Can Ecstasy, Primarily Known as a Club Drug, Help People Suffering From Trauma?
Israeli drug trials are investigating whether MDMA can be a useful psychiatric tool in treating post-traumatic stress disorder
During the Six Day War, a 24-year-old communications officer named Josef was stationed on the front line in the Golan Heights when one morning, a bullet tore between the eyes of his commanding officer. He was a bright and pleasant fellow whom Josef had grown fond of—they had slept beside each other, talked about their families, and worked closely together in the army. Josef was rattled by his death, as he was by the rest of the carnage he witnessed that day, when more than a dozen other young men were killed.
After the war, Josef went back to the kibbutz where he lived with his wife and two children and tried acting like everything was normal, except it wasn’t. He became prone to explosions of anger. His marriage fell apart. He felt distrustful of everyone. He remarried and divorced again, and then again. He started abusing drugs. Nothing could shake the memory of what he had experienced that morning in the war and his crippling shame over having survived. “I got hurt mentally in ’67,” he told me. “I see all kinds of pictures from the event itself. I can smell it.”
In the mid-1990s, he began having nightmares. “Every night the same,” he said. “It’s a dream of a trap I can’t get out of. It’s called different names, but it’s the same place. You see and feel it, heavier and heavier. You can’t stop it.”
Josef went to see a therapist but scoffed at her recommendation that he take medication; a previous trial with psychiatric drugs had backfired and triggered his violent temper. Nor did he want to become dependent on sleeping pills. He sought help at Beer Yaakov Mental Health Center, half an hour southeast of Tel Aviv, and found out about a clinical trial taking place there to test the effects of MDMA—the drug commonly known as Ecstasy—on post-traumatic stress disorder. He felt he had nothing to lose.
As a patient in the trial, Josef participated in a series of psychotherapy sessions, followed by two days of taking a dose of MDMA with a pair of therapists sitting quietly nearby and monitoring his vital signs. From the outside, it didn’t seem like much. Internally, however, what happened to him was unspeakably complex and cathartic. “I didn’t become what I’m not, but I had a big release,” he said. “I released my guilt: ‘Why him and not me? How come I’m alive at all?’ Whatever happened, happened, and I can’t do anything about it. On the basic level, I got rid of these heavy feelings that I was carrying.”
Josef is 70 now and lives in a village in the Galilee overlooking the sea. He speaks about his MDMA experience with a tinge of amusement, aware of how incongruous it must seem that an aging former soldier with 10 grandchildren took a drug best known for fueling all-night dance parties and youthful bacchanalia. For him, of course, it was something entirely different. “It was a kind of salvation,” he said. “Those two pills really did it.”
Researchers in Israel believe that Josef’s experience can be replicated, and that MDMA could become a significant tool in helping those with chronic, intractable PTSD. An official clinical trial that began at Beer Yaakov in February is on track to test the drug’s effects on 10 patients within the next two years, one of a number of related studies happening around the world. If the results are positive, MDMA may become known as something far more profound than the impetus for a gazillion teenagers to don neon, wave glow sticks, and grind their teeth all night to ear-splitting bass lines. It could become a vital element of psychiatric care.
If MDMA surmounts its illicit reputation and becomes a prescription medicine—a goal that researchers have been working toward for more than a decade—one might say that it all started with Rick Doblin’s bar mitzvah.
Doblin, 59, is the founder of the Multidisciplinary Association for Psychedelic Studies or MAPS, a nonprofit organization that has driven the effort to cultivate a legal, therapeutic context for the use of MDMA and other psychedelic drugs for over 20 years. Doblin grew up in a Conservative Jewish family in suburban Chicago in the 1960s, the kind of heady, engaged household where remembrance of the Holocaust and devotion to Israel got equal billing with complex conversations about the Vietnam War. He was a spiritual seeker from a young age: His personal path was in many ways kick-started by the deflation he felt at his own bar mitzvah.
“My bar mitzvah was pivotal for me because nothing happened,” he said. “I was really expecting a spiritual experience, and it was a big shocker for me that my bar mitzvah didn’t transform me into a man. I was 17 when I first took LSD, and I had a somewhat difficult time, but I felt like I was engaging a kind of psychic energy that I had anticipated from my bar mitzvah, that deeper spiritual experience that older rituals don’t offer most people anymore.”
