April 13, 2011
That Lovin’ Feeling
By: Lauren Slater
ELLE magazine reviews the origins of MDMA’s therapeutic uses in marriage and family therapy and specifically discusses MAPS’ role in helping psychedelic therapy return to mainstream medicine. The article includes an earnest and in-depth interview with MAPS Founder and Executive Director Rick Doblin, Ph.D., and discusses why—despite the possibility that MDMA-assisted therapy could help couples reestablish lost connections—MAPS has chosen to focus on helping individuals overcome their traumatic pasts.
Originally appearing at http://www.elle.com/Beauty/Health-Fitness/That-Lovin-Feeling.
It’s a truism that conflict, boredom, and domestic responsibilities corrode relationships over time, but what if a popular ’80s club drug were taken out of the raves and put into the clinic? What if therapists could use it to bring disaffected couples together again?
Now that she’s gone, he can’t recall what it is they fought about. He can recall her face, and how it aged each day at the end. He can recall her furze of curls and shard-sharp intelligence and how generous she was, with almost everyone. “Toward the end,” he said, “she recommended certain women I might match well with, women to go out with once she’d died.”
Richard Vaughn, now 66 years old, has been a widower for 18 months. He was married to Annie Levy for 10 years, a stable marriage by all accounts: two people passionate about Buddhism and good food, two people who liked fine wine and excellent books, reading them in bed, the pillows propped up behind them. She was a neuropsychologist, he a lawyer, eminently eligible but unmarried until, at 54, he fell in love with Annie. “When I met Annie, it had been a long time since I had a successful relationship,” Richard says; “you’d think this one was bound to fail.” But it didn’t, and Richard and Annie became a couple in love with their work and each other, not in that order.
Then came the night Annie asked her husband to feel a little lump in her abdomen. “Get seen for that, why don’t you?” he’d suggested, unworried. Everything was going so well, and the presence of this one modest mogul did not suggest to him that the castle was coming down. But before Richard knew it, his wife was having a tumor removed from her ovaries. It turned out to be malignant and aggressive, spitting out cells that adapted lickety-split to almost every chemical concoction the doctors tried to douse it with. Still, it was not for seven years—in mid-2009, after the cancer had spread through Annie’s body—that doctors said there was nothing else they could do.
When a husband or wife is dying, one might assume that a couple’s disagreements melt away, replaced by a melancholy kindness in matters large and small, but that isn’t as common as we’d wish, and it isn’t what happened for Richard and Annie. When Annie had no options left, she and Richard started to argue, or “squabble,” to use his word. Each of them focused on minutiae—an effort to ward off the hugeness hurtling their way? Perhaps, but that’s just a guess. Richard says he doesn’t know why he and Annie fought so much at the end of her life. All he knows is that they did: You and you, and where are the car keys, and you forgot to take out the trash, and you and you—pointing with fingers and voices and eyes, their relationship all rasp, no silken spot to rest your head.
The situation was made worse by the fact that Annie felt like her Buddhist faith was crumbling, eaten up by the anxiety inherent in dealing with a terminal diagnosis as well as the side effects of the treatments—nausea, sores on her tongue and gums, pain everywhere; she didn’t want to die. She looked over the ledge and saw the unfathomable and couldn’t find a thing to clutch. Thus, when she heard about a pilot study at the Harbor-UCLA Medical Center in Los Angeles designed to test the safety of synthetic psilocybin (an ingredient in the drug mushrooms) to mitigate what the researchers called the “existential anxiety and despair” of advanced-stage cancer, she signed up. Annie, like the 11 other people in the study, led by Charles Grob, MD, a professor of psychiatry and pediatrics at the UCLA School of Medicine, was admitted to the hospital on a Friday evening for a physical exam, then on Saturday given the psilocybin in capsule form. For the next six to eight hours, with Grob and his research coordinator Alicia Danforth at her side, she lay in bed, listening to music through headphones and wearing an eye mask to help her focus on her inner thoughts. Afterward, Annie talked through her encounter—“integrated it,” Grob says—and then in follow-up appointments explored the feelings, thoughts, and “psychospiritual” content of her psilocybin experience, as well as had her mood and anxiety levels measured. Although the study was too small to be definitive, Grob and his colleagues reported in the January 2011 Archives of General Psychiatry that the subjects overall showed a significant reduction in anxiety, at one and three months post-treatment, without suffering any physical or mental harm.
