MDMA, the active ingredient in the drug Ecstasy, has been reviled as a menace and even a killer. Now some therapists claim it can help light the way out of a traumatic past.
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.
Photo: Dan Saelinger

To a layperson, the notion of using a drug like Ecstasy as a therapeutic tool for healing trauma might make as much sense as adding cocaine to a diabetic's weight loss regimen. Ecstasy was the signature stimulant fueling a worldwide party culture in the 1980s and '90s, epitomized by massive all-night dance "raves" crammed with blissed-out revelers and pulsating with electronic music at festivals and exurban warehouses across North America and Europe. By the turn of the century, Ecstasy—in tablets frequently laced with methamphetamine, tranquilizers, or PCP, and sometimes containing little actual MDMA—had spread from the cavernous clubs of Manchester and Toronto to mainstream hip-hop culture: Missy Elliott named an album after it, Eminem boasted about writing songs under its influence, and more recently, Jay-Z gave it a cameo in his anthem "Empire State of Mind" ("MDMA got you feelin' like a champion").

For ravers and rappers, E stood for euphoria, energy, empathy, escape. It was the "hug drug," the "love drug." For worried parents and government officials, however, Ecstasy equaled psychedelic mayhem, as reports and rumors swirled that it could cause nervous breakdowns, memory loss, Parkinson's disease, even death.

Yet MDMA's beginnings were innocent, even banal. In 1912 it was included as an intermediate chemical in a patent that the German pharmaceutical company Merck filed for an antibleeding medication. Then it all but vanished from sight until 1976, when the psychedelic researcher and former Dow chemist Alexander Shulgin—acting on a tip from a female student he has never named—synthesized MDMA in his lab and, as was his M.O., tested it on himself. "I feel absolutely clean inside, and there is nothing but pure euphoria," Shulgin wrote after his first MDMA trip. "The cleanliness, clarity, and marvelous feeling of solid inner strength continued throughout the rest of the day and evening." Therapists in Shulgin's circle began experimenting with the drug in couples and family counseling. One of them, Oakland-based psychologist Leo Zeff, dubbed the drug Adam for what he saw as its power to return patients to an Eden-like state of uncorrupted consciousness.

Untold thousands of practitioners have risked their licenses to use MDMA in underground clinical settings since 1985, when the drug was added to Schedule I (the Drug Enforcement Administration's category for substances with no accepted medical use and a high potential for abuse). To these therapists, MDMA offers the opposite of party-hard escapism—instead, they see the drug as a catalyst for digging deep into the human psyche. For the four or so hours that a dose lasts, it prompts a surge in serotonin and dopamine (neurochemicals associated with sensations of happiness and pleasure) and oxytocin (the chemical messenger of trust and bonding that, for example, mothers feel when nursing their babies). MDMA also tames the brain's fear center, the amygdala, and subdues the fight-or-flight response that pushes the nervous system into adrenaline-fueled overdrive in times of stress. Any apprehension a trauma patient might ordinarily suffer in therapy—about revisiting trigger memories or confronting painful emotions—is muted, but without the sedative effects of antianxiety medications. MDMA enhances the patient's powers of visualization, but without the involuntary hallucinations conjured by psychedelic drugs such as LSD or psilocybin. And MDMA has profound (and as yet mostly mysterious) full-body analgesic properties. An injured veteran or victim of abuse can suddenly enter a world free of pain. A rape survivor or a person with an eating disorder can grasp what it's like to be comfortable in her own skin.

Supporters of legalized MDMA therapy believe it can be applied in couples counseling and in treatment for depression, body-image disorders, chronic pain management, and end-of-life anxiety. But many advocates think its best chance at mainstream acceptance is as a tool for people with PTSD. Later this year, Michael Mithoefer, MD, a psychiatrist in Charleston, South Carolina, will publish the long-term follow-up results of the small pilot study that Sarah first heard about six years ago. The outcome: Seventeen of 20 subjects no longer met the diagnostic criteria for PTSD after just two or three sessions of MDMA-aided therapy led by Mithoefer and his wife, Ann, a psychiatric nurse.

"With MDMA, you not only see your fear but trust yourself to go past it," says Marcela Ot'alora, 52, a Colorado therapist who took MDMA under a psychologist's care in 1984 to treat PTSD stemming from an abusive relationship. "It shows you how to be kinder to yourself, and how much you're capable of. It allows you access to a place in your mind that's compassionate and full of love. You might have abandoned that place, but it never abandoned you."

