Photo: Dan Saelinger
Sarah lived in a basement for a few weeks when she was a child. But in a way, she lived there much of her life.
Her father terrorized their family. He hit her, threw hot coffee at her, locked her in closets. Once, he held a gun to her sister's head. The winter Sarah was 11, she brought in the wrong wood for the fireplace, so her father locked her in the family's unfinished concrete basement. Her meals were brought to the top of the stairs. It was a freezing Christmas in Pennsylvania, more than 30 years ago.
Sarah eventually left home for college, earned a master's degree in education, had a son. Surprisingly, she stayed in close contact with her parents. But the sound of a door clicking shut made her heart pound; if her dog barked, electric sparks shot through her limbs. At a party, she'd struggle to follow the conversation; the room would spin and the lights would smear; her ears rang with blurring voices. She slept badly, and always with the windows open and the doors unlocked. "I couldn't stand to feel trapped," she explains. She was often irritable or paranoid, short-fused, consumed with self-loathing.
Sarah's nervous system was stuck in the amber of childhood, when her psyche had been conditioned for chronic danger. Decades after leaving her father's house, her mind and body remained on 24-7 high alert, poised to duck a flying fist or slip through a closing door. She was in her early 30s before she received the formal diagnosis: post-traumatic stress disorder (PTSD).
She attended counseling sessions with a social worker. She self-medicated with food, exercise, alcohol. She chain-smoked. She did group therapy and Alcoholics Anonymous, Paxil and kundalini yoga. A psychiatrist sent her to a crime victims' unit, where she tried prolonged exposure therapy: a highly successful treatment for PTSD that requires patients to describe traumatic events again and again in acute detail—staring down a terrifying ordeal until it retreats safely into the past. After a handful of sessions, Sarah dropped out. "I was totally resistant. I was obnoxious," she admits now. "I remember playing with the Play-Doh in the psychiatrist's office, thinking, I'm smarter than you." Her bad attitude, she realizes today, was a defense mechanism—bravado masking fear of her own memories.
At the start of 2005, after a break-in at her home, Sarah's PTSD symptoms—the nightmares, sleeplessness, and hypervigilance—were worse than ever. She was a single mom, and she agonized over how her disorder might be affecting her toddler son. Then a friend told her that a researcher was recruiting subjects for a small pilot study of a promising new drug treatment for PTSD. Sarah was intrigued and hopeful. She was also apprehensive: The drug in question was 3,4-methylenedioxymethamphetamine, or MDMA, which Sarah knew to be the active ingredient in the street drug Ecstasy.