As a student at the New College of Florida, Doblin studied the era of psychedelic research that flourished mid-century and decided that he wanted to become a psychedelic therapist, an unlikely goal since almost all such work had ended with the criminalization of psychedelic drugs amid their explosion in the ’60s counterculture. Still, Doblin harbored his dream and became particularly interested in the therapeutic reputation of a substance called MDMA.
Synthesized by German chemists in the early 20th century, MDMA was a compound that didn’t have much of a life until the 1970s, when an underground community of therapists discovered its unique ability to reduce anxiety and facilitate openness, and they started exploring its benefits in treatment. By the 1980s, however, it had seeped from therapeutic to recreational settings, where it was renowned for melting inhibitions, pumping out feelings of empathy, and enhancing the sound of dance music. In 1985, it was outlawed.
Yet interest in MDMA’s therapeutic potential never really went away, and for Doblin it became deeply personal. In 1986, his grandmother, Leona Perlman, was suffering from unipolar depression, and he suggested to his family that he facilitate a session of MDMA-assisted therapy with her. His parents balked because of the drug’s illegality, so Doblin took it himself and sat with her one afternoon at her house on Chicago’s west side. (“I figured I would try for a contact high,” he said.) As his grandmother declared that she wanted to die, Doblin gently invited anything deeper she wanted to process.
She admitted that there was one thing she’d never found closure around: In 1923, her Orthodox father—Doblin’s great-grandfather—had fulfilled a lifelong dream by moving their family from Chicago to Israel, and there she started a romance with a young Jewish man who served in the Palestinian police force. For reasons that were unclear—perhaps because the young man was irreligious or lower class—her parents disapproved of the relationship and sent her alone back to Chicago, where she eventually married the man who would become Doblin’s grandfather. Yet she never forgot about that youthful romance, and she showed Doblin an illuminated copy of the Song of Songs, a shriveled rose, and a note the young man had given her for her wedding.
Doblin attributed her revelation of this buried family secret to his own demeanor under the influence of MDMA and the space it afforded his grandmother to open up, and it triggered a mission within him. “I came out of being under the influence of MDMA feeling like we had to get politics out of the way so we can do the science and see what it can actually be helpful for,” he said. “We’ll never know if MDMA could have helped my grandmother, but I think it could have.”
That year, Doblin founded MAPS with the intent of reintroducing MDMA as a prescription drug in the United States and, ultimately, around the world. The Santa Cruz-based organization has since flourished as a nonprofit broadly devoted to drug policy reform, public education, and research on the medical benefits of a wide range of psychedelics as well as marijuana. Yet even as the organization’s profile has expanded, it has maintained Doblin’s original goal of establishing legal MDMA-assisted psychotherapy as part of its focus.
Because of hurdles to psychedelic research in the United States, Doblin developed an international strategy to try and get MDMA research approved elsewhere. In Israel, he saw not just a place where he had deep personal ties and feelings of kinship, but a country that had already produced some of the world’s top PTSD researchers, that had a culture of independent-mindedness, and that frankly harbored a lot of trauma.
“All that meant that we had a really good chance of doing research in Israel that would potentially contribute to the entire field,” Doblin said.
PTSD began being recognized as a serious mental condition in Israel after the 1982 Lebanon War, two years after it was first identified in the Diagnostic and Statistic Manual of Mental Disorders. Naftali Halberstadt, a cognitive psychologist who serves as one of five therapists in the current MDMA study, became active around that time in a fast-growing community of trauma-treatment professionals in Israel, and he eventually became the director of trauma programs for the American Jewish Joint Distribution Committee.
Trauma, he explains, is basically a problem of processing a negative event into a regular bad memory. “If you have a bad memory, it sits in your brain and it can even be painful, but it’s not like it’s happening right now,” he said. “The traumatic memory stays very much in the here and now. The part of the brain that’s trying to care of you, the limbic system, is saying, ‘You’re in danger,’ because the trauma material is still sitting there. It hasn’t been transferred into the place where permanent memories are supposed to reside.”
