The Ecstasy Therapist
"Growing up Jewish in the shadow of the Holocaust, and learning that insanity had affected a whole culture ... I grew up very interested in psychology and the unconscious." This is how Richard Doblin describes the genesis of his life's work.
Doblin came of age at the height of the social tumult of the '60s. But initially he was unlike many others of his generation: "I was not interested in drugs," he says. "I thought that drugs were something that made you crazy." Then, in college, he tried LSD. "It opened up this whole deep emotional world and it struck me as something that worked as a tool for rites of passage for growing up, whereas other traditional things, like my bar mitzvah and my high-school graduation, hadn't really moved me at those deep levels."
It wasn't long before Doblin decided, in 1972, to combine these two inclinations and become a "psychedelic therapist." Wary of Timothy Leary, the most recognizable face of the American psychedelic movement at the time ("I couldn't quite trust what he was saying, because he talked about the positive sides but he really didn't talk about the struggle"), Doblin instead gravitated toward the work of renowned LSD researcher and therapist Stanislav Grof.
"What really inspired me was Stan Grof's merger of science, spirituality, and therapy," Doblin says. "It wasn't just philosophy, it was [using psychedelics] to help people feel better and deal with difficult emotions.'"
In college, Doblin studied with Grof at the Esalen Institute in Big Sur, California. It was there, in 1982, that he first came in contact with 3,4-methylenedioxymethamphetamine, better known as MDMA, or "ecstasy." MDMA was legal then, and used primarily in therapeutic circles. But its gradual entry into the realm of recreation attracted the attention of the DEA. By 1985 it had been classified as Schedule I ("no currently acceptable medical use") -- legally banned.
In 1986, Doblin founded the Multidisciplinary Association for Psychedelic Studies (MAPS). According to its Web site, the organization has "positioned itself at the center of the conflict between scientific exploration and the politically-driven strategy of the War on Drugs," and works toward "the cultural reintegration of psychedelics and marijuana through good science." With nearly 2000 members worldwide, MAPS funds studies of MDMA, LSD, psilocybin (found in "magic mushrooms"), and ketamine here and abroad.
Doblin recently earned his PhD at Harvard's Kennedy School of Government with a dissertation on the medical use of psychedelics and marijuana. We talked with him last week to get his thoughts on psychedelics, therapy, and the war on drugs.
Q: Tell me about MAPS.
A: MAPS has two roles. One is a nonprofit psychedelic and medical-marijuana pharmaceutical company. Our goal is to create a legal context for the beneficial use of psychedelics and marijuana, initially in a medical context through the FDA, but then for personal growth, for creativity, for marital therapy. We want to start with people who have diagnosable illnesses and then create a legal context, showing that that is a situation where you can get more benefits than harms. Then we'll continue to negotiate with the culture about expanding this zone of acceptable uses. In that context, we are a scientific organization that supports research with the FDA and government agencies in other countries. We are also a community of about 1900 people who share this interest. A substantial number of them are doctors and therapists, a lot of them are professionals in other areas. A lot of them are young people.
Q: What sorts of dialogue have you had with the DEA and other federal agencies?
A: The US Sentencing Commission wants to increase penalties on MDMA, so last week I was in Washington presenting testimony with some of the doctors that we work with. I don't know if we'd call it a dialogue. It was more of a monologue where we talked, they didn't listen, and they ignored us and they made penalties for MDMA, dose for dose, more severe than for heroin.
The dialogues with political authorities -- this most recent one was about criminalizing non-medical use. But I've also brought up the idea of medical use. So most of our dialogue is with the FDA or with NIDA [the National Institute on Drug Abuse], which funds massive amounts of research trying to show what's wrong with MDMA so that they can help justify the criminal penalties. And we feel that NIDA distorts the implications of their research, is excessively fear-mongering, takes the worst case and tries to pretend that that's the average case. But we have, tragically, no dialogue with the National Institute of Mental Health, which funded most of the psychedelic research in the '50s and '60s.
Q: Do you have any MDMA studies planned?
