Under the Spell of MDMA (Ecstasy): Feeling Close Does not Mean Acting with Empathy

Do inner feelings of euphoria and closeness that come with the “love drug” actually translate into observable empathic behavior?

We often judge ourselves as having been changed by experiences that make us feel better. We believe that this makes us better people. Could we be fooling ourselves at least some of the time?

I confess to once taking 3 tablets of MDMA in a Dublin bar. I did not tell the Irish-American psychologist who unexpectedly joined me at a front corner table. He soon was thinking that he had acquired new brilliance in explaining multilevel statistical modeling to me. He was delighted that I shared his fondness for the potatoes cooked five different ways that his distant Irish relatives had served him the night before.

I kept hydrated by matching the psychologist's beer intake. Eventually, I went to the toilet. Luckily, my need was not urgent. I only wanted to enjoy my good spirits while taking a break from talking about statistics. It took me 20 minutes to cross the backroom on the way to the toilet.

I felt I could not pass up dancing with the dreamy women who swirled about like faeries, their feet barely touching the floor. They also appeared under the influence of ecstasy.

We did not speak and made little eye contact, but one of them made the first overture in accommodating me in their movements as I attempted to walk by.

I fell in love with neither the statistician, multilevel modeling, nor boiled potatoes with parsley, but no garlic or hot sauce. I felt somewhat attracted to the young Irish women, but I at most touched fingertips with some of them before moving onto the next one.

The next day I felt drained, not really depressed, just blah. I concluded that MDMA had minimal abuse potential, at least for me.

This was an uncontrolled, unscientific self-experiment conducted in an unromantic setting with a drug for which the circumstances under which it is taken matter a lot.

I had no direct comparisons between my experience that afternoon and visiting that bar without the drug while believing I had taken it. That would be what scientists who conduct drug trials call a blinded comparison.

The episode occurred at a time when lots of other mental health professionals were experimenting on themselves by taking the drug.

Some couples therapists were acquiring a reputation for discretely conducting sessions in which their clients ingested what was already being called the love drug. The therapists could have lost their licenses or even could have been arrested for treating clients with an illegal substance of no proven therapeutic value.

A book, Love Drugs: The Chemical Future of Relationships, has just been published and contains interviews with two psychiatrists who treated couples with MDMA in the 1980s. The authors, Brian D. Earp and Julian Savulescu raise some important moral and ethical issues about chemically repairing relationships, particularly marriages with young children who at risk of growing up living with only one parent if there is a divorce.

All of this enthusiasm for the mental health benefits of MDMA takes for granted that some highly subjective inner experiences of euphoria and connectedness will translate into empathic behavior and better relationships.

I studied psychological coping for many years, part of the time as Co-Principal Investigator with Richard Lazarus on the Berkeley Stress and Coping Project that produced the Ways of Coping Checklist. I concluded that after 1000s of studies, our understanding of human coping remained quite rudimentary.

As a coping researcher, I could not tell myself the psychotherapy trainer much except “It’s complex.”

I was also convinced that translating the good feelings and intentions developed in a therapy session into effective coping and better relationships in everyday life was a very uncertain process.

Feeling good is still a long way from doing good and from changing relationships on a lasting basis.

A new study tested these assumptions about the process. It was conducted in the laboratory of Professor David Nutt at Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London. The former drug czar for the U.K., Professor Nutt is serious about promoting the safety and medical usefulness of MDMA and other psychedelics as mental health treatments, particularly in drug-assisted psychotherapy.

Yet, Professor Nutt and his research team required evidence. They tackled some open questions by adopting a skeptical attitude toward whether the warm feelings reported under the influence of MDMA actually translate into observable differences in behavior.

This study is small and far from perfect, and its conclusions could prove incorrect in future research. Regardless, I think the study is valuable because it gets us to stop and think about whether some things that we thought we know are not true.

Even readers who don’t care about ecstasy or who are anti-drug can find something of value here.

We often judge ourselves as having been changed by experiences that make us feel better. We believe that this makes us better people. Could we be fooling ourselves at least some of the time?

People who meditate and who pay attention to positive psychology assume that changing their inner life will automatically lead to better relationships and a better world. Maybe this is not so, at least not all the time.

Depending on our expectations, things like sham acupuncture or taking homeopathic remedies change our subjective sense of well-being. This can fool us into believing that these feelings are accompanied by changes in bodily function and behavior. Lots of research indicates that we can be mistaken. That is what placebos are all about.

First, what is MDMA/Ecstasy/Molly?

• 3,4-methylenedioxymethamphetamine (MDMA) is a synthetic drug that alters mood and perception. It is chemically similar to stimulants and hallucinogens.
• MDMA acts by increasing the activity of three brain chemicals: dopamine, norepinephrine, and serotonin.