PTSD is not as palpably physical a wound as a burn or a broken bone, but the disorder leaves a real physiological scar on the human brain. When a person experiences a traumatic event—a rape, a car accident, a tour of duty—the fear-stoking amygdala sends panicked messages to other regions of the brain, including the hippocampus (the brain's HQ for storing long-term memories). The adrenal glands flood the body with fight-or-flight stress hormones, searing fragments of the memory onto the mind with a fire that's hard to extinguish: Past events reignite in the present tense, taking the shape of nightmares and flashbacks.

What's more, anytime the patient stumbles on a trigger—the smell of stale cigarette smoke that she associates with her rapist, a backfiring car that sounds like gunshots in Basra—the amygdala reactivates and stress hormones crank themselves up afresh, reinforcing the memory and creating a vicious cycle. MRI scans of PTSD patients show decreased volume in the hippocampus and lower activity in the prefrontal cortex, both of which modulate the amygdala.

"A strong emotional reaction to extreme stress is normal and adaptive," says John Krystal, MD, chair of the psychiatry department at the Yale School of Medicine and chief of psychiatry at Yale–New Haven Hospital. "In fact, many of the lessons of extreme stress are important—for example, a person who's injured in a car accident might learn to be a more careful driver." But PTSD teaches the brain some skewed and inflexible lessons. "Responding to threats with aggression is highly adaptive in war, but it can have disastrous effects on a marriage," Krystal says. "Or if someone is sexually assaulted, she may learn to mistrust all intimacy and end up depriving herself of emotional support that she needs to cope."

Emily, a 51-year-old horticulturist in San Francisco, showed symptoms of PTSD after she was raped by an acquaintance in 2003. "Most people can draw on a reserve of psychological strength when they need it," she says. "With PTSD, you exhaust all your strength just trying to get to work, pay the bills, feed yourself, and keep up the facade that you're a normal person. So when a little thing comes along like a flat tire or a coworker in a bad mood, all that's left is that fight-or-flight panic response."

For years after the rape, Emily slept terribly, and when she did, she kept having the same nightmare: "A guy—sometimes the guy who raped me—would walk into my home or my workplace and drive a knife into my chest, over and over. I'd wake up sweaty and panicked." She got drunk almost every night. When she was having sex with her boyfriend, she couldn't close her eyes because she'd see her rapist's face. Her temper was short. At an office where she worked, a former coworker brought in her infant one evening. "She was changing the baby's diaper on a table, and I just started screaming at her—I went totally off the wall. That's when my boss took me aside and said, 'You need to get help.'"

The paradoxical power of trauma is that it hides in plain sight; its potency depends in part on the victim's never really looking it in the eye. "PTSD is maintained by avoidance," says Barbara Rothbaum, PhD, director of the Trauma and Anxiety Recovery Program at Emory University. "The memory gets frozen in time, and it's often tangled up with feelings of guilt and responsibility. You have to look at the trauma closely and break down your fear of the memory, so you can start thinking about it differently. But you can't think about it differently if you can't even think about it."

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."

After MDMA was placed on Schedule I in 1985, illicit use of Ecstasy skyrocketed and the drug's reputation grew ever more demonic. On a 2000 MTV special, nuclear radiologist Dominick Conca, MD, presented a cautionary brain scan showing what looked like actual holes in the gray matter of a heavy Ecstasy user, Lynn Smith; the following year, Smith and her scan appeared on an episode of The Oprah Winfrey Show. But although the high-contrast image seemed to be proof positive of MDMA's powers to turn young minds into Swiss cheese, it in fact merely depicted variations in cerebral blood flow.

Even peer-reviewed scientific journals were vulnerable to Ecstasy panic. In 2002 Science published a sensational paper by Johns Hopkins neurologist George Ricaurte claiming that injecting recreational doses of MDMA into monkeys and baboons causes dopamine toxicity—that it poisons and destroys the neurons that synthesize dopamine, which can result in early-onset Parkinson's. Two of the animals in the study died instantly. A year later, the paper was retracted in its entirety when researchers discovered that vials of MDMA had been accidentally switched out for methamphetamine. (An editorial in Nature called the mix-up "one of the more bizarre episodes in the history of drug research.")

Urban legends notwithstanding, MDMA undoubtedly has its risks. In addition to increasing heart rate and blood pressure, the drug causes the heart to pump less efficiently (increasing its demand for oxygen), which puts stress on the cardiac wall. MDMA can also clash with other medications (including the antidepressants known as MAO inhibitors) to cause "serotonin syndrome": The brain literally overdoses on its own reserves of serotonin, resulting in sweating, tremors, and hallucinations. In severe cases, the syndrome leads to hyperthermia (a dangerous increase in body temperature), which can cause seizures, renal failure, even coma and death. But serotonin syndrome is a risk with many medications that we think of as safe, such as the antidepressants known as SSRIs.