A: We are primarily gearing up, for this last year and a half, to have a major discussion with the FDA about starting research in the United States with the therapeutic use of MDMA. So far, since MDMA was made illegal in 1985, there hasn't been one single study permitted where MDMA was given to patients. We hope to submit a protocol to the FDA in April for MDMA and the treatment of post-traumatic stress. And we expect that it will be approved after several months of negotiations.
Q: When did you first come into contact with ecstasy?
A: From the time that I decided to be a psychedelic researcher in 1972, I really couldn't deal with a lot of my psychedelic experiences.... I didn't have a supportive enough environment, and I wasn't strong enough emotionally. And so I dropped out of college -- I went only for one semester -- and I spent 10 years working on myself and getting into the physical world.
In 1982, at age 28, I went back to college as a freshman, to an experimental liberal-arts college in Florida that permitted off-campus study. My very first semester I spent a month at Esalen in Big Sur, studying with Stan Grof. And that's when I learned about MDMA, in 1982. And it was still legal.
Q: Was it being used only in therapeutic circles at this point, or was it being used recreationally too?
A: Initially it was only in therapeutic circles, and around 1980 or so, some of the people who got it in therapeutic circles saw that this was a tremendous money-making opportunity. And they approached it in a different light. The drug's code name in the therapeutic world was "Adam" and then, when it changed to ecstasy, that's when it was used in more public settings or for recreational uses, and that's what attracted the attention of the DEA. So in 1984, the DEA moved to try to criminalize MDMA.
By that time I was in school trying to study psychedelics, and I felt this was an incredible opportunity to [bring] some group [up] from the underground and to speak in a public setting without the fear of going to jail, because MDMA was still legal. So I started a nonprofit called the Earth Metabolic Design Lab, and we sued the DEA to have these administrative-law-judge hearings. And when I walked into the -- oh wait [after much noisy searching, produces photo of himself standing in front of DEA offices] -- this is me in 1984, right before I walked in to file the request for the administrative-law-judge hearing. And what became clear was that even though we had some strong support, and even though the judge said it should be Schedule III, meaning that doctors should still be able to use it, the head of the DEA said, "Forget it, we're putting it on Schedule I. Nobody can have it."
So then I recognized that the main way we were going to make progress was through the FDA. As a medicine. Everything but that channel was completely blocked. So that's when I started MAPS, in 1986, in my mind as a nonprofit psychedelic-pharmaceutical company to try to develop MDMA through the FDA. And we funded studies of the dog and the rat, 28-day toxicity studies that are FDA-required before you do human studies.
Q: How many times have you done ecstasy? How recently?
A: I hardly ever do it now. I very rarely have time for it. But it's the kind of thing that, I think, will be something that I will use, rarely, for the rest of my life. Over the last 19 years, I've done it a total of about 90 times.
Q: What has it done for you?
A: It's made me more accepting of myself, more able to express my emotions, a better listener to other people. It's helped me deal with loneliness.... I did a series of explorations with people in the religious traditions: monks and rabbis who were willing to use MDMA in small doses to help them meditate. And one time I spent one night by myself using MDMA and thinking what must it be like to live as a monk - -- without a woman, without human nurturance, but to try to get nurturance from the universe. I felt like for a few hours that I was able to understand that. And that helped me tremendously to be more comfortable to be alone.
Q: Have you ever had any major problems with the government or with law enforcement?
A: I'd say that the major problem in my life where the government directly intruded, was with my grandmother, back in 1986. She had unipolar depression: she didn't have mania, she just was down. She'd had electroshock therapy earlier in her life and it had helped her. But her depression returned. She had electroshock therapy again, but this time it didn't help. Her psychiatrists gave her every drug they could think of -- didn't help her.
So I went to my family. My father's a doctor, my brother's a doctor, and I said, "Let's give her MDMA. It might help her." Because underneath this depression was this incredible anxiety and fear. She didn't want to see her friends, she didn't want to leave the room, she didn't want to go outside, and so I thought maybe it would help her.... Maybe somehow it would reset her clock the same way that electroshock therapy does. And my parents said that I could give it to her, but only if I got government permission. And we were never able to do it. And she ended up not getting better, and stopping eating, and dying from the depression. And the government's rationale was that they had to save her from neurotoxicity.
Q: How does a therapeutic session work? How is it set up?
