E is for Ecstasy, Chapter 9

[Contents]
[Chapter 8][Chapter 10]

E for Ecstasy by Nicholas Saunders
Chapter 9: Psychotherapeutic use in Switzerland

The most extensive use of MDMA in psychotherapy has taken place in the USA.(135) However, when the US government outlawed the drug in 1986, this practice was pushed underground.(129, 134) The US Drug Enforcement Agency also requested the World Health Organisation (WHO) to include MDMA in the International Convention on Psychotropic Substances and so make the ban world wide.(94) The WHO appointed an Expert Committee to make recommendations to member nations, and these included a recommendation to follow up preliminary findings that MDMA had therapeutic potential.(15) Although Switzerland is not a signatory to the Convention, the Swiss government was impressed by this clause and decided to be guided by its recommendation. In December 1985, a group of psychotherapists in Switzerland obtained permission to use psychoactive drugs in their work including MDMA, LSD, Mescaline and psilocybin. They formed The Swiss Medical Society for Psycholytic Therapy(95), and besides treating patients with these drugs, members take one of the drugs together at twice yearly meetings. The word 'psycholytic' means 'mind-dissolving'.

Originally five members, all fully qualified practising psychotherapists, were licensed to use the drugs with their patients, and they were allowed a free hand without government interference until the summer of 1990, when a patient died while under the influence of Ibogaine, the psychoactive root of an African plant. Although Ibogaine was not illegal, the therapist involved was severely criticised for his conduct: he had administered the drug in France, where his license was not valid, and he had failed to screen his patients for health problems. The incident was a disaster for the Society: all its members were subsequently banned from using psychoactive drugs.

After a year and much diplomacy, permission was restored for the remaining four therapists to use MDMA and LSD, but with severe restrictions. They were only allowed to use these drugs with existing patients until the end of 1993, and under the observation of a professor at the University Hospital in Basle. The professor has made it clear that, although the therapists appear to have treated many patients successfully, their reports are regarded as anecdotal because treatment has not been conducted within the context of a scientific study.

Comparative study

This has prompted Dr. Styk to plan a comparative study examining whether psychotherapeutic treatment is more successful if it includes the use of psychoactive drugs. If the results of this study are positive, he will use them to support his application to extend licences.

The study will compare two methods of treatment: 'meditative' therapy combined with psychoactive drugs and breathing techniques combined with body work. Dr. Styk intends to use as subjects patients suffering from lifetime depressive neurosis, obsessive-compulsive behaviour and, possibly, eating disorders; conditions for which he believes treatment with MDMA and LSD is particularly suitable.

He will take on twenty patients of each type and treat them all himself, using a random method to select the ones to be treated with and without drugs. He will then study and report on the progress of both groups for one to two years. In addition, Dr. Styk will also present the authorities with a dissertation on past case histories. This is being prepared from the licensees' notes by a psychiatrist who has not used psychoactive drugs in his work.

Dr. Widmer believes a more confrontational approach to licence renewal should be taken. Rather than trying to appease the authorities, who he believes make their decisions on political grounds rather than clinical results, he wants to carry on giving treatment in whatever ways he sees fit. He originally persuaded the authorities to give their permission by being pushy, and he believes that a combination of insistence on being able to practice with LSD and MDMA combined with keeping on friendly terms is likely to work best. However, Dr. Styk also acknowledges that the decision as to whether to extend the licenses depends on factors other than the effectiveness of the treatment, such as whether giving approval might benefit or damage the careers of the officials who make the decision.

In January 1993, I attended the Society's annual dinner where I met about 30 members. I interviewed each of those licensed to practice at their place of work over the following few days.

Of the four licensees, only one, Dr. Bloch, uses MDMA on its own. I have included my interview with her in full, as it is the one most appropriate to this book and, I believe, gives a clear picture of how MDMA is used. Both Dr. Styk and Dr. Widmer also use LSD, and Dr. Widmer runs a training group for psychotherapists who want to learn the techniques. I have included notes on the differences between the way they work and Dr. Bloch. The fourth licensee, Dr. Roth, has stopped using psychoactive drugs, and I include his reasons for making this decision. I also mention the activities of some of the unlicensed members who I met at the dinner.