Psilocybin, needless to say, is not your average antianxiety med. More generally labeled a psychedelic, it amplifies the sensual world so music might sound deeper, more dimensional; touch might tingle or come in colors; ordinary thoughts might drop away. In their place, some say, come fresh insights, understandings, questions—the user emerging with a new view of what is, after all, an old, old world.
Psychedelics have been ingested for centuries by people seeking spiritual enlightenment and emotional escape, but in the 1960s and 1970s they became welded in the public mind to the counterculture. “Turn on, tune in, drop out,” as Timothy Leary, LSD’s most fervent promoter, famously put it. According to the first National Household Survey on Drug Abuse, 5 percent of 12- to 17-year-olds had tried psychedelics in 1972. Seven years later, the lifetime prevalence of psychedelic use was up to 25 percent among people ages 18 to 25—a spike accompanied by high-profile stories about famous people (or famous people’s children) who’d died or been harmed by so-called bad trips. Against this backdrop—and with Richard Nixon and his “silent majority” decrying the hippies, their drugs, and their protests—the Bureau of Narcotics and Dangerous Drugs, the precursor to the Drug Enforcement Administration, classified psilocybin as a Schedule I drug in 1970. Like LSD, it was considered to have no known medical use and a high potential for abuse, and its possession and sale were criminalized.
Since then, psychedelics have hovered on the margins of Western society, alongside tie-dye and love beads and Jerry Garcia strumming stoned on a stage. “Leary didn’t do psychedelics any favor when he made them agents of rebellion,” says Rick Doblin, the executive director of the Multidisciplinary Association for Psychedelic Studies, a nonprofit based in Santa Cruz, California, that develops and funds clinical trials of psychedelics to treat conditions that have proven resistant to traditional drug treatments. “There was a sort of arrogance to Leary’s stance. He was telling people to sever themselves from society, to go form communes, to go back to the land. It was a rejection of the dominant culture in the extreme. Leary promoted no sense of ‘Hey, we’re all in this together. We’re all a part of the system and therefore need to work together.’”
While “the dominant culture” may continue to be dubious of psychedelics, the medical community is undergoing somewhat of a revolution. Researchers from South Carolina to Southern California to Switzerland to Sweden are investigating the drugs for their potential to alleviate everything from the aforementioned death-related anxiety to cluster headaches to addiction and post-traumatic stress disorder. Perhaps more fascinating still, there is budding interest in psychedelics—particularly the newer MDMA, or Ecstasy—for use as “empathogens,” compounds that induce enhanced states of love and acceptance, along with an increased ability to focus and listen.
John Halpern, MD, director of the Laboratory for Integrative Psychiatry at McLean Hospital in Massachusetts, is one of MDMA’s cautious enthusiasts. “Delic,” he announces, typing the letters into his computer, “comes from the Greek roots of d-eloun, ‘to show’ and d-elos, ‘evident.’ That’s what these drugs do. They reveal people to each other; they increase awareness of the signals others are sending.” Halpern wants to study high-functioning autistics who use MDMA to help connect to the “neurotypical” world. Based on preliminary discussions with autistic people he’s met online, he says he hopes to get grants “to conduct high-quality medical research that will test what we hear anecdotally—that psychedelics in general and MDMA in particular could be made into medicines to treat a whole range of conditions, from distinct diseases to the ‘shadow syndromes,’ like extreme shyness.” Another potential arena for application: couples therapy, since marital discord, Halpern points out, is often rooted in “impaired connection.”
Annie Levy probably wouldn’t have been surprised by this. Sadly, she died in September 2009, a year after the psilocybin study ended, but the impact the hallucinogen had on her gives a snapshot of how certain psychedelics can both improve and intensify some relationships, according to her husband and to researcher Danforth, a PhD student in clinical psychology. Prior to the study, Annie and Richard had become alienated and demoralized by their constant bickering. “I remember driving down there in the car,” Richard says, “and the whole way we were arguing. I dropped her off at the center and made plans to pick her up the next morning, so we said goodbye, and I wasn’t particularly expecting anything big to come out of this, but when I returned the next day I was shocked. Shocked. I had never seen Annie look so radiant as she looked after she’d taken the psilocybin.” According to Richard, the drug was able to help his wife stay in the here and now rather than get lost in her anxious thoughts; it also allowed her to understand on a very visceral level that the fighting in their marriage was a circle she could step out of, in part by not “taking the bait” and in part by seeing her husband’s pain and responding with compassion instead of anger. “There is no question that the psilocybin allowed us to improve our relationship and the time we had left together,” he concludes.
