by Don Lattin, originally published on californiamag.org
Writer Ayelet Waldman was teaching a class on drug policy reform at UC Berkeley when she and her husband, the popular novelist Michael Chabon, decided that MDMA, the illegal party drug fueling those all-night raves, might also be a medicine that could save their marriage. They got the idea after Alexander “Sasha” Shulgin, the psychedelic chemist and so-called “godfather of ecstasy,” spoke to her class.
That was about a decade ago. Since then, the couple have gone off once every few years for two-night getaways on the California coast, something Waldman calls “our marriage-recharging ritual.”
“We get up, go for a hike, and when we’re on our way back, about a half-hour from the hotel, we take the pills,” said Waldman, a former federal court public defender. “Then, for the next six hours, we talk about our relationship. When I tell my women friends about this, they softly say, ‘Yes.’ The men all go ‘Noooo!!!’”
Chabon, the bestselling author of such books as Telegraph Avenue and Moonglow, declined to sit down with us and talk about this, even for six minutes, when I interviewed his wife around the kitchen table in their Craftsman brown-shingle in Berkeley’s Elmwood neighborhood. Michael appeared at the end of the interview, politely shaking my hand, saying “hello” and “goodbye” while ushering me out the front door.
Waldman, on the other hand, was eager to discuss her illegal psychedelic drug routines, in part because she’s just out with a new book titled A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life. Most of the book is about how this irrepressible mother-of-four took minuscule, sub-perceptual doses of LSD in an attempt to quiet her mood swings and focus her mind.
Michael did not join Ayelet in that month-long acid test. But both of them, she says, have benefited from their occasional, regular-dosing sessions with MDMA, a compound that “allows us to delve into incredibly painful things, but with love and compassion.”
MDMA was back in the news recently because of positive results from government-approved, privately-funded clinical drug trials that legally used the as a tool in psychotherapy sessions for patients suffering from Post Traumatic Stress Disorder, including U.S. veterans of the Afghan and Iraq wars.
While that is news, couples have been using this drug, with or without a therapist, legally and illegally, for decades.
Adjusting the legal status of MDMA to routinely treat PTSD could open the door for doctors to prescribe the drug as an off-label psychotherapy tool to treat depression, anxiety and marital problems. Unsupervised recreational use would still be illegal.
First, a little history about MDMA, chemically known as methylenedioxymethamphetamine:
In 1985, the federal government banned MDMA amid an early wave of young people using the compound as a party drug to fuel raves, all-night dance parties that would nevertheless continue to grow in the 1990s with hundreds and sometimes thousands of celebrants packed into private warehouses and public auditoriums. There were a number of deaths at these events, sometimes resulting from people dancing all night and not drinking enough water, or by combining MDMA with alcohol and other drugs.
Despite anecdotal evidence of its medical benefits as a therapeutic tool, the drug was classified as a Schedule 1 substance, meaning the federal government had concluded that MDMA was easily abused and without medical value. (Under the strange disconnect between state and federal drug laws, marijuana is still a banned Schedule 1 substance by the feds, even though it is now legal for recreational and/or medical use in many states, including California. Cocaine, on the other hand, is not a Schedule 1 drug, meaning it can be used for medical purposes).
Earlier, in the late 1970s and early 1980s, a growing number of psychotherapists began quietly using MDMA, then called “ADAM,” as a therapeutic tool for individuals and couples. After the 1985 ban, some of these therapists kept doing this work in a psychedelic-assisted psychotherapy underground, risking criminal action and the loss of their professional licenses.
“It’s not always pretty, but it’s alive. Seeing the other partner express fears can create more honesty in the relationship, and more intimacy.”
One longtime underground psychedelic therapist, who for obvious reasons asked to remain anonymous, told me she has safely and effectively used MDMA with dozens of couples. In an interview in her cozy San Francisco office, she explained how the drug can make her clients less defensive and less likely to project past traumas onto their partners.
“It’s not always sweet and schmoozy,” she said. “They often have difficult issues and come to me to look at the dynamics of their relationship. Who has the power? Who wants sex more than the other? Should they separate? It’s not always pretty, but it’s alive. Seeing the other partner express fears can create more honesty in the relationship, and more intimacy.”
Her protocol begins by seeing each partner separately and leading them on an individual MDMA journey, which can last three to four hours. Sometime later, the couple comes together for a joint session in which they are given time to both inwardly reflect on and then talk about whatever issues they want to address. The therapist then gives them time to be alone.
There’s a queen-size futon with sheets, blankets and pillows. “It’s okay if they get naked,” she said. “They can be physical—bodies, skin—without being sexual. After 20 or 25 minutes I’ll knock on the door and ask to come in. This is often the time when we might talk about their love language or their sex life.”
