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On a February day in 2005, Sarah is reclining on a futon beneath a skylight, with Michael and Ann Mithoefer seated on either side of her. A half-hour earlier, Sarah swallowed a yellow capsule containing 125 milligrams of MDMA, and relaxing instrumental music plays softly as she waits, eyes closed, for the drug to take hold. The first signs are ripples of nausea—she thinks she might throw up, yet she also senses her body relaxing. The usual ringing in her ears vanishes. "That constant hyperawareness of my environment—it was receding," she says now.

At this point, she heard "the grinding of a pen." The sound of the nib bearing down on the page was magnified, "like it was hurting the paper, beating and pounding on it," Sarah recalls. In the alternate reality of MDMA, she says, "I thought Michael was drawing circles around me, making fun of me, laughing at me. I felt the anger rising in my body. I opened my eyes and—he was just sitting there, taking notes."

It was an epiphany. "That's the moment when I discovered that my perception and reality were not always the same," Sarah recalls. She'd assumed that her caretaker was jeering at her, that she was an object of scorn and derision—a painful conditioned response imprinted by an abusive childhood. Sarah always had an intellectual grasp of how her early years had shaped her, "but this was physiological," she recalls. "That's when I knew I had to repair the connections, the chemicals that had gotten all screwed up when I was a kid."

To make those changes, she says, "I had to go back to the basement. Even lying there with the rush of the drug and all that serotonin pumping through me, I didn't want to go there. I wanted to go up, go higher, leave it behind. But I knew that I had to go back to the place that still ruled my life."

Over two eight-hour sessions, Sarah shut her eyes and let her mind become a movie projector, screening images from her subconscious. She saw herself descending into the basement on a ladder; she saw her father in a casket shaped like a house, borne aloft by a white dove. She glimpsed herself as a baby wrapped in a soft white blanket. She watched a sword fight with her father (she won; he retreated). Toward the end of her second round, Sarah's mind placed her on one side of a Formica table, her father on the other. "We were finally on an even playing field," she says.

Once in a while, Sarah would open her eyes and ask after her co-therapists. "At one point, I said, 'Oh my God, you guys, you have to eat something!' They said, 'We ate already.' 'Oh, where did you all go?' 'We were right here.' 'Oh, I must have been busy working on something.'"

She laughs at the memory. "Yes, they were enjoying their lunch while I was off sword fighting."

A few weeks after I talk to Sarah, I visit the scene of the sword fight—the denlike back room of Michael Mithoefer's offices in Charleston where he conducted the MDMA study. A former emergency room physician, Mithoefer is a youthful 64, with an affable but intently focused vibe and a soothing cadence seemingly designed to prime oxytocin flow. Only his graying ponytail and occasional penchant for New Age–y jargon hint at his position at the edge of psychiatric research.

"The protocol was very nondirective," Mithoefer says of his study. "A useful analogy might compare MDMA to antibiotics. A short course of antibiotics simply controls bacteria long enough to let the immune system take over and do its own healing. You could say that MDMA appears to be a catalyst for another kind of internal healing process."

In 2008 Emily did a single session of MDMA with the guidance of an underground therapist. "I took myself through the rape and I felt the trauma deeply, but I also stepped outside of it," she says. "I had what they call the 'God view' in a computer game. I saw it objectively, and with compassion. I wasn't thinking, I shouldn't have been there or I'm a piece of crap or This is all my fault."

After her own MDMA experience, Marcela Ot'alora says, "instead of avoiding triggers—which is impossible, they're everywhere—I asked myself, How should I take care of myself when I get triggered?" An omnipresent tripwire was people behind her, whether at the supermarket checkout or standing on a bus. "I would start sweating, the hairs on the back of my neck would stand up, my legs would shake, and I'd have to sit down," Ot'alora says. "If I went to the movies, a friend would have to stand in line for me, and we'd have to go early to make sure we got seats in the back row.

"I used to think, I'm a broken person. I'll never be able to do this simple thing. But after my first session, I thought, Well, it's okay not to stand in line. It's okay to go early. I stopped judging myself, and I didn't avoid my life anymore. Which was wonderful." A quarter-century after taking MDMA, Ot'alora still gets triggered from time to time, particularly in crowded places. "But it's much more short-lived now," she says. "Sometimes it's a matter of a second before I bring my body back to a safe zone."

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