A: You don't take somebody who doesn't want to work on their issues, because that's a recipe for panic and for disaster. You need a willing subject who says, "I realize I have a problem and I want to work on it." And that may take weeks or months of therapy. You develop a therapeutic alliance between the therapist and the patient. You teach them about what's likely to happen.
The session starts in the morning usually. People are rested, and they lie down. It's an internalized session, often with eye shades so people are focusing on their internal material. You have music that supports them, but the music generally doesn't have words so that you don't key people into other associations or other imagery. And then you just really support them as material emerges. And if it's ketamine, it's a two-hour experience. If it's MDMA, it's a four-hour experience. If it's LSD, it's an eight-hour experience.
Q: So do you ask them questions? Let them talk it out themselves?
A: Well, a lot of it is nonverbal. You check in every now and then and you also guide them back to things that they're still dodging, or you ask them to share with you what's happening, but there's a certain respect for the wisdom of the unconscious. That things will come up that they are working on or need to work on.... It's not like you have an agenda, y'know: at two hours you have to cry and say you're horrible and you've hurt everybody. It's not like a specific sequence. But the idea is that they've then had this very powerful experience that is the emergence of things that they've suppressed.
Then you let them rest, you probably spend the night in the same place, they don't have to move, and you turn it into a several-day experience. The next day you come to them and they often will do drawings to try to express in art what happened. There's this process of integration the next day where you go over it, you talk about it.... And then you support that by meetings every week for several months or so after, so that really it's an inspirational experience.
The mistake of the '60s, of the psychedelic era, was [to think] that the experience itself was what you need and that will do all the work. But you really have to just get inspired from it and then you have do the work yourself and then move in little steps. Maybe after a couple months you'll do another session. And then maybe after another couple months you'll do another session. But there's lot of heavy emphasis on the preparation and the integration. And then, also, you try to join people in groups so they can support each other and help each other. That's the general approach.
Q: I know you're doing a study in Spain. How has it been going?
A: It's the first scientific study of MDMA ever approved. It's going slowly [chuckles]. Slowly, slowly. We have really just very preliminary results. It looks promising, but the way the study is designed in Spain, we have to start at low doses. So we start at 50 milligrams. And then a group of women -- it's women survivors of sexual assault with PTSD [post-traumatic-stress disorder] who've failed with one other treatment. And so we have to give a group of women 50 milligrams and another group 75 and another group 100, then another group 125, and then the final group gets 150. And we think the real therapeutic dose is starting at 100. So we're a long way from really being able to get at that level, but preliminarily we're going to show safety.
Q: How do these doses work? How does it relate to what a typical kid would take at a party?
A: One pill is somewhere in the neighborhood of 80 to 100 milligrams. And some pills are as much as 125 milligrams. We've found that after you get one pill, it takes about 45 minutes or so for people to really get into the experience, they plateau from like one hour to three hours, and then they start to come down. But at around two and a half, if you take half the dose that you originally took, it extends the plateau. So that's how the underground therapeutic use of MDMA is done. Somewhere like 125 milligrams first, then after two and a half hours something like 60 milligrams. And that will give you a therapeutic window of about four hours.
Q: Are you completely convinced that ecstasy isn't dangerous?
A: I'd say that I'm completely convinced that ecstasy is dangerous. The government likes to say, "The proponents of MDMA say that it's completely harmless. But it's not! Here are the risks ... " And therefore it's got to be illegal because we've got some risks. So what we're trying to say is that it's not so simple. We never said that [there are no dangers]. Nothing is completely risk-free. But the relative risk of MDMA, compared to heroin or cocaine or other drugs, is much, much lower.
Taking MDMA in a rave, dancing all night and not resting and not drinking fluids, can lead to overheating, and people can die from it. But MDMA taken in a clinical setting, where people are taking it lying down, with their eyes closed, for an inner experience, where they occasionally will drink some fluids -- nobody has ever died from overheating in a clinical study. So the context really has a lot to do with the risk.
Q: What about the charges that it affects serotonin levels, that it could permanently affect mood?
A: First of all, I believe that's vastly over-exaggerated.... I've known hundreds of people over the last 19 years that have been doing MDMA. I've known thousands of people. And I don't see it, in terms of this cognitive decline.