“What these empathogens do,” explains Julie Holland, a New York University School of Medicine assistant professor of psychiatry, “is cut through the tit for tat and take a person, or a couple, to the heart of the matter.” Holland, who specializes in psychopharmacology, is the editor of an anthology called Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA, which includes articles about everything from the biochemistry of the drug to therapeutic and spiritual applications.
As for the risks, Holland, who ran the psychiatric ER at New York’s Bellevue Hospital on weekends from 1996 to 2005, says they’re mainly related to taking too much, for too long—and the fact that people don’t know what they’re getting because MDMA is illegal and its production unregulated. The drug can cause overheating, and heat stroke was a problem for the ravers of the 1980s, whose all-night dance parties made Ecstasy famous. Another rare but potentially fatal hazard is so-called water intoxication; because MDMA increases levels of an antidiuretic hormone called vasopressin, drinking too much water may lead to tissue swelling and a potentially fatal electrolyte imbalance.
These risks fall away, however, Holland says, when Ecstasy is taken under what she calls “the medical model of MDMA-assisted psychotherapy”—and she’s hoping to someday study its effectiveness for treating schizophrenics. George Greer, a psychiatrist who’s used MDMA in his practice, had this to say in Holland’s book: “Once you’ve used MDMA in psychotherapy, it’s like being an artist who’s only painted in charcoal and then one day finds oil colors and realizes everything that’s available to him, only to have the oil colors taken away because people started sniffing them.”
MDMA was first created in the early 1900s by the German pharmaceutical company Merck, then quickly put on a shelf. Merck’s scientists had no idea what they’d created; they’d been searching for a medication to reduce bleeding. MDMA popped up briefly again in the 1950s when the CIA, interested in its potential as a truth serum, tested its safety on animals. It was not until the early to mid-1970s that the drug began to seep into the culture at large, which is when legendary Californian psychedelic chemist Alexander “Sasha” Shulgin cooked up a batch and tried it himself at gradually higher doses. In his September 1976 lab notes, Shulgin wrote: “I feel absolutely clean inside, and there is nothing but pure euphoria. I have never felt so great or believed this to be possible. The cleanliness, clarity, and marvelous feeling of solid inner strength continued throughout the rest of the day and evening. I am overcome by the profundity of the experience.” A handful of therapists also caught on to the drug and, because it had not yet been criminalized, some began using it with patients. Now-deceased Oakland, California, psychotherapist Leo Zeff, PhD, was one of them. On MDMA, he claimed, patients were able to retrieve otherwise inaccessible memories, some of them traumatic, and explore them in a state of serenity. In addition, he told of previously self-hating patients who became self-accepting and, if only for a short time, had the chance to see the world without the serrated edge of cynicism that often accompanies neurotic suffering.
Zeff also used Ecstasy in couples therapy, as did Ann Shulgin, the wife of chemist Alexander and joint author with him of the 1991 book Pihkal: A Chemical Love Story (Pihkal is an acronym for “Phenethylamines I Have Known and Loved,” phenethylamines being the drug family containing MDMA). Zeff and Shulgin contended that MDMA had the power to restore vibrancy and energy to fraying pair-bonds, even after the drug had worn off.
That’s the $10 million question, after all: Can chemically stoked love last? The information collected so far is obviously scarce and based largely on case histories, but it’s tantalizing. I myself briefly corresponded with an autistic man online who told me, simply and gratefully, “MDMA shattered my shell.” Another man with autism told Halpern that while taking Ecstasy he can appreciate and respect others’ feelings, and then afterward remember what he learned and more or less “fake it till he makes it.”
If it were the late 1970s or early 1980s, people with autism or Asperger’s syndrome would be able to get MDMA legally, although there’d be no guarantee that what they were buying wasn’t cut with other drugs. Back then, MDMA was part of a new wave of psychedelics unregulated by the government. You could get it in a nightclub and charge it on your AmEx card, or trot down to your corner grocery store and pay a modest sum for a vial of white powder labeled “Sassafras.” (MDMA is derived from the sassafras tree.) Recipes were cooked up in Texas and Boston, and for the chemical chefs, business was good, even great, their main concern being coming up with a marketable name for the stuff. Its original name was Adam, based on its Edenic properties, but that seemed too biblical, and MDMA, the chemical shorthand, too sterile. An entrepreneur who funded one of the largest MDMA operations in Texas suggested Empathy, but ultimately chose Ecstasy—because what’s better than that?