Interview with Dr. Bloch

Dr. Marianne Bloch graduated in medicine in 1970, then went on to train as a Freudian analyst in the USA from 1974-76. From 1976-80 she trained as a child psychiatrist in Luzern, and since 1983 she has had her own private practice treating adults. Over the period 1980-90 she was trained in Organismic Body Therapy by Malcolm Brown. Over the past decade she has herself tried various psychoactive drugs.

Do you use LSD as well as MDMA?

No. Although I have permission to use LSD, and use it for myself, I have decided only to use MDMA with patients. LSD lasts too long, both for the patient and myself. In my own experience, I like LSD much better in a one-to-one setting. I don't like LSD in a group, and therefore I don't want my patients to use it in a group either.

What is the problem with using LSD in a group?

I become too sensitive. There were too many stimuli for me - I guess it depends on one's personality. The more I was able to allow things to come through, the more difficult it was for me to handle them. In a one-to-one setting it was OK, but I don't want to do it with patients.

Do you do individual work with MDMA or just group work?

I do both. Mostly I use MDMA in a group, but when there is a patient who needs complete attention I use it individually.

When did you start using MDMA with clients?

In 1989. At first it was with single patients, then later with groups.

What are the particular advantages of using MDMA? For instance, is there a particular character type or problem that it is suitable for? Is it perhaps only suitable when clients reach a block?

I use it with patients who are in an intense psychotherapeutic relationship with me. I usually start after six months or a year of ongoing therapy. Most of my patients come every week for individual therapy, and monthly to my Grof holotropic breathing weekends*. Among them are a few who I select for MDMA therapy as well. These are mostly patients who have difficulties with their feelings - even with the breathing work and body therapy they don't get deep enough into their feelings. So they are mostly character-armoured people.

Aren't all patients character-armoured people?

Yes, but there are some who have much weaker armour. For instance, oral people*. Their armouring is not as hard to get through.

So you use MDMA with the people with the hardest character armour?

Yes, I prefer to work with MDMA with people who have very hard character armour. These are, for instance, women with bulimia and some compulsive characters and depressive patients.

Are they extreme depressives?

I would say moderate depressives. And then there are the most rigid people who have difficulties in contacting their feelings. Mostly they had some symptoms beforehand but then during therapy, I mean body therapy, the symptoms went away. They are left with hard character armouring which prevents them getting to their feelings.

What about other groups such as people who have suppressed a memory of a trauma?

Yes, that is another group. For instance I had a woman patient whose problem was Bulimia, but then it came out that she was abused by her father, although she had no recollection of it beforehand. With MDMA she said "Oh, there is some incest problem" and I was very surprised as she had not mentioned it before, and now with the MDMA it comes out clearer and clearer. This person is completely out of her body, how shall we say it, yes completely detached from her body feeling and her emotional feelings.

Does the MDMA help her to become more integrated?

Yes, it helps a lot. It's the method that helps her most to integrate and to get into her body. She is much less armoured in normal life than she was before, but she is still armoured and this blocks her from feeling her body. Very often she says "I can't feel my legs" but on MDMA she says "I feel good, I can feel my body". It seems to have something to do with energy flow.

If you had not used MDMA with this client, presumably she would have made some progress just with the body work, massage, touch and expressing emotions?

Yes, but I am not sure that I would have come to that deep knowledge about her background, the incest problems with her father. It was so deeply covered, she had no idea it existed.

Did it take a long time to come out? Was it in the first MDMA session?

It was in the second. She had MDMA sessions alone because she was so frightened, and later she had sessions in the group.

How often do you run an MDMA group?

Twice a year.

That is very infrequent. Is that a policy or is that because it takes so much time?

I decided that because of the toxicity patients should not take it more than four times a year.

Now that new research shows that MDMA is not so toxic, do you think you might give it more often?

No, for me it is enough. Actually I don't want to use more drugs than I have to. I also get results with breath work and body work. With some patients, these methods work well. It is the hard core ones who sometimes need a push.

With what proportion of your clients do you use MDMA?

In 1990 it was forbidden and we were only supposed to complete our therapy with patients who had already been given MDMA. I strictly follow this ruling. There are only six patients now who continue and I am not allowed to use it on new patients. I have done MDMA sessions with 20 patients. Eleven of them could have continued, but only six really wanted to continue, so now I continue the treatment with these six. I don't use it as much as my colleagues, since I want to use the least chemicals possible.

Why did only six out of eleven patients want to continue using MDMA?

