Dr. Julie Holland on MDMA, Group Ritual, and the Business of Antidepressants
I make a point of distinguishing Ecstasy from MDMA. When someone takes a pill at a party or on a beach, nobody can be sure what's actually in it. In a research setting, by contrast, you can state plainly that the compound is MDMA. That said, it's obvious enough that people come together and take Ecstasy at house parties, while camping, at huge raves, or at something like Burning Man, and for many of them the experience does real therapeutic work. The sense of belonging, the flood of affection and acceptance, the oxytocin-driven bonding and trust that builds between people who feel they're part of the same tribe: that kind of connection can heal. Much of why people are so anxious and depressed and wound up comes down to isolation. Feeling plugged back into a group, feeling less alone, can genuinely help.
Erik raised a point some listeners might not know: MDMA can no longer be patented. That matters, because without a patent there's little money to be made, which is part of why pushing it through the approval pipeline is such a slog. He asked how a drug like this might threaten Prozac, Zoloft, and the other compounds that manage symptoms without actually curing anything.
I have a book out called Moody Bitches, and part of what I'm doing in it is pushing back against the SSRIs. They're handed out far too freely. People have options, changes in how they structure their days and their lives, that can leave them calmer and happier without reaching for a prescription every time. But understand the scale here. Right now one in four American women is on some kind of psychiatric medication. Antidepressants are a multibillion-dollar enterprise, and there's a certain satisfaction in imagining MDMA-assisted psychotherapy chipping away at that. Globally, though, I don't see the SSRIs fading anytime soon.
For some patients, especially those carrying post-traumatic stress, these drugs mostly sweep the dirt under the rug. You end up with a lumpy carpet. What I want from MDMA-assisted psychotherapy is different: you haul the carpet out back, beat it until the grit falls out, scrub the floor underneath, then lay it flat again. No lumps. It's a harsher, more direct way to confront what's wrong, going straight at the problem rather than hiding it.