The most successful treatment for the condition is exposure therapy, which systematically and gradually exposes sufferers to their traumatic memory and guides them through processing and making a complete narrative out of it, which takes the limbic system off high alert and turns it into something that be accepted as in the past. For many people this works. For a certain percentage, it doesn’t. MDMA is thought to essentially facilitate the same sequence by allowing a person who is resistant to traditional exposure therapy to safely access their traumatic event. By flooding the brain with serotonin, the chemical associated with pleasure and trust, and relaxing the amygdala, the part of the limbic system that regulates fear—the same neurological process that makes Ecstasy feel so amazing on the dance floor—the PTSD sufferer is more easily able to confront and process trauma.
Not everyone in the psychiatric community is comfortable with the idea of Ecstasy in their therapeutic toolkit. It is, after all, an illegal drug with real risks, as underscored by a spate of recent deaths attributed to MDMA overdoses in the electronic dance music scene. But Halberstadt, like other therapists, sees it through the dispassionate eyes of a clinician as well as the compassionate eyes of a healer. Having worked with trauma in Israel for two decades, he is hopeful that the study will amass enough data to someday support offering MDMA-assisted therapy as a viable treatment option for those in need, untainted by its dance-drug reputation.
In 1999, MAPS hosted a seminal international conference near the Dead Sea on MDMA psychotherapy, and in subsequent years, Doblin and his partners in Israel’s mental-health community pushed the ball steadily forward to win approval from the country’s Ministry of Health and its Anti-Drug Authority for a study there of MDMA-assisted therapy for PTSD. (A similar study that MAPS simultaneously tried to help establish at the largest mental hospital in Amman, at the behest of the Jordanian military’s former chief psychiatrist, was officially declined, although Doblin still speaks of a quixotic hope for “joint Israeli-Arab cooperation on healing” through MDMA.)
To Doblin, the receptivity to the study in Israel speaks to politics as much as to deep-seated patterns in the collective national psyche. “There are very few places in the world that have more PTSD than Israel,” he said. “There’s the awareness that missiles can reach everywhere now and the entire country is vulnerable. There’s the leftover trauma from all the wars. There’s multigenerational PTSD from the Holocaust and before. I think it’s the prevalence of trauma, combined with the focus on healing and compassion toward the sick in Judaism, and the pragmatic nature of Israel that has made what we’re doing there completely mainstream.”
After a false start in 2010, the Israeli study began in earnest earlier this year, funded by MAPS (at a total anticipated cost of about $450,000) and overseen by Dr. Moshe Kotler, the chairman of the Israeli National Council for Mental Health and former chief psychiatrist for the Israeli Defense Forces. Although the study has sought referrals from the IDF of people with war-related trauma, it’s open to all Hebrew-speaking adults who suffer from chronic, treatment-resistant PTSD of any origin (and who need not be Jewish—the study’s recruitment poster was recently translated into Arabic).
The protocol is set up to treat patients for three to four months, beginning with three preparatory meetings, followed by two doses of MDMA taken a month apart, with integrative psychotherapy sessions and regular telephone follow-ups after each dose. Patients are to be assessed 12 months after completing the study on the extent of their PTSD symptoms as well as other factors like depression, quality of life, and quality of sleep. Doblin foresees the Israeli study’s results ultimately being bundled with those from similar studies in the United States, Canada, Spain, Switzerland, and elsewhere as MAPS and its clinical partners move ahead to propose a Phase 3 drug trial—a large, multisite, multimillion dollar trial involving hundreds or even thousands of patients. If successful, that would likely be the last major hurdle to MDMA’s approval by the U.S. Food and Drug Administration as a medication to treat PTSD. “It’s 27 years since I started to try and bring back MDMA as a prescription medicine,” said Doblin. “We’re probably 10 years away.”
For now, the Israeli study is being closely watched. “At the end of the day, I’m a huge believer that the proof is in the pudding,” Halberstadt said. “It’s certainly unorthodox. But there are very often treatment situations in which, if you’re not going to be unorthodox, you’re not going to have a breakthrough. Unorthodox doesn’t mean unethical. When you’re talking about people who aren’t being successfully treated by more traditional methodologies, then ‘unorthodox’ is merciful.”
It’s a type of mercy that Josef, the war veteran, thinks could help many in Israel. “The wars didn’t do good to most of the people I know,” he said. “In their past is trauma. It’s a kind of handicap. We call this a ‘scratch.’ Here, there are many scratched ones.”
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