Editor’s Note: Today’s post comes from contributing editor Peder Clark. Dr. Clark is a historian of modern Britain, with research interests in drugs, subcultures, health, everyday life, and visual culture. He completed his PhD in 2019 at the London School of Hygiene and Tropical Medicine (LSHTM) and currently holds a position at the University of Liverpool.
Popular perceptions of MDMA (3,4 Methylenedioxymethamphetamine) are of its identity as “molly” or ecstasy—a good-time party-drug for young people around the world. So, flicking through the Guardian newspaper a few weekends ago, I was intrigued to read a feature on a recently opened clinic in Bristol, UK, that intends to use MDMA for psychotherapeutic purposes. The bio-tech company, Awakn Life Sciences, led by consultant psychiatrist Ben Sessa and clinical psychologist Laurie Higbed, is not currently able to offer MDMA therapy, and the newspaper reports that the company is “hamstrung by the current global legislation, which says the drug can be used only in an experimental setting.”
Consequently, the clinic offers ketamine-assisted therapy, initially focusing on alcoholism with ambitions to eventually provide treatment for “depression, anxiety, eating disorders and most addictions.” As the article makes clear, Awakn’s clinic is part of a much wider interest in what, it calls, “psychedelic-assisted therapy,” leading to a veritable “psychedelics gold rush” as investors sense a growing market.
By coincidence, I also happened to be reading Lucas Richert’s latest book Break on Through: Radical Psychiatry and the American Counterculture. As its title indicates, Break on Through is situated in the 1970s and features, among other episodes, the early years of MDMA-assisted therapy. MDMA was first synthesized in 1912 as a hemostatic agent (i.e. to aid blood-clotting and prevent bleeding) in the laboratories of Merck, the Darmstadt, Germany, based pharmaceutical corporation. Patented that same year, the company only occasionally mentioned MDMA in internal company documents up until the 1950s. Despite these inauspicious beginnings, the patent also contained a clue to one of its further usages, alluding to its potential use “as an intermediate in the production of therapeutic compounds.”
By the 1950s, the chemically similar and historically-linked substance MDA (3,4 methylenedioxyamphetamine) had found a variety of uses. The US military experimented with it as a potential “truth serum,” and pharmaceutical companies marketed MDA for selected medical purposes including as a cough remedy and appetite suppressant. As awareness of MDA’s hallucinogenic properties grew, the drug started to find its way into recreational use, “quickly develop[ing] a reputation for producing a sensual, easily manageable euphoria, thus its nick-name ‘The Love Drug’”.
MDMA was re-synthesized around the same time—the Californian chemist Alexander Shulgin claimed to do so in the mid-1960s—and some histories suggest that it was considered less toxic than MDA. Although Shulgin was unlikely to be the first to rediscover MDMA, he is widely accepted as being responsible for its introduction into clinical use through his friendship with psychiatrist Leo Zeff. Like LSD— as documented by Erika Dyck in Psychedelic Psychiatry—MDMA, sometimes accompanied by relaxing music, supplemented talking therapies in couples and group sessions and in one-to-one encounters.
While Zeff and other associates used in MDMA in “hundreds of [psychotherapeutic] sessions,” its potential as an intoxicant was also recognized. Indeed, Shulgin himself would refer to MDMA as his “low-calorie martini,” an understated description which belied the bacchanalian reputation Ecstasy would later attain.
By the mid-1980s, the Drug Enforcement Administration (DEA) estimated that MDMA was available in 21 states across the US and Canada but was concentrated on the east and west coasts—primarily in New York, California, Florida. The southern state of Texas, though, was one significant exception. According to some accounts of ecstasy lore, the nightspots of Dallas were responsible for ecstasy’s reputation as a drug perfect for dancing in nightclubs, as well as its unmaking as a viable psychotherapeutic supplement in the US.
As Richert relates, psychiatrists who were enthusiastic about MDMA’s ability to evoke “honesty” and lucidity from patient-users became concerned that recreational use would tarnish its reputation as had earlier happened to LSD. He writes that “clinical work went on secretively and mostly underground in an attempt to avoid the fate of LSD, which was criminalized and popularized recreationally.” Indeed, researchers were at pains to distinguish MDMA from existing psychedelics and coined new descriptors, dubbing the drug as “entactogen” or even an “empathogen.” Some researchers, though, rejected the latter term, suggesting it might be unattractive tp psychiatric patients, and that, anyway, “MDMA do[es] more than simply generate empathy.”
Of course, these secretive endeavors were in vain. MDMA made the journey across the Atlantic to a highly-receptive British audience, and its link with raves and dance culture was assured. The United States banned MDMA and classified it as a Schedule 1 drug in the mid-1980s, meaning that medical and therapeutic research on the drug was no longer possible.
Only relatively recently have these restrictions been relaxed, and some psychiatrists are now optimistic about its potential for treatment of Post-Traumatic Stress Disorder (PTSD). As Richert notes, in 2016 “researchers … applied for and were granted breakthrough therapy status with the FDA [Food and Drug Administration], which would accelerate the approval process.” This research, through Phase 3 trials, hopes to make “MDMA-assisted therapy into a FDA-approved prescription treatment by 2023.”
To borrow a phrase from the 2012 book by Ben Sessa, Awakn’s chief medical officer, MDMA’s recent revival, is part of the well-publicized “Psychedelic Renaissance” in psychiatry and the wider culture. Interestingly, Sessa makes a couple of cameo appearances in Richert’s book, talking about MDMA and, less obviously, cannabis.
I encountered Sessa at a workshop a couple of years ago, and I was intrigued by his persona: one part brusque consultant psychiatrist barrelling through his slides and throwing out p numbers to a mostly baffled humanities crowd, and one part aging raver with an evangelical glint in his eye eager to tell you about that night back in 1992. Indeed, Sessa is one of the founders of Breaking Convention, a “biennial multidisciplinary conference of psychedelic consciousness.”
To me, though, he seemed to want to to have it both ways: the authority of the medic and the counter-cultural cool of the psychonaut. Reading Richert’s book, I was reminded of Canadian psychiatrist Albert Hoffer’s description of Scottish radical psychiatrist and “therapist rock star” R.D. Laing. “I object,” Hoffer said, “to a masquerade (game) in which my colleagues take every advantage of their M.D. and comport themselves like non doctors.”
Beside my personal observations, this is where, I think, the crux of the “new” psychedelic therapy sits. The sniffy attitudes of the likes of Hoffer in the 1970s—appalled at the counter-cultural connotations—scuppered the prospects of MDMA, psilocybin, and LSD as legitimate clinical tools. Conversely, it strikes me that today, part of the therapeutic appeal of these substances to contemporary audiences (if not to all clinicians), is their “radical” nature. For micro-dosing Silicon Valley executives, for example, LSD is perhaps a throwback to hipper, more utopian times. Similarly, while MDMA researchers in the US are keen to distance themselves from the recreational associations of Ecstasy or “molly,” I wonder if, in an age of ‘90s nostalgia, bio-tech investors and potential patients feel differently about the drug’s reputation.
Sessa points out that recreational use has been demonstrated to have relatively low morbidity and mortality, which means that its countercultural reputation could be a help rather than a hindrance to MDMA’s progress to clinical acceptability. Richert, in accordance with the recent historiographical pivot towards interrogating the porous divide between “drugs” and “medicines,” suggests that, for 1970s American psychiatry, the tension between recreational and therapeutic use was unresolvable.
Whether this will hold true for the 21st century iteration of “psychedelic therapy” remains to be seen, but in the meantime journalists are happy to trade on the ambiguity.