Some scientists speculate that MDMA could be just a rough draft of an effective PTSD drug. "Therapeutic MDMA didn't come about through rational drug design—it fell into their laps," says William Fantegrossi, PhD, assistant professor in the department of pharmacology and toxicology at the University of Arkansas for Medical Sciences. Fantegrossi wonders if, through trial and error in the laboratory, a research chemist could uncouple the signature flourishes of the MDMA "high"—the mental euphoria, the sensory rapture—from its healing powers, crafting a prescription drug with far less potential for abuse. "If we could take MDMA as a starting molecule and tweak it to get rid of the intoxicating effects, the accelerated heart rate, the hyperthermia—who would have a problem with that?"

But even if MDMA could be given a low-intensity makeover, many psychologists would point out that people with PTSD already have an extremely effective option for healing trauma—one that's clinically safe, drug-free, widely available, and perfectly legal: prolonged exposure (PE) therapy. In PE, patients rake over the details of their trauma in eight to 15 weekly sessions; between appointments, homework assignments include listening to recordings of sessions and visiting triggering environments (a walk down the street where you were mugged, perhaps). A completed course of PE therapy is reported to work in up to 95 percent of cases—a stunning success rate. But the number of dropouts hovers around 20 percent, and no one knows how many potential patients count themselves out of the difficult, rigorous protocol before giving it a chance.

The pioneer of PE therapy is Edna Foa, PhD, professor of clinical psychology at the University of Pennsylvania and director of its renowned Center for the Treatment and Study of Anxiety. Foa says she was intrigued when Michael Mithoefer first described his MDMA study to her. Then she watched a video of a session. "I didn't know what was going on there. I was alarmed," she says. "Two therapists, a husband and wife, in very close physical proximity for hours to a patient who looks very drugged. The patient just talks about whatever he or she wants to talk about, and gets a lot of support. The therapy doesn't make sense to me.

"It's not that I'm so conservative," Foa continues. "But I am conservative with regard to the well-being of my patients. With MDMA, you're submitting your patient to a drug that you agree you have to be very careful about, and from what I can tell, you don't get better results than you would otherwise. I would like to see a much larger, much more well-controlled study that can be replicated with a high probability of success before I get everybody excited about it."

Psychotherapist Elna Yadin, PhD, also of the Center for the Treatment and Study of Anxiety at Penn, shares her colleague's reservations. Recovering from PTSD "requires a lot of hard work, but when you make that investment to break this disorder, you feel so good about yourself," Yadin says. "Research shows that, in psychological treatment, if you get healthy from a medication you've taken"—instead of a drug-free treatment such as PE—"it's not as satisfying.

"I joke with my patients: 'My magic wand is on back order from the magic-wand company, and it might never show up,'" Yadin says. "People are impressionable, and you have to be careful about what you give them. They want hope. They want magic. There is no magic."

In the days and weeks after her two MDMA sessions, Sarah didn't think in terms of magic: The effects of her therapy were less cosmic, more workaday. But drop by drop, she says, these effects radically transformed her life. Suddenly she could sleep through the night, with the windows closed and the doors locked. Her cholesterol went from 260 to 165, and stayed there. She attended spin class faithfully, drank less caffeine, ate better. "I didn't learn from the therapy that chips and cheese puffs are bad—I knew that," says Sarah, who's now in her mid-40s. "But I lost my interest in self-sabotage. I wanted to take care of myself." Her relationships with her close friends and young son subtly changed. "I was able to be present with them rather than feeling obligated to be the court jester, making jokes all the time to deflect my anxiety. I was so much calmer. The paranoia went away—the fear that I wasn't good enough, smart enough, or pretty enough to interact with them.

"There's part of me that would have wanted the classic psychedelic journey, the great shamanic experience in the Amazonian rainforest or whatever," she says. "This therapy didn't do that. It taught me to eat well, to wear my seat belt. The little things in life, so I can get through the day or sometimes just get through the minute."

Some minutes are easier to get through than others. Sarah's father died two years ago, and "he was mean to the end," she says with a rueful laugh. "But I had forgiven him at that point, and I just wanted to be there for him. Because of the therapy, I was able to feel empathy." A year later, Sarah lost her job as a social worker; after many months of looking for work, she found a position as a substitute teacher. Money has been tight. She has started smoking again—though nothing like before, just a few sneaks a day.

