Doctor X

RICK DOBLIN spent high school reading big novels and thinking about big issues like the Vietnam War and worrying about big things like when he’d be able to muster up the courage to ask a girl for a date. Not long after his 1971 arrival as a freshman on the campus of New College in Sarasota, Florida, however, he discovered LSD and mescaline. He suddenly found himself tripping under the palm trees, dancing all night, jumping into the coed naked pool at dawn and generally slipping the shackles of his suburban Chicago upbringing. It was, in many ways, a typical college education of the early Seventies, and it had a typical ending: Doblin lasted but one semester. “And that’s not the worst of it,” he says. “There were three semesters in a year. I barely lasted three months.”

Not that Doblin hasn’t rehabilitated himself since then in fact, we are standing atop one of his rehab projects right now: a house he built when he was twenty-one years old, when he was so shattered that merely “to do something and go to sleep and come back the next day and find that it was still there was a great comfort.” Nearly thirty years later, it’s still there, and easy to find: You drive down a street in a typical Florida neighborhood of stucco ranches and bungalows with red-tiled roofs and lawns carefully cut around palm trees until a vestige of jungle appears on your right, and behind the tangle of green you can just make out a cedar-sided, rambling two-story house.

A knock on the fortresslike double door produces Doblin, a short, well-built man with a mop of curly hair who greets you with a hug and an elfin grin that makes him look younger than his forty-seven years. He proudly ushers you into one of the strangest interior spaces you’ve ever seen.

You go into the living room and stand in front of a granite fireplace, its soaring chimney adorned by carved wooden idols. You wander through the warren of spaces demarcated by wooden walls on wheels, notice the double bed hanging from chains beneath a skylight, the mandala inlay in a wall, the hand-carved mushroom switch plates, the gorgeous stained-glass windows, the riot of oblique angles. You climb the twisting staircase into the six-sided master bedroom that sits top and center, then up a ladder and out a window and up another ladder to the terrace astride the roof, all the while listening to Doblin’s nonstop narration of the theory and meaning behind the million details of this Frank Lloyd Wright-on-acid design, and you can’t help but think that what he is saying is true: that his house beckons you onward and upward and further and deeper into a world behind the world.

And then you realize something else: The house, which Doblin has named Arcturus, not only embodies psychedelic drugs’ universe-in-a-nutshell consciousness, it would be the perfect place to achieve it. Which is the point, he is quick to say. After he dropped out of school, he traveled for a few months, then returned to Sarasota and began to build a life, and eventually a house, that would have the ongoing, serious, intentional use of psychedelic drugs at its heart.

“I spent the next ten years reading, tripping and building,” he says.

But it wasn’t just about getting high. “I thought there was a link between the things I was doing with psychedelics and certain types of altruistic social consciousness and action” a thought that has inspired him to go where few psychedelic warriors have gone before: into the halls of government regulatory agencies, where he is attempting to get one of his favorite psychedelic drugs, MDMA, approved for prescription use.

Doblin thinks that MDMA is a unique, and uniquely beneficial, medicine. He says that because it creates a sense of well-being and fosters empathy and introspection without the risk of the frightening cognitive and perceptual distortions of other psychedelics, it can be a powerful aid to psychotherapy, one that “can be used in any situation in which people have to confront difficult, emotionally challenging issues, in which avoidance is likely and insight will be helpful.” This, he claims, makes the drug particularly useful in psychiatric conditions such as post-traumatic stress disorder, in which, it is thought, the daunting task of coming to terms with traumas like sexual assault is more than a person can face.

He also claims to have used the drug to help people dying from terminal illness handle their anxiety and depression and difficulty talking with their families. He says it’s also benefited couples whose marriages are on the rocks, and the “worried well” – people whose difficulties are below the threshold of psychiatric illness but are nonetheless likely to be the occasion for a trip to the therapist or a prescription for Prozac. And, Doblin adds, MDMA “can help us to study love and self-acceptance, to open a scientific window on processes that are a central part of human nature.”

These beliefs lie behind the task to which he has devoted himself for the past fifteen years. As the head of the Multidisciplinary Association for Psychedelic Studies – a nonprofit drug company whose headquarters are in Arcturus – he has doggedly pursued his ultimate goal: to make MDMA, which you may know as Ecstasy, safely and freely available to people who need it for medical purposes. This part of Doblin’s rehabilitation is not finished yet, but he’s closer than you might think, closer than most people know.