While they are still feeling the effects of the MDMA, this therapist begins the important discussion about how they are going to integrate the drug experience in their daily lives. “How are they going to follow up on these insights? They make decisions right there,” she said.
The actual MDMA journeys take place in a woodsy location outside the city. Some couples go for a walk in a nearby forest toward the end of their trip, or even spend the night at a cottage on the property.
There are then two follow-up visits back at the San Francisco office to talk more about “integrating the journey.”
This therapist charges $2,500 to $3,000 for the preparation, MDMA journeys, and the follow-up counseling.
While MDMA is seen as a valuable tool for couples’ work, psilocybin mushrooms are often the medicine used for individual sessions by underground guides. Mushroom journeys tend to head into more mystical realms, and involve ego dissolution, or the melting away of the boundary between self and other.
“With MDMA, the ego structure is intact,” the therapist explained. “The person can reflect inwardly without seeing the walls moving.”
She and her husband have been doing this work and quietly training other underground guides for 30 years.
Historically, the two leading lights behind the psychedelic psychotherapy movement and the popularization of MDMA were chemist Sasha Shulgin and Jungian analyst Leo Zeff, both of whom studied at UC Berkeley. Shulgin, who earned his PhD in biochemistry in 1954, going on to inspire the rediscovery of MDMA in the late 1970s and early 1980s. Shulgin met Zeff, who died in 1988 at the age of 75, at the Caffe Mediterraneum on Telegraph Avenue in 1964. When they met, Zeff, who briefly studied psychology at Cal, was already leading LSD therapy sessions. Shulgin was busy synthesizing a dizzying array of new psychoactive compounds in a funky laboratory tucked away in the Orinda hills.
Sasha Shulgin’s wife Ann, who gave Ayelet the idea to take ecstasy with her husband during a guest appearance at Waldman’s drug policy reform class at Berkeley Law, lead therapy sessions with couples taking MDMA. She told Waldman that they could accomplish more in a single six-hour ecstasy session than in six years of traditional therapy.
MDMA produces a different experience from LSD or other drugs considered to be hallucinogens, such as mescaline and psilocybin, the active ingredients in peyote and magic mushrooms. When taken in larger doses, LSD is a powerful mind-altering substance that can blast users into uncharted, sometimes frightening, psychic territory.
MDMA has a softer effect. Some people call it an “empathogen” because of its ability to produce feelings of compassion and empathy. People on the drug tend not to have the intense visual distortions one may experience on LSD. They may feel less stoned, yet transformed— at least for a few hours.
Dr. George Greer, a New Mexico psychiatrist who treated patients with MDMA before the 1985 ban, said the compound puts couples in an altered state, but they still have their “full intellectual faculties for communication.”
“MDMA prevents the emotional fear response to a perceived threat,” Greer told me. “Married couples don’t get into their normal knee-jerk reactions. Fear does not push the mind into a defensive posture…During sessions they learn to communicate in more honest, direct ways. Then they learn how to employ that skill later without the drug.”
Greer is now the medical director of the Heffter Research Institute, which has sponsored double-blind placebo trials at Johns Hopkins and New York University using psilocybin-assisted therapy to treat the depression and anxiety that often accompanies a life-threatening diagnosis.
In an interview with CALIFORNIA Magazine, he advised against couples trying ecstasy on their own, mainly because it’s illegal and users can’t be certain they are actually obtaining pure MDMA.
Waldman recommends that couples get an MDMA test kit and analyze any illicit substance obtained from a source they don’t completely trust. But even with pure MDMA, Greer notes, a slight risk to people with cardiac issues because the drug increases the heart rate.
“MDMA primarily works through a complex and only partially understood interaction of three mood-regulating brain chemicals: serotonin, dopamine, and norepinephrine”
Even so, Greer acknowledges that “millions of people have taken MDMA and had good experiences.”
In the brain, MDMA primarily works through a complex and only partially understood interaction of three mood-regulating brain chemicals: serotonin, dopamine, and norepinephrine. That (and the fact that the “MA” stands for methamphetamine) explains why users feel euphoria and increased energy as well as increased sensitivity to light and sound. MDMA also seems to affect the flow of oxytocin, a hormone linked to human mating and bonding.
“It’s a perfect storm of pharmacology, creating a great set-up for psychotherapy,” said Dr. Julia Holland, a New York City psychiatrist and writer and editor of the book Ecstasy: The Complete Guide. “You want to talk and connect. You feel more trusting and have this sense that all is good.”
David Presti, who has been teaching neurobiology, psychology and cognitive science at UC Berkeley since 1991, believes the connection between brain chemistry, compassion and empathy among MDMA users has been “highly over-interpreted.”
