feel Love: MDMA and the Quest for Connection in a Fractured World,” a new book on the history and resurgence of the drug, the journalist Rachel Nuwer writes that it was first synthesized in the U.S. in 1965, by Alexander Shulgin, a gifted chemist at Dow Chemical. Shulgin, who taught at the University of California, Berkeley, and consulted for the Drug Enforcement Administration (D.E.A.), was part of a community of psychedelic enthusiasts who “tended to think of MDMA as a cherished and respected medicine,” Nuwer writes—“something to assist with transcendence, growth, and healing.” The drug became popular among therapists of a countercultural bent, who administered it to patients and sometimes took it themselves. But, as others began to synthesize and share it, Shulgin feared that it would become known as a recreational drug and the D.E.A. would criminalize it.
MDMA’s reach grew in the early eighties, when a former Catholic priest named Michael Clegg introduced it to the Dallas club scene. It proved successful enough there that, one day, he visited Bob McMillen, who had been a major marijuana distributor in California. He told McMillen that he had been using a drug that was going to be a big deal, and he wanted to sell it on the West Coast. Clegg even had a name for the molecule: Therapy. After some cajoling, McMillen agreed to sample it. He put on an album by the New Age instrumentalist Deuter and sat on his couch, under a sheet. “I floated off in a wonderful euphoria,” he later recalled. “Then I threw the sheet off, sat up and said, ‘Sold! How much can I get?’ ” But McMillen insisted on a rebrand: Therapy was too corny a name to move any product. He chose the name of the Deuter album, and in four days he sold five thousand units of Ecstasy.
MDMA was gaining a sort of split personality, as a potentially therapeutic chemical on the one hand and as pleasure in pill form on the other. Shulgin hated the name Ecstasy; when Nuwer visited his widow, she called it “penicillin for the soul.” On the party scene, however, it was becoming commonplace for clubbers to go to a bartender and order “a beer and an Ecstasy,” one of Nuwer’s sources recalls. Users didn’t necessarily know what they were getting: Ecstasy is often cut with other drugs, such as fentanyl. In part for this reason, in 1985, the D.E.A. named MDMA a Schedule 1 controlled substance—a classification reserved for drugs “with no currently accepted medical use and a high potential for abuse.”
In the decades that followed, a research and advocacy organization, the Multidisciplinary Association for Psychedelic Studies, or MAPS, tried to make psychedelics acceptable and accessible to the public. But not until the two-thousands did studies of MDMA’s therapeutic potential start to gain wider traction. In a Phase 2 clinical trial started in 2004, a hundred and seven people with a P.T.S.D. diagnosis received several weeks of talk therapy; during two of the sessions, about a month apart, participants received either MDMA or a placebo. When the study concluded, fifty-six per cent of those given MDMA and therapy no longer met the diagnostic criteria for the disorder, more than twice as many as those in the placebo group. One downside of such studies is their small size; another is that they do not test MDMA without therapy, making it difficult to disentangle the impacts of the drug from the sessions.
Nuwer argues that the effort to recontextualize MDMA as a treatment for trauma is both “the latest installment in a long history of hype that’s surrounded this unique molecule” and a return to the drug’s roots. “The pendulum is swinging back to where MDMA began,” she writes. Recently, an Australian law made MDMA and psilocybin, the compound in psychedelic mushrooms, available by prescription; an Australian biotech company raised $2.5 million to develop a program for psychiatrists to provide MDMA during therapy. In 2021, a psychiatrist associated with MAPS, Michael Mithoefer, published a Phase 3 trial—the first late-stage clinical trial involving MDMA—with promising results for patients with severe P.T.S.D. Now that Mithoefer and his colleagues have completed an additional Phase 3 trial, his team plans to submit an application for prescription use to the F.D.A. Nuwer writes that some psychiatrists are skeptical about whether the drug is ready for “widespread clinical use,” but many experts think that it could be approved as soon as this year.