BEFORE TECHNO and trance, before the all-night rave, before it was the scourge of anxious parents and grim law-enforcement officials, before it was even called Ecstasy, MDMA, officially known as 3,4-methylenedioxymethamphetamine, was a favorite drug among a little-known, quasi-clandestine group of psychedelic therapists – psychiatrists, psychologists and counselors – scattered around the country. Many of them had long used drugs such as LSD and mescaline in their professions – sometimes exclusively, sometimes as part of a more mainstream practice. Indeed, one of the first proposed uses for psychedelics was as psychiatric medicines; they had shown great promise in the 1950s and early 1960s, particularly in the treatment of addictions. They had been the subject of many research projects, some of them infamous, particularly those run by Dr. Timothy Leary and his colleagues at Harvard.

But it wasn’t long before Leary, in full messianic mode, tried to bring the new tablets out of the academy and directly to the people. Psychedelics spilled out into the streets, and the nation was swept by hysteria about broken chromosomes and defenestrated daughters. In 1970, the Controlled Substances Act made most of the drugs illegal and drove underground the few therapists willing to take the risk. But MDMA wasn’t known well enough to be made illegal. So, not only was it a powerful therapeutic agent that rarely had negative side effects, it also could be used without the fear of arrest and imprisonment. And when it was “discovered” in the mid-1970s – it had actually been synthesized by Merck in 1912, for unknown purposes – it caused a small renaissance in the psychedelic-therapy profession.

Like Prozac, MDMA mainly affects the body’s levels of a chemical called serotonin. Also, like Prozac, scientists can’t fully explain why MDMA does what it does. We do know that while serotonin is manufactured everywhere in the body, in the brain it has a particularly important role: It is one of the neurotransmitters, the chemicals that carry nerve impulses (and, it is thought, information) across the synapses – the gaps between brain cells. Increases or decreases in serotonin strongly affect mood, sleep and appetite. Large changes in serotonin can lead to hallucinations and other altered states of consciousness.

MDMA’s effect on the brain is to hyperstimulate serotonin manufacture. The torrent that is unleashed brings about a state of consciousness in which it is difficult to feel anxious or depressed, or anything other than love and warmth and good will toward oneself and one’s fellow human beings.

This is the quality that got the attention of psychotherapists, some of whom have written of their work. Typically, they would give the drug to clients in an intensive, daylong session in which the barriers, both interpersonal and intrapsychic, which often make therapy slow going, were quickly and easily lowered. These accounts suggest that a client, buoyed by a sense of trust in both himself and his therapist, could talk about his deepest fears and misgivings about himself, relive his traumas and let them go, recover lost memories, see his problems in a new and constructive light and experience what life would be like if he were relieved of all anxiety. Therapists claimed that a single MDMA session, perhaps followed by infrequent “boosters” and coupled with talk therapies, could relieve depression and anxiety for a long time, perhaps even permanently.

One such case study comes from a therapist who calls herself Alice, and her client Dan. Dan was mildly depressed and prone to panic attacks; he also had unexplained shooting pains in his legs that plagued him whenever he flew – which his job required him to do often. Dan had been in traditional therapy for about seven months, with little progress, when he agreed to an MDMA session.

In the course of the session, Dan recalled something long forgotten: When he was in second grade, a ceiling had collapsed on his classroom and trapped him by the legs under his desk. His father, who was the school principal, and mother had refused to discuss the matter, urged him to put it out of his mind – which he had done, with the result, according to Alice, that he suffered from a typical post-traumatic stress reaction: low-grade anxiety and depression, mysterious physical symptoms and difficulty getting better. Dan never took MDMA again, but a year later he reported that the leg pains were gone, his anxiety was greatly reduced, he had fallen in love and was getting married.

Whether stories like this are mere anecdote or part of a record that lends scientific credence to the therapeutic claims about MDMA is unknown partly because the therapists who used it, mindful of what happened with LSD and psilocybin, kept their work very quiet. But still the drug slipped out, turning up on college campuses and in nightclubs (and acquiring its familiar nickname) in the early Eighties. In July 1984, the Drug Enforcement Administration declared its intent to outlaw it. The MDMA therapists had been so quiet that the DEA was taken by surprise when it was served with a petition, signed by researchers and clinicians (and hand-delivered by Rick Doblin, who was once again a college student, now getting academic credit for helping to sue the DEA), asking for a hearing on the subject, which was held in 1985.

After a tumultuous three years, and despite an administrative-law judge’s recommendation that MDMA be made a regular prescription drug, the DEA prevailed, and MDMA was permanently placed on Schedule One in 1988, the same category designated for heroin and marijuana.

Some therapists continue to practice with MDMA – for instance, a married couple whom I will call Charles and Virginia. They met with me in one of the offices on the West Coast where they practice psychedelic therapy entirely illegally. Charles is in his late forties, Virginia is fifty. Both have advanced degrees and many years of training as psychedelic therapists.