The name is, of course, not the sole reason Ecstasy caught the attention of police, politicians, and distressed doctors—who were seeing the rave-related medical consequences cited by Holland—though it’s hard to imagine a more provocative one. Spurred in part by the complaints of powerful Texas senator Lloyd Bentsen, who was concerned about the huge raves in his state, as well as by a paper by then PhD pharmacology student George Ricaurte suggesting that MDMA caused neurotoxicity in rats, the DEA gave Ecstasy a Schedule I classification in 1985 and it became, like psilocybin, an illegal drug. Rick Doblin, who was already lobbying on psychedelics’ behalf, challenged the rating in the DEA’s administrative court, arguing, among other things, that Ricaurte’s model for interpreting the data was wrong because humans and rats metabolized MDMA differently, and that MDMA has a low potential for addiction.
Then as now, Doblin was not vying to keep the drug available to clubbers; what he wanted, and still wants, is to see MDMA scheduled such that it can be used as a prescription medicine. Doblin won the battle but lost the war. While the judge recommended that MDMA be classified as Schedule III, with other controlled medications such as Vicodin, the DEA rejected that advice. MDMA would remain Schedule I.
More than two decades later, Ricaurte was still warning of the perils of MDMA and in 2002 published the most alarming paper of his career. In the prestigious journal Science, he reported that he’d fed recreational doses of the drug to 10 primates, and two had dropped dead. Accompanying the data were ghostly black-and-white images of primate brains post-MDMA, with huge ragged holes ripped in them—the damage so obvious and horrid that Oprah put Ricaurte on her show to testify to Ecstasy’s dangers. “It didn’t make any sense,” Doblin recalls. “We’d seen thousands of people safely use MDMA, sometimes as many as 40 times.”
Adds Holland, “There was nothing about the Ricaurte study that seemed plausible. Based on everything I’d seen and on the published data, MDMA just isn’t a significant cause of psychiatric crisis.”
But this time, the MDMA proponents came out on top. A year after publishing Ricaurte’s article, Science had to run a retraction because it was discovered that, incredibly, the researcher had given his monkeys not MDMA but methamphetamine, or crystal meth. (The problem, Ricaurte said, was that his supplier mislabeled some of the drug’s bottles.)
In any event, just months after the retraction was published, the DEA gave Doblin and South Carolina psychiatrist Michael Mithoefer the final go-ahead to administer MDMA to treatment-resistant PTSD patients, the theory being that while taking the drug, they’d be able to retrieve terrifying memories without feeling terror, effectively disentwining the memory from the dark emotions that saturated it. As reported in The Journal of Psychopharmacology last year, Mithoefer et al. used a double-blind design in which 12 patients were given MDMA and psychotherapy, while eight got a placebo and psychotherapy. The subjects took a standard test known as the Clinician-Administered PTSD Scale (CAPS) four days after each of two MDMA sessions, then again at two months. In the placebo group, only two of eight participants had a significantly lowered CAPS score, whereas 10 of 12 MDMA takers did. All of them maintained their progress at the two-month follow-up—and were so improved that none of them met the criteria for PTSD. In the second phase of the study, the researchers allowed seven subjects (six of whom had failed to respond to the placebo and one of whom had relapsed) to take MDMA. This time, 100 percent showed significant progress, and in what Mithoefer called “an unplanned observation,” the three subjects whose PTSD had left them unable to hold down a job were able to return to work.
Neither my husband nor I have PTSD, but we’re both deeply curious about whether MDMA could help us as it helped Annie and Richard, or the couples in therapist Leo Zeff’s care. A tablet of Ecstasy is so much cheaper and faster than taking the two-month vacation Ben and I would otherwise need to find our way back to the long-lost—but not completely forgotten—love we once had for each other, a love I see as a salve for the world-weary, financially strapped parents we’ve become. Yes, I think we’re perfect candidates for a blind date with an empathogen, which might thrust us back into a past still glimmering but fading fast; I see snow, merlot in a glass goblet, our wedding night in dark December, the trees, their candelabra branches slicked with silver ice.
But how to go about this, to make, so to speak, “the arrangements”? My husband suggests “scoring” some on our own, but I’m scared of getting something off the street. Instead, I approach Doblin. “Where is the MDMA, anyway?” I ask. “When the DEA gives you permission to do a study, where do you get the drug if it’s illegal?”
Doblin explains that the DEA sends you the MDMA once you’ve submitted an acceptable storage plan and, of course, gotten approval from the FDA and an institutional review board to study it. He himself gets it from a university in the north, he says.