We’re used to thinking of psychiatric medications as working separately from therapy, with the former making physiological changes to brain chemistry and the latter helping patients understand their emotions, adjust their thinking patterns, or change behavior. But MDMA doesn’t fit that model of psychiatric medication; it’s fundamentally different from the drugs that currently treat depression or anxiety. No one is suggesting that patients take MDMA every day, like Wellbutrin, or as needed to combat acute distress, like Xanax. Instead, MDMA is a drug that one might take in combination with therapy, during sessions—less a treatment than a treatment enhancer.
The exact mechanisms through which MDMA works are not well understood. During the last four decades, most research on the drug has focussed on whether it damages the brain; studies are ongoing, and Nuwer’s expert sources are convinced that it doesn’t—although, she writes, it is clear that “high, repeated doses can inflict major changes” on the serotonin systems of lab animals. One of Nuwer’s important contributions is dissecting two seriously flawed studies of MDMA that have been corrected in the scientific literature but have nonetheless shaped public opinion. In one, researchers mistakenly administered methamphetamine to subjects, yet reported the results as coming from MDMA.
Gül Dölen, a researcher at Johns Hopkins, has found that MDMA and other psychedelics reopen what neuroscientists call a “critical period” in the brain—windows of time, mostly occurring during childhood and puberty, during which neural connections can change and reorganize. It’s unknown whether this has anything to do with the feelings of empathy and social connection associated with the drug. Dölen points out that individuals receiving MDMA-assisted therapy need to be treated with particular care, not just during their sessions but afterward; even after the drug’s acute effects have worn off, patients will “continue to exhibit heightened sensitivity, malleability and vulnerability during the open state.” (One woman who had participated in a MAPS-sponsored trial, in Canada, continued treatment with two therapists who had conducted the trial; she later accused one of them of sexual assault during sessions. He claimed in legal filings that the relationship was consensual; MAPS cut ties with both therapists.)
If the F.D.A. approves MDMA for use during therapy, this will represent an unprecedented development both for psychedelic drugs and for therapy. A substance that has long been associated with parties could be mainstreamed and medicalized; many more people might try a new category of mental-health care, which could come with new kinds of risks. There could come a day when MDMA is associated less with feeling good than with trying to get better. As patients in Mithoefer’s studies have told him, “I don’t know why they call this Ecstasy.”
In the late nineteen-nineties, a psychiatrist named Charles Grob published a study showing that MDMA could be safely administered in a medical setting. His researchers administered the drug at a hospital to volunteers who, per the F.D.A.’s requirements, had prior experience taking it. The only person who had a problem with the tests, he reported, was the head nurse. She was annoyed that her nurses were neglecting their duties, instead choosing to spend time with the study participants. “The subjects were so empathetic and interested in the lives of the nurses,” Grob wrote, that the nurses gravitated to them, eager to talk. One of the peculiarities of MDMA is that it turns its users into listeners. Back in college, during our “session” with John, it was our MDMA-heightened empathy that helped the conversation along. John didn’t need to take drugs to benefit from its effects; he just walked into the room.
Nuwer writes that, when she tried MDMA for the first time, at a warehouse party in Brooklyn, she was worried that the drug would cause her to “spontaneously start making out with everyone.” But the sexiness associated with MDMA might not be one of its intrinsic properties; instead, the drug might work more broadly to deepen our interest in others. Therapy is a social pursuit: a good therapist provides not just insight and tools but a relationship in which it’s possible to change. When someone takes MDMA in the presence of a therapist, they might feel more supported and secure in this bond, and more able to dredge up painful feelings or hard memories without being overwhelmed by fear or shame. When I took it, I felt my bond with John a little more powerfully.
It could be that MDMA simply intensifies something that’s already present in successful therapy. Therapy helps, in part, because human connection is good for us. It matters when someone listens to you, and when you listen. Recently, I reached out to John to ask him how he recalled our encounter in the dorm bathroom. On the phone, our old rapport quickly reëstablished itself; the longer we talked, the better I felt. When I asked about that day, he laughed and told me that he remembered our conversation as a soothing one. But he never suspected that we were on MDMA. “You guys were my friends,” he recalled. “I knew you were empathetic people.” That had been enough. ♦