They work largely with clients referred by a network of psychiatrists and psychologists – mostly people who have not been able to overcome their problems in any other way. (“They’re desperate when they come to us,” Charles says.) The couple speaks with a measured clarity and professional precision that is not unlike what you would expect from their law-abiding colleagues in a discussion about Prozac and Xanax.

In the last decade, Charles and Virginia say they have administered to more than 500 people the whole range of psychedelic drugs in a three-day treatment: The first day is spent getting to know the client, finding out what they want to get out of the treatment and deciding what drug is best for them. (“The drugs are like surgical tools once we understand the person, we can say that MDMA or LSD or psilocybin is the right one,” says Charles.) The second day is the “session work,” during which the therapists guide the patient through the drug experience, encouraging them to face the psychological difficulties they encounter, offering whatever help and support and insight they can. The third day is for debriefing, for starting the process of integrating the experience into their everyday lives. And sometimes the third day turns into a fourth and fifth “We don’t send them back until they’re ready to go,” Virginia says.

“MDMA is very different from the other drugs,” she adds. “It gives a framework, a safety net. It’s really good to start psychedelic work with.” Beginner drug or not, “MDMA gives you a brand-new relationship with yourself,” she says, something that is very helpful in a case like the one that Charles described. A man came to see them, and after his first MDMA experience, started having strange dreams. In the second session, they encouraged him to explore the images from those dreams, Charles says, to “really let himself stay with them and see what they meant to him, and the memories came back. When he was thirteen or fourteen, his uncle abused him. All this stuff came at him. And it triggered something very helpful in his life. He looked at his relationship to his sexuality, to women, to men. His marriage was falling apart, he was screwing around, he had a hard time being honest, and this one experience shifted his whole outlook. He’s still married, he’s happy. He did the sailboat trip he wanted to do all his life. But he needed this powerful therapy to get his life in order.”

Charles and Virginia are not the only people practicing psychedelic therapy. “The West Coast is full of people doing it,” Charles says.

THE STORY of legalized MDMA, if it ever comes to pass, will have to be told by starting with Rick Doblin’s own drug tales, about which he is open – disarmingly so. These aren’t the war stories of a twelve-step meeting, or the half-regretful, half-nostalgic accounts of youthful experiments gone awry. They’re stories about what makes a man undertake the task of getting the United States government to give its seal of approval to a psychedelic drug.

We’re out in the full and unrelenting sun of a Sarasota summer, and we’re talking about his first semester at New College, when he was tripping frequently (many times on the same sunbaked wall on which we are sitting). It wasn’t all good times, though. In fact, it was the bad trips, some of them harrowing, that started Doblin down his strange path. A counselor at the school, hearing Doblin’s account of a bad trip (and his wish to figure out how he could get back to good trips) gave him a copy of Realms of the Human Unconscious, a book by psychiatrist Stanislav Grof, one of the leading psychedelic researchers of the Sixties. Under the book’s influence, Doblin came to feel that he had set himself unwittingly on a therapeutic course, that his bad trips were the result of his alienated emotional life and that his task was to make himself whole a process that could be aided by psychedelic drugs and that would make their use more rewarding in the bargain.

Doblin’s quest for wholeness didn’t allow him to settle for a life of navel-gazing on the margins of society, waiting for the day when the whole world would change. “This is not a revolution,” he proclaims. “Leary’s idea of revolution is that you start fresh and then it’s glorious paradise for everyone. You’re all enlightened because you had this one experience. But the idea that there’s an away we can all go to, that that’s somehow an ethical choice when there’s such struggles going on in the world, that’s a mistake. I’m trying hard for the opposite, which is integration.”

The key to Doblin’s hopes to integrate MDMA into the mainstream is science – generating the data that will prove the claims about the drug’s therapeutic value. But scientific inquiry, for Doblin, is no mere game to be played because the authorities require it; nor is it a reduction of the cosmic significance of psychedelic insight to the mundane terms of a textbook.

Rather, he says, “Science is holy,” a maxim that came to him when he witnessed some of the early research into MDMA neurotoxicity. Doblin had arranged for studies to be done on the effect of the drug on dogs’ brains – research that required them to be killed. He describes watching the scientists euthanizing the dogs, then opening their skulls and removing their brains.

“I felt that there was something so feeble and pathetic about our attempt to understand life in these simple ways,” he says, “but I also felt there was something sacred about this that these procedures were the mind of man trying to make sure that what we found was really out there rather than what we wanted to be out there.”

Taking the name of science in vain was, according to Doblin, among Leary’s biggest mistakes. Investigating one of Leary’s best-known studies – which claimed that prison inmates who were given psilocybin shortly prior to their release had lower recidivism rates than other parolees – he discovered that Leary had manipulated the statistics so they would say what he wanted them to say. Doblin is distressed by this, perhaps most by what it reveals about Leary’s character and how that stacks up against Doblin’s sense of the lessons of psychedelic drugs.