The evidence for MDMA in combination with psychotherapy being effective for PTSD (post-traumatic stress disorder) is rated as being of moderate quality in a recent review funded by the US Department of Veterans’ Affairs that found only 4 studies.

I can find no evidence one way or the other for the effectiveness of couples therapy conducted with clients under the influence of MDMA.

The study

Borissova A, Ferguson B, Wall MB, Morgan CJ, Carhart-Harris RL, Bolstridge M, Bloomfield MA, Williams TM, Feilding A, Murphy K, Tyacke RJ. Acute effects of MDMA on trust, cooperative behaviour and empathy: A double-blind, placebo-controlled experiment. Journal of Psychopharmacology. 2020 Jun 15:0269881120926673

A total of 25 participants were selected after being screened for mental and physical health problems. They were deliberately chosen for low levels of anxiety and depressive symptoms. There were 7 women and 18 men with a mean age of 34. The participants had all had used multiple drugs. All of the final group had previously used MDMA at least once, with a range from once to 100 times.

In the first of two sessions in which the drugs were administered, participants completed some baseline subjective self-report ratings. The six self-report ratings included the participants’ level of empathy, trust, and cooperation. They then received a capsule containing either 100 milligrams of MDMA or a placebo capsule with 100 milligrams of Vitamin C.

Participants completed same the self-report ratings two hours later, played some computer-based games in the third hour, and completed the same self-report ratings in the fourth hour.

The research team chose computer games that allowed them to look at social processes they believed to be important for MDMA’s having any benefit as an add on to psychotherapy: trust, cooperative behavior, and empathy.

In between sessions with the drug, participants came to the laboratory, but only completed the self-ratings, without playing computer games.

In the second session with drugs, participants “crossed over” and received whatever drug they had not received in the first session, MDMA or Vitamin C. The rest of the protocol was the same.

Neither the research assistants nor the participants were informed which pill the participants were being given.

The investigators were interested in the interaction between group assignment and the passage of time in predicting subjective self-ratings. Presumably, the participants would be the same at baseline but would diverge over time, depending on whether they were in the group getting MDMA or Vitamin C. The two groups at first the same, but get more different over time.

That hypothesis held for whether the participants felt they had been given the MDMA. Participants who had actually been given MDMA increased their belief over time that they had received the drug, but those who had been given Vitamin C did not change their ratings.

The same finding held for self-ratings of euphoria and closeness. Being given MDMA again had an effect that increased over time that was not observed for Vitamin C.

There were no other significant effects of receiving MDMA versus Vitamin C on self-ratings of being energetic, trusting of others, empathic, friendliness, wanting to be with others, compassion or amicability to others.

On the tasks, participants who had received the MDMA were no more likely to be trusting, cooperative, or empathic.

For instance, in a trust investment task:

Participants were told they had £500, which they could choose to invest in 20 different entrepreneurs. They were shown the face of the individual running the business and asked to choose an amount that they wished to invest. Participants were told they would be paid a proportion of the money they won.

Participants receiving MDMA were no different in the amount of money invested.

In an interview with a journalist, the researchers acknowledged some limitations to their study.

“An important caveat is that this was a study done in a fairly sterile laboratory setting where, which potentially limits its applicability to the real world. It was also done with people who didn’t have any of the psychiatric conditions that MDMA is being tested for. These factors give us the advantage of testing ideas in a controlled, simple way, but it may be that the tasks we used were too different from the very personal process of psychotherapy.”

The scientific literature concerning MDMA and MDMA-assisted psychotherapy is quite limited and full of contradictions. This study makes a modest contribution at a time when extravagant claims are being made without good evidence.

I recommend thinking about the results of this study to challenge some assumptions you might be making about yourself.

Life is difficult right now with the pandemic, economic hardship, social unrest, racial injustice, a divisive political landscape, and a climate crisis.

Maybe you can obtain some experience that you think transforms your inner self. Be skeptical about whether it causes you to do good for others.

There are lots of people in need who could use a little or a lot of help. If you would like, assist them in any way you can, but don’t burden them with your concern about feeling better about yourself. Best not to tell them why you are helping or make a big fuss to other people about it.

Suppose you are self-experimenting with drugs or mediation or whatever to find out if the inner change causes you to be more effective with others. Rig the experiment by deliberately doing something for someone who seems in need. That ruins the experiment, but the science of self-experimentation is usually flawed anyway.

Maybe you will even find that simply doing good for others or taking some risks with people you care about is a more direct route to feeling good about yourself than what you thought you had to do. There is no guarantee.