Two of them had become pregnant, and so could not continue. One thought that the holotropic breathing work had brought her as much benefit as MDMA, and decided to do without taking chemical substances. Another felt that MDMA opened her up too quickly and this frightened her. She too preferred the holotropic breathing sessions, where she had more control over the process. The last found it difficult to integrate the MDMA experience into everyday life, which, I believe, requires a certain intellectual capacity. After discussions with this patient, we decided together to discontinue the MDMA treatment.

Have you written any papers on your work?

No, I am not a paper writer. I recently gave a speech at the Luzern Psychiatric Association. But I just like to do my work.

Before the restrictions were put on, how many people were there in your MDMA groups?

Twelve. I didn't want to take more. And I always work with my colleague, another woman therapist.

Widmer told me it is important to have a male and female therapist present in a group.

Yes, I think it would be better to have a male and female therapist present, but it just happens that my colleague who trained with me in Psychotropic medication is a female. I did have problems with a man client - his problems had to be thrashed out with a man. It was very clear that I, as a woman, couldn't get to him any more, he needed a man. So he had to switch to a male therapist, because he needed a father figure with whom he could continue the therapy.

What doses do you give people?

125 mg.

You don't vary the does according to body weight?

Earlier, yes, there were some small patients and they got 100 mg.

Do you find MDMA is much stronger for some clients than others?

I don't find so much difference, no. Some take a longer time to get into it.

Do you give it in one dose?

Yes.

Do you take it yourself, or does your assistant?

No.

When you do the group work, can you describe how you do it, how formal it is, if you have any ritual attached to it?

We meet at 8 o'clock in the morning. We all sit around in the circle; say how we are feeling at the moment; if we have any news; how we feel about taking the drug. Of course these people all know each other because they have taken the drug several times together and go to the monthly breath workshops. They really don't have to introduce themselves any more. Then we do some meditation. We sit there in a circle, breathe and go deep into ourselves. It's like Zen. Then after a while my colleague starts playing the Monochord, a string instrument with only one tone. Then they take the drug.

Do you take it in a ritual way?

We just pass it round and take it. And then we eat some chocolate.

Oh! Chocolate?

Yes, it speeds up the effect of the drug.

Really? How is that?

Albert Hoffman [the discoverer of LSD] told me about it with reference to LSD, and he said that there are some receptors that it speeds up, and now we do it with MDMA and it seems to me that it works. They always have to take their orange juice, their pills and the chocolate. I think it has something to do with endorphines.

How long does it take to come on?

About half an hour. After they have taken the pills they lie down and my co-therapist continues to play the monochord.

Do you have any rules or agreements about how clients interact with one another or with yourself? How do you run the group?

Mostly I say that the patients are by themselves. They lie on the mattresses in their space; it's something that has to do with internal work and they have to stay by themselves. But lately I have started to say "Why don't you mix a bit?". Maybe they were looking around and would say "This person seems to be very sad" and I would say "OK, if you feel like going over to this person who you think is sad you can do so." I mean, I encourage them to communicate with each other. But this is new, in the beginning I wanted to keep each of them separate, just going into their own space.

How do you deal with the situation where the person might be feeling sad but actually not want someone to approach? Do they have to ask before moving?

Yes. A patient who feels they want to go over to another has to ask: "I would like to get closer to you, how is it for you? Do you want me or not?", and the other person has to decide. I tell them that they all have to be very honest. They have to feel for themselves what they want. Does the problem come up that you get one or two clients who draw the attention to themselves, and the others feel they have lost their opportunity? Is that a problem?

Of course, this might evoke an old problem. Maybe a sibling has had more attention and now it's a similar situation. They have to work with the sadness and jealousy that comes up.

When I stay with a patient, I always watch my own feelings, because there are some people who want to draw attention forever, they want to have me forever, and I can feel in my body exactly how long it is OK for me to stay. Suddenly I get the feeling it is no longer good for me and I just go. And then the patient has to deal with the loss, not getting enough attention, that's a very important experience.

So if it brings up these feelings it can be part of the therapy?

Of course, it is very important that it brings up feelings of disappointment, and not getting enough, and jealousy. That's why I do groups. Otherwise I could do it in a single session and they would have 'Mummy' all the time, but that is not life.

Do you ask people to keep their eyes closed?