“Tim flitted on the surfaces, kept busy to keep away from things that were deep and painful. His message was, ‘You’ll take drugs and then you’ll know.’ The part about how you think you’re dying, going crazy – the struggle was left out.” Doblin shakes his head, and for a moment he sounds sad. “I’ve been inspired by him, but he covered up the dark side. Leary rose to the level of fraud.”

MDMA may not make you feel like you’re dying, but it may still have a very troublesome side – one that Doblin does not deny, despite the threat it poses to his cause: MDMA may be dangerous.

Some of the danger is not directly the result of the drug’s action. Tolerance develops very quickly, so frequent users have to rapidly increase their dosage, which leads to an increase in the amphetamine load the drug puts on their bodies. A large dose, followed by vigorous dancing and alcohol consumption in a poorly ventilated room the typical conditions of a rave can lead to dehydration, high fever, seizure, organ failure and death; according to government statistics, forty-seven people may have died in this fashion in 1999 (the last year for which statistics are available), and there were 2,850 Ecstasy-related emergency-room visits that same year.

Doblin’s company, MAPS, takes the position that MDMA’s risks can be minimized. They are a major supporter of DanceSafe, an organization that, among other things, sets up a small chemistry lab at raves to test the purity of ravers’ Ecstasy tablets and provide information on the dangers of dehydration and overheating. But Alan Leshner, director of the National Institutes on Drug Abuse, doesn’t believe that harm-reduction measures can make MDMA safe. “You can’t create that [low-risk] situation on a reliable basis,” he told me. “You don’t have control over a club. You only have control over the substance that an individual is taking.” People ought to be prevented from taking the drug, he adds, because “the data shows us that [MDMA] produces long-term changes to serotonin function. There is data that suggests that there are behavioral consequences tied directly to those changes. That sends to me a simple message – this is risky behavior.”

MAPS may be moving a little closer to finding out about the risks and benefits of MDMA in humans, at least for medical use. In 1999, Doblin received a letter from the FDA indicating that he has moved a little closer to his goal. The agency “has decided to allow the sponsor [MAPS] to undertake a proof-of-principle study without further preclinical data.” In plain English, this means that the FDA, on the basis of its analysis of the data (some of it generated by MAPS-sponsored research) about MDMA’s neurological effects, has decided that it is safe enough to give to humans in order to investigate its therapeutic effects. A MAPS-supported researcher has already designed a study of the effects of MDMA on pain and depression in terminal cancer patients. MAPS is helping to run a research project in Madrid in which MDMA is being used to treat female victims of sexual abuse who suffer from post-traumatic stress disorder, and FDA approval is being sought for a similar trial in this country. If studies like these can be implemented, and if the results are positive, then even officials like Alan Leshner will be hard-pressed to continue their opposition to the drug, at least for medical purposes. “If it works; if it’s a good randomized, controlled clinical trial; if it meets all the criteria and it’s a good medicine, wonderful – use it as a prescribed medicine,” Leshner tells me.

If Rick Doblin gets his way, there will be more human studies, and MDMA, should it prove effective, will eventually get approved as a prescription drug. He is uniquely prepared for this outcome – his Harvard doctoral dissertation includes a plan for how to regulate and bring to market a psychedelic drug. He thinks that at first MDMA will have to be stringently regulated, available only by direct mail to specially certified clinics that will administer the drug on-site and carefully prescreen and monitor their patients.

But unlike some medical-marijuana crusaders, Doblin freely acknowledges that therapeutic use is only the first step toward greater freedom, toward a policy that encompasses both the benefits and risks of psychedelic drugs to self and society. He even envisions a licensing process, in which people who have used psychedelics under supervision without incident and who have no history of mental illness get a license to buy and take the drugs independent of any physician or clinic. The government would provide neutral information about the dangers of drugs, and drug users would take it seriously, rather than ignoring the hyperbolic claims that currently issue from federal and state agencies. Users who abuse the drugs (and Doblin is clear that MDMA, like any drug, can be abused) would lose their licenses. It’s a loopy idea, to be sure, but no more loopy than the idea of spending $18 billion a year to make sure that citizens get high only on alcohol, nicotine, caffeine and Prozac.

“This is just the first step, getting the culture ready,” Doblin says. “It may take another decade or generation or even two generations, but there will come a point in time when we can introduce people to the idea of the therapeutic use of psychedelic drugs, and they won’t be as likely to freak out. They’ll see people who have gone through it and say, ‘Look at this guy. He’s supposedly healthy and experienced, and he’s used these drugs.’ ” Doblin, in many respects, is that guy, and he says he won’t rest until his lifelong rehab project is complete.