“You can’t reveal where it’s actually stored?” I ask. “I’d rather not,” he replies. Then there’s an awkward pause in the conversation, and I feel my face beginning to burn. “Would you,” I ask, “consider getting some for my husband and me to try?” I feel loopy inside. Think about drugs too much and you start to act like you’re on them. Drugged and dopey and inappropriate.
Doblin and I are sitting on the roof deck of his home in Belmont, Massachusetts. It’s one of those gorgeous days in early autumn, before the trees have turned and the air has cooled, the greenery lush and verdant. Somewhere a dog is barking. I hear music from the house next door. Before Doblin can answer, I say, “I’m on other medications, like Effexor, for depression.”
“You can’t take MDMA with an SSRI,” Doblin says, explaining that SSRIs mute its effectiveness, but I’m not really listening. I’m hearing, instead, the radio and the staccato barks of the dog, and then there’s the disappointment I feel in Doblin—that despite all the various and significant ways MDMA might be able to help people to connect, he and his organization are going to pursue only one use right now. I’m thinking about something Doblin said a while ago, about how PTSD victims—war veterans, rape survivors—make MDMA seem like a serious, even patriotic drug, whereas couples counseling contains echoes of hippiedom.
“Marriage can’t be conceived of as a disease,” Doblin says to me now, “so how could we devise a study if there’s no discrete set of symptoms to increase, decrease, or stabilize?” Beyond that, he says, “couples counseling just doesn’t carry the importance, in the public’s eye, and we need to think a lot about the public…and that eye.”
Even as I understand the need for such pragmatic strategizing, I disagree that marital treatment either is or risks being perceived as some sort of floppy endeavor that can’t be quantified. For one thing, there are scientifically validated scales that measure marital distress and satisfaction. “I’ll get you a good measurement device,” I tell Doblin, “and if I can’t find one you like, I’ll make one.” He laughs.
The sun is slowly sinking as we speak, inching down bit by bit, so slowly you can’t even see it and won’t notice it until, suddenly, there are shadows everywhere and it’s evening—just like that. This is how many marriages devolve as well, the shine waning so subtly no one notices until one day, in year 12 of your sanctified union, you can’t rinse the stale taste out of your mouth, and when you try to trace the path that got you here, all you see are seemingly festive landmarks: babies born, first day of kindergarten, etc. I don’t want to argue the case that divorce is a disease or that a failing marriage is the same as a sickness. That is a subject that goes, as the scientists say, beyond the scope of this paper.
But what I can say swiftly and with ease is that divorce, even if not an actual illness, leaves a trail littered with symptoms and syndromes—the depression, for instance, that can come when a pair dissolves, the “generalized anxiety disorder” or “adjustment disorders” that at times afflict children whose parents break up. I would have no trouble arguing that repairing frayed and friable marriages is a noble goal, that there’s nothing remotely “trippy” about it. Why Doblin believes he can’t package that for the public is somewhat of a mystery to me, though that said, as a longtime beneficiary of a panoply of psychiatric meds, I’m definitely a woman who embraces better living through chemistry.
“Do you think,” I ask Julie Holland a few days later, “that MDMA could save the American marriage?” Now Holland is laughing too. She’s already on record as wanting to investigate how MDMA might be used to treat schizophrenia: the catatonia, the blankness. “I don’t know,” she says.
“I’d like to try it,” I say, and as soon as the words are out of my mouth, I realize I probably will. One way or another, I can find a way to get pure MDMA, so I’d be taking it safely, and then I wonder what “safely” really means. Is there a truly safe way of taking a substance that promises to pull back the curtain that comprises your reality, giving you a chance to stare through to the other side and all that lives there?
When I think about it once, MDMA seems like an excellent tool to help couples rekindle the lost sparks and burning embers of their early days, but when I think about it twice, it strikes me that the psychedelic might reveal something I’d rather not know, some secret I haven’t yet told myself. Perhaps, in some distant part of my mind, I don’t want to be married at all. Perhaps I yearn for the freedoms of my younger years, and what I want is to toss all my burdens overboard and reclaim for myself the fierce, clear reverie from which the finest writing springs. Could it be true? I doubt it, but that smidgen of possibility reminds me that when you take a psychedelic, you’re agreeing to open up an envelope and read what’s written inside. I have two children I adore, a husband I care for deeply, and stories I find the time to write in my less than perfect circumstances. My boat is paint-peeled and pierced, for sure, but I’m reluctant—no, unwilling, at least for now—to rock the ricketiness I love.
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