"I do think one more MDMA session would have helped me integrate what I learned into my daily life better," Sarah says. She wishes therapeutic MDMA were legal, but says she'd never take it underground. "I'm too well to go that far."

Yet despite the decades of bad publicity, illegal MDMA therapy—to treat PTSD and just about anything else—remains in quiet demand. It's especially popular in pockets of northern California, where, judging by anecdotes from the clinicians and patients with whom I spoke for this article, an MDMA journey or two is virtually a rite of passage in many upscale, well-educated circles.

"I have lawyers, appellate court judges, doctors and surgeons, teachers, Stanford graduates, Harvard graduates," says a West Coast therapist whom I'll call Beth. "I've had rabbis and priests. I had a 75-year-old nun. It's not just the hippies. It's often people high up in their fields, very centered professionals who have come to a place in their lives where they're stuck." When a fellow MDMA therapist suspected that a patient's spouse was about to report his work to authorities, Beth reached out to a lawyer for advice. "Here's this mainstream criminal attorney, and he says, 'I need to tell you something: My wife and I did that in couples therapy. It saved our marriage.'"

But even the drug's fiercest advocates will say that for MDMA to save a marriage, it has to be a marriage worth saving—the substance can unearth buried love, but it can't create love from scratch. It can't implant an empathy chip in a sociopath or strip the egotism from a narcissist. "I don't think MDMA can give you access to an emotional experience that's not already within you," Ot'alora says. "It's not a miracle drug."

Of her patients, Beth says, "My work is to allow them to empower themselves to take charge of their own lives. It's not up to me and it's certainly not up to the drug." She has "zero tolerance," she adds, for recreational use of MDMA.

I've watched DVD footage of a few underground MDMA sessions, such as the ones that Beth leads. Somewhat like Edna Foa, I felt befuddled, uncomfortable. Patients seem dazed; they murmur slowly and slurrily about love, love, loovvve. These blissed-out voyagers may be reveling in newly discovered gifts of mental clarity, but those powers aren't visible to the naked eye. Foa is right: Even if, like me, you've spent countless hours reading about MDMA therapy and speaking with patients and therapists, it's impossible to grasp what MDMA feels like from the outside. So with some trepidation, I decide to try it from the inside.

On a rainy October day, I'm in a borrowed apartment in downtown Manhattan, chatting quietly with an underground therapist I'll call Eli. (When I ask Eli where he gets his product, he replies, "My friend has a friend with a lab," with a firm smile that says, End of discussion.) It's been 20 minutes since I swallowed about 125 milligrams of pharmaceutical-grade MDMA, and I'm detecting an anticipatory rumbling in my cortex: electrical signals are popping and whirring, neurotransmitters are choo-chooing into place. "Something is happening to me," I tell Eli, who murmurs, You're okay, everything is okay, all you need to do is breathe. "I'm going to go over here for a bit," I tell him—by which I mean I'm going to sit exactly where I am on the sofa, drop my chin to my chest, and bury my face in my hands.

For a while my five senses cohere in a synesthesia of inhale, exhale, inhale, exhale, like the surge and fallback of the ocean lapping the shore. A flash flood of dopamine, serotonin, and oxytocin is pouring through me, setting my teeth chattering. I'm overwhelmed yet not anxious; my mind's fear center has been put to a peaceful, dreamless sleep, like Dorothy in the poppy field. Imagine the instant right before orgasm or before a roller coaster tips over its peak height, then stretch that instant to the length of a pop song—or maybe two songs, or three. Imagine every pore and molecule in your body yawning open, vibrating with the effort, an exhilarating stretch that reaches almost far enough to touch pain.

A religious person might say that her circuit boards were jamming with the light of God. A transcendentalist might feel the boundaries between himself and Creation joyously dissolving. As for me, I'm aware as never before of my mind and body as an astounding machine: the sponges and honeycombs of my pumping lungs, the dendrites tickling toward my glowing cell bodies.

At some point I lift my face from my hands and turn toward Eli. It's deeply strange, yet pleasant and not at all startling, to see him still sitting there on the opposite side of the couch. The vaguely pulsating room is like a David Lynch movie stripped of dread—as if I'd closed my eyes and woken up in a parallel world where everything looks and sounds almost the same, but isn't. Eli appears crisper, more distinct, yet there's a delicate gauze hung between us. As I begin to speak, the lower range of my voice purrs and buzzes—my words are velvety physical things, trilling against my throat. I feel like I've just emerged from anesthesia, only there's no lingering grogginess. I'm clear, lucid, on point.

