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June 28, 2011

MDMA Recognized as Most Promising Treatment of PTSD

By: Ralph Metzner, Ph.D.

Ralph Metzner's Blog

Psychologist and veteran psychedelic researcher Ralph Metzner, Ph.D., who worked with TImothy Leary and Richard Alpert on the original Harvard Psilocybin Project has a few things to say about the status of MDMA research. In this blog post, Metzner writes about why MDMA is such a promising treatment for PTSD, how it’s both similar to and different from the other “classical” psychedelics like LSD and psilocybin, and how MAPS’ research are paving the way for a new era of mainstream psychedelic science.


Originally appearing at http://ralphmetznerblog.com/2011/06/28/mdma-recognized-as-most-promising-treatment-of-ptsd/.

In the 1980s, before it was made illegal, MDMA (which later became popularized as the rave drug Ecstasy) acquired a reputation among psychotherapists as being one of the most effective, fast and safe ways of helping people heal from severe trauma, as well as opening up interpersonal communication in couples. I was one of a couple of dozen therapists who were initiated into this healing modality by the late Leo Zeff, whose work has been described in the book The Secret Chief, by Myron Stolaroff, available from the MAPS website. A useful compilation of essays on MDMA research and applications is Ecstasy: The Complete Guide, by Julie Holland MD.

Unlike most psychiatric drugs, such as anti-depressants or sedatives, but like other psychedelic drugs, such as LSD and psilocybin, the use of MDMA as an adjunct to therapy requires an experienced guide and a protective setting for its benefits to be realized.  Also like these other drugs, this first and ideal use in individual or small group settings, with a healing and spiritual orientation,  did not prevent the spread of MDMA into the street-drug culture – where it morphed into Ecstasy, consumed by thousands at rave clubs and gatherings around the world.

Unlike the classical psychedelics however, MDMA is distinctive in that the main effect is a heightening of positive interpersonal feeling awareness, or empathy, with a reduction of fear, while perception is not altered at all and there are no hallucinations or visual distortions.  As one client of mine observed when first experiencing this, “everything looks just the same, but I feel completely differently about it.”  That’s why I suggested the term empathogenic – generating a state of empathy – for this class of substances (though some European researchers prefer to use the term entactogen).

In my book MindSpace and TimeStream, I speculate about the possible neurochemical basis of the MDMA effect.

“In the case of MDMA, for which I coined the term empathogenic (“empathy-generating”) in its subjective effects, the serotonin enhancing effect may be the basis of the calm, non-anxious, emotional balance that is particularly valuable in the therapeutic treatment of interpersonal conflict, trauma and PTSD. The dopamine releasing effect, which the other amphetamines also have, probably accounts for its role as Ecstasy, the drug of choice at hours-long dance parties with pulsing music, known as “raves.”  In addition, the presence of MDMA in the body triggers the release of prolactin – the hormone released during mother-infant bonding and breast-feeding – perhaps the paradigmatic example of empathic, non-striving, relaxed empathic mergence of two beings.” (page 134)

In my 1985 book Through the Gateway of the Heart, which is now out of print (though copies maybe available from some libraries), I collected accounts of therapeutic experiences with MDMA (and other empathogenic substances) and offered guidelines for its use in that context. I concluded then and still believe that, because of the reduction of fear (which can be greatly magnified with the classical psychedelics), the three most promising applications of MDMA in psychotherapy would be (1) in heightening empathic communication – e.g. in couples relationships; (2) in the training of psychotherapists, for whom conscious empathic understanding (not unconscious sympathy, and not mere verbal expressions of understanding) is core to the process; and (3) in the treatment of trauma (PTSD), where the person is locked into a limbic system emotional stress reaction that can be triggered by a chance stimulus.

Officially sanctioned research on using MDMA in the treatment of war trauma has recently been gaining some attention. The MAPS organization has sponsored the research of Michael Mithoefer, MD who is conducting protocol studies on the use of MDMA with veterans.

According to some estimates there are something like 350,000 US veterans suffering from wars in Vietnam, Iraq and Afghanistan. The suicide rate among returning veterans is disturbingly high (as much as 15 per week, according to some reports). The only approved treatments, psychotherapy with anti-depressant drugs like Prozac, provide maintenance only at best, while underlying trauma patterns are not resolved or healed.

MAPS and Mithoefer’s major breakthrough showed that over 80 percent of the subjects in the MDMA group no longer qualified for a diagnosis of PTSD, as compared to 25 percent in the placebo group,” he told AlterNet. ”An even more important breakthrough, which we are currently working to write up in a scientific paper, is from the results of our long-term follow-up evaluations of the subjects, administered at an average of 41 months post-treatment. We found that, on average, the subjects have actually gotten a bit better over time, demonstrating that MDMA-assisted psychotherapy has lasting benefits.”

In the 1980s, before MDMA was illegalized, I did a successful one-session MDMA therapy with a traumatized vet from Vietnam, who went on to found a group called Veterans for Peace, which conducted educational sessions in LA area high schools, informing potential recruits for America’s war system of the real personal costs of war.

This story was recently written up in the form of a dialog and published in the MAPS Bulletin: From Traumatized Vet to Peacemaker Activist by Ed Ellis and Ralph Metzner (maps bulletin, vol XXI, No. 1)

Sad to say, officially VA-approved PTSD-MDMA treatments are still a long way away, despite the promising research. As Rick Doblin writes:

“We’ve been trying for 15 years to motivate the VA to explore MDMA-assisted psychotherapy for PTSD in veterans, and this was the first time we were told the research is important and somebody, but not the VA at this time, should be doing it. Such is the progress in our field!”

While discussing this depressing situation recently with a friend and colleague familiar with the drug culture in both Israel and the US, he informed me that the news that MDMA (or Ecstasy) can be demonstrably helpful in dealing with war trauma has permeated the culture to such a degree that veterans familiar with the drug have, on their own initiative, started to provide self-help empathogenic therapy for their comrades. This was news that gladdened my heart and gave me hope!


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