“Brain and behavior are more subtle and complex than that,” said Presti, the author of a new book titled Foundational Concepts in Neuroscience: A Brain-Mind Odyssey. “In the quest to find simple explanations for the complexities of human behavior, there is a desire to assign dominant regulatory roles to single molecular entities or specific brain regions…How those differences translate into differing behavioral effects awaits further elucidation.”
According to the National Institute on Drug Abuse, “some heavy MDMA users experience long-lasting confusion, depression, and selective impairment of working memory.” Many experienced recreational users report “feeling down” several days after a session, and advise against taking the drug more than once or twice a year.
“What everyone seems to agree on is the more you do it the worse you feel,” Holland told me. “There are really diminishing returns.” She also pointed out that people taking anti-depressants will probably feel little effect from ecstasy because their daily medication blocks the serotonin receptors MDMA needs to reach.
Advocates of medically supervised therapeutic use, who generally guide patients through one, two, or three sessions spaced over a period of several months, report no serious adverse reactions in hundreds of documented sessions. Each session lasts four to six hours and takes place in a space that looks more like a living room than a medical office. Volunteers are gently guided by the pair of trained therapists who encourage volunteers to wear eyeshades and listen to evocative music to intensify the drug’s introspective effects.
Ralph Metzner, a veteran psychedelic researcher, who lives in Sonoma County, said MDMA does not have the same psychological risks as LSD. “You can’t have a bad trip, he said.”
Like Greer, Metzner used MDMA as a therapeutic tool for couples and individuals in the 1980s. He collected accounts of those sessions in a book titled Through the Gateway of the Heart. In one of those stories, a 37-year-old businessman said the drug gave him “a sudden openness to giving and receiving unconditional love and adoration.” This patient said several MDMA sessions saved his relationship with his partner. “The accumulated grievances of a stormy five-year relationship paled into insignificance” he said.
As a therapist, Metzner also favored the approach of supervising separate sessions with each partner, especially for first time explorers. Then the couple would take ecstasy without supervision. “They might soon drop out of therapy,” he said. “They’d say, ‘We don’t need you (the therapist) anymore. Now we know how to talk about our difficulties.’”
Surveys of illicit drug use reveal that ecstasy (or at least pills on the black market that claim to be MDMA) remains a popular recreational high. So it’s not hard to find couples using it for all kinds of reasons. One pair, aging baby boomers, sat down with me one evening last month in their home in San Francisco’s Noe Valley neighborhood. We sipped herbal tea and talked about how the drug has helped them through the pleasure and pain of three decades of married life.
“MDMA was pivotal for us,” said the husband. “It helped us survive some really difficult times, just having a little oasis of pleasure and joy.”
“Just being in that expansive, loving place,” added the wife, reaching out and touching her partner’s hand. “I think it really deepened our relationship.”
They and others note that MDMA is more of a “love drug than a sex drug.”
This husband and wife also happen to work as psychotherapists. And both dream of the day when they might be able to legally use MDMA to help their patients talk about difficult issues and find better ways to understand their spouses, parents, children, and themselves.
That dream may be come true sometime in the 2020s. Or it may not.
Most of the clinical trials with MDMA are sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS), a private nonprofit research and lobbying group based in Santa Cruz. Its principal investigator, Dr. Michael Mithoefer, a South Carolina psychotherapist, is conducting a new MDMA therapy study of couples in which one spouse has been diagnosed with PTSD.
Ten couples are treated with MDMA-assisted therapy, including the member of the couple who does not have a clinical diagnosis but is nevertheless “experiencing problems associated with the psychosocial circumstances” of their partner’s condition.
Mithoefer said the first couple—a man with PTSD from child sexual abuse, and his wife—has completed joint therapy, and the next three couples will be treated in February and March. The month-long treatment program includes two MDMA sessions and uses a couples’ talk therapy technique developed by Dr. Candice Monson, a clinical psychologist and PTSD expert at Ryerson University in Toronto, who is working with Mithoefer.
“PTSD affects peoples’ relationships so much that a good way to treat it is within the relationship,” said Mithoefer.
Much of Mithoefer’s work these days involves training the next generation of psychedelic therapists in separate programs run by MAPS and the California Institute of Integral Studies in San Francisco. Some of these therapists will be working on the final phase of clinical trials that MAPS and the Heffter Research Institute researchers are conducting over the next few years with MDMA and psilocybin.
Mithoefer said his office has been flooded with calls and emails from individuals and couples hoping to get into his PTSD programs. Most who want MDMA-assisted therapy must be turned away. “It’s sad that we are so limited in what we can offer now,” he said. “But we hope that will change.”
Don Lattin is the author of five books, including The Harvard Psychedelic Club and the forthcoming Changing Our Minds: Psychedelic Sacraments and the New Psychotherapy, which will be published in April. This story was originally published californiamag.org