I rub and stretch my legs and walk about, and wonder why I don't pay more attention to these ingenious contraptions that move me around all day. I sit on a futon, pushing and pulling my hands against the duvet and squeezing the pillows, delighting in a sensation that has been available to me forever. I talk about my childhood and my amazing husband and how much I love swimming and cycling and coral reefs. I talk about the ways I squander my time and my talents—but my attitude toward these shortcomings is kindly and curious, not judgmental or self-deprecating per usual. I am ready to be at my own service. I say, "Everything seems possible right now." For three hours, I am swept up in a proactive, scientific empathy toward myself—a place where safety is euphoric, and euphoria feels safe.

Precisely at the start of the fourth hour, I tell Eli, "It's changing." The trip turns itself inside out. Hour Four is possibly the worst hour of my life. Waves of shame and humiliation shudder through me. I sit on the floor, knees to chest, sobbing with my whole body. I'm consumed with remorse for everything I've ever said or done, for the obscene calamity that is me. Old heartbreaks and embarrassments take on the jagged contours of monsters I can't quite see, screaming in my head. My mind is a slaughterhouse. If the first three hours of MDMA were a dream made real, Hour Four reveals them to be a fiendish practical joke.
"These thoughts don't belong to you," Eli keeps saying, gently. "You have to give them away."

After Hour Four, my mind is picked clean. It's hollow and badly bruised, like a pumpkin with its innards roughly scooped out. I'm aware of a panic just beyond my recognition. I can't stop saying, "My mind is blank." I point at a table. "That table has more going on in its head than I do."

Eli shrugs. "Okay, so be the table," he says. "People do years of meditation trying to get where you are now."

"But I don't want to be where I am now." I fumble around looking for—what? Frustration? Fear? Resignation? I can't feel my feelings.

"Your mind has run a marathon," Eli tells me. "It's exhausted. You've done good work here today, Jessica. You're going to be okay."

And he's right. In the weeks that follow, I read voraciously, I see more of my friends, I crave exercise. Junk food holds no appeal; nor does Facebook or other online time-wasters. I don't duck away from mirrors. When a colleague seems irritable, I wonder if she's having a bad day, rather than racking my brain for what I've done to upset her. Friends keep saying, "You're just different." Riding my bicycle through the park, I find myself engaged in a dopey interior monologue: "Hey, legs! You're doing a great job, legs! Go, go!" MDMA has turned me into a dork, and I like it.

In retrospect, I figure that hours one through three of my session showed me what was possible—a mindful existence defined by love, gentleness, curiosity, nerdy enthusiasm—and the diabolical Hour Four showed me the splattered-Expressionist-canvas version of what I do in miniature every day: flog myself for mistakes years after the fact, obsess over a poorly chosen word here or a social fumble there. It was awful to look at, but perhaps only then could I grab hold of it and throw it away. Though I tried MDMA out of professional interest, weeks afterward I feel like the beneficiary of a wildly successful scientific experiment.

Which isn't to say that there's anything scientifically valid about my MDMA experience. It's purely anecdotal, like most of what we know about this drug. Michael Mithoefer's study is the only one of its kind; his second trial of MDMA-aided therapy for PTSD is now under way in Charleston, focusing on veterans of the Vietnam, Afghanistan, and Iraq wars. The Multidisciplinary Association for Psychedelic Studies, which funded both Mithoefer trials, is also trying to get studies of MDMA-aided psychotherapy off the ground in Israel, Jordan, Canada, and Australia. Even if these studies are enrolled and completed, though, that brings the tally to perhaps 100 subjects—a statistical blip.

But here's another anecdote. A few weeks after my MDMA session, I accidentally e-mail a blank file to the entire editorial staff of O. Instead of what would normally happen—heart pounding out of my chest, flushing, sweating, apologizing compulsively, days of ruminating about how stupid and careless I am—my fight-or-flight mainframe simply does not respond. Nothing. It couldn't care less. As dozens of e-mails drop into my in-box ("Why are you sending this to me?" "What do you want me to do with this?" "???"), I politely respond to each one. Then I gaze out my office window at the blazing autumn colors of Central Park and absorb the, yes, ecstatic news that I've acquired a brand-new nervous system.

I don't fully understand how it happened. I don't know if this smooth-running equipment is only on temporary loan to me, or how durable it is, or if I could have obtained a similar upgrade with a placebo. By the time you read this, it may have broken down. But with every day that passes, this mode of being feels less and less like a drug-induced delusion or some kind of euphoric hangover. It doesn't feel like an escape from myself. It just feels like me.

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