There's a couple things that we need to ask. First off, are there serotonin changes? And then secondly, do they matter? Now let's just look at dopamine and Parkinson's disease. You can have major declines in dopamine, and you have to have declines in the neighborhood of 90 percent before you get Parkinson's. Now, MDMA affects serotonin. Serotonin doesn't decline that much with age. One study I looked at said two and a half to four percent per decade.
So the time-bomb theory -- this is NIDA's favorite, because when you look at ecstasy users, most of them seem fine -- the time-bomb theory says that even though there may be minor changes now, when people age, this generation of young people, when they get to be 40 or 50, after 20 years of aging they're going to start manifesting problems. But that really requires serotonin to decline with age substantially, which it really doesn't. The other question is, does this really happen at human dose levels?
Q: Where does MAPS's money come from?
A: Donors and MAPS members. But I'd say that the main money actually came from this one guy who I met a month before he died of cancer in the '70s. He was interested in spirituality and believed in the value of psychedelics ... it was one of those things where the stars align and everything just works out right. We had a mutual friend, he was getting ready to die, figuring out where to put his money. I spent three days with him, and he died three days later and left half a million dollars.
Q: How does the widespread use of ecstasy as a club drug, and the popular perception of it as such, affect your work?
A: It makes it extremely difficult. Once a drug is criminalized for its non-medical use, then subsequent pressure is placed to criminalize its medical use. NIDA's message is: one drug, serious danger, be careful, don't ever try it. So the rave movement and the non-medical use has made it much more difficult. The underground therapeutic use of MDMA was going fine until it emerged from those confines into recreational use, and that's what attracted the DEA.
Q: Can you say a few words about the cover story that ran in the New York Times Magazine on January 21? It mentioned a couple of MAPS-sponsored studies, and quoted someone as saying, "[Batman] ... spends his life fixing the problems of the world. I've started to think that a real Batman of today would become a psychiatrist who dispenses ecstasy."
A: That piece was attacked by Senator Graham, I think, in the Senate hearing where they spent three hours talking about ecstasy. The article was a remarkable success. It was an unusual bleeding through of the wall of propaganda in that it was a balanced article about someone who took ecstasy 15 years ago and is reflecting on it in a positive light. That's what was attacked. He said he had a good experience with it, but we know that these drugs are dangerous and people are harmed by them!
The view of the Senate was: no matter what he said about his experience, he was wrong. It's like, "You don't know what happened to you. We have to go to some scientist to tell you that you're more seriously damaged than you realized." [It's also significant that] he had the experience 15 years ago, so if there were these long-term medical problems he hasn't seen them. We're still not at a point where we can have honest discussions. I thought that was a very courageous piece.
Q: What are your visions for the future? What would you like to see happen? What do you think will happen?
A: What I would like to see happen is that as a society we understand that we are an anomaly. That most cultures have integrated altered states and psychedelics in some fashion or another. I hope that people will slowly start to be educated more and more about the medical use of marijuana and the fact that they have been, in large part, lied to by the government about the dangers of MDMA.
At the same time, we will start to create beneficial uses of psychedelics. The two areas we're working on are post-traumatic stress and terminal cancer and end-stage AIDS -- helping people to deal with dying.
So what we're saying is that this drug is not just for your raver kids. This drug is for everybody. This is not just for the baby boomers, but it's for their parents who are now at the end of their lives and are scared of dying and are scared of pain and that we can help them. That we, meaning the psychedelic community that's learned how to work with these substances, have something to offer that our current medications don't offer. So we have to show that this is something that can be normalized, that can be integrated into society in a beneficial way.
And then we also have to have a little bit of a different understanding about risk. The head of NIDA has said that people can die from MDMA, therefore there's no such thing as the recreational use of MDMA. But people die from high-school football, people die from skiing, people die from scuba diving, mountain climbing. Dale Earnhardt died from race-car driving. We have to do our very best to do harm reduction and prevent all deaths from MDMA or any other drug. And yet we also have to say that as a society that we can't prevent all risks.
Visit the Multidisciplinary Association for Psychedelic Studies at www.maps.org.