Yes, when they start they mostly have their eyes closed, but later on they sit up or they talk, and can walk around to ask someone if they can get close to them. But sometimes I feel that they talk too much, so I say "You are too much outside yourselves" and then they all have to go back to their places. It just depends on how I feel the group is going.

Do you allow people to be alone in another room?

It depends. Very often people say in advance they will have to be in another room since they can't be together with so many other people. I say "OK, we will see when the drug is affecting you, then we will decide." So far I've never experienced someone who wanted to leave the group and be alone.

So after people have started opening up, what do you do next?

Then I play music on tapes. Mostly meditative music but also some with bass, rhythmic bass - it stimulates some feelings and activity. It's completely different to the music I use in holotropic treatment, because there the music is actually the 'drug' that stimulates the activity. With MDMA, the stimulus comes from the chemical substance, so the music has a different intent in each setting.

Do you use different kinds of music to stimulate people in different ways? To bring up aggression, for instance?

Yes, and sometimes also anxiety.

What kind of music stimulates anxiety?

It's some kind of dramatic music.

Film music from a thriller?

That's right. But people require different stimuli. I mean, it's not only music which stimulates feelings, but also contact. Sometimes it's very important that closeness between a patient and myself brings up a feeling of anxiety, because they are afraid of closeness.

Even on MDMA?

Even more so. I remember an obsessive-compulsive character who was never in touch with her feelings of closeness, and the last time with MDMA she really got in touch by being close, having close body contact and also eye contact. The first time she felt her panic by being close.

Do you use that as a technique, suggesting that people make close eye contact?

It depends, it depends on the situation. With this patient it was important.

The three of you who are practising using MDMA all seem to be doing body work. Do you ever do purely verbal therapy using MDMA?

No, not purely verbal. As I see it, that would be to stimulate just one level. But I believe it is very important that people use the MDMA to get into the body and out of the head. There are people who only want to talk, and after a while I just cut them off and say "No more talking".

Because it's separated from their feelings?

Yes. Of course. And from their awareness and sensitivity of the body, it's very distinct.

Can you give me a few more examples of when MDMA has been particularly useful?

One patient was an extreme stutterer who had been in therapy for a long time. With MDMA, she could really talk about her history for the first time - because before she was only able to write things on a slip of paper. With MDMA she spoke about her father, how she was held back and not accepted as a child, and all of her emotional feelings came up in regard to this theme.

So on MDMA she was able to talk freely?

Yes, it was incredible. It was also incredible how her body opened up. She started to breathe dramatically, and then sounds came out, and she could talk without difficulty. But it was also significant that after the MDMA session her stuttering came back. It was not as bad, but she continued to stutter.

So MDMA didn't cure the stutter, but enabled her to talk about her pain concerning her father.

Exactly, and this opened up a different area that could be worked with in ongoing psychotherapy afterwards. Material came up that was not known about before. And so this opened up certain feelings.

Couldn't she have overcome the problem by writing?

Although she seems to be of normal intelligence, she couldn't go to a normal school because of her stuttering. So her writing is slow and it would have taken too much effort to write everything down.

Do you think that she might be able to cure the stutter through MDMA?

She is a rather difficult person to treat. In the last session with MDMA she used her new ability to talk in a very intellectual way. So talking became a defence mechanism against feelings that were too painful for her to admit. But we will see.

Can you tell me about one of the Bulimia cases?

The main theme of one of the Bulimia cases is her fear of closeness and contact with her body. The Bulimia is cured, she doesn't eat and vomit any more.

Was she cured without MDMA?

Yes, after about two years of body therapy and breathing sessions the symptoms went away, but then she discovered different problems. She realised that she was not in contact with her body in normal life. Through MDMA she learned what it means to be in contact with her body.

How important do you think it is for people to have guidance from a therapist to make these connections and to get in touch with feelings on MDMA? What I am thinking of is the vast number of people who take Ecstasy in England, do you think they are bound to get in touch with their feelings anyway, or is the therapist's influence and therapeutic setting necessary?

The setting is important, and also a person who acts as a mirror. Sometimes I am the mirror. When I work with someone, I get in contact with my feelings and then I tell them exactly how I feel. If they have feelings which they can't admit to or which they are not aware of, I have these feelings, and then I become their mirror. For instance, I suddenly become sad and I know, "Oh, I have no reason to be sad". Then I know it is not my sadness, it's their sadness and that I am feeling it on their behalf, since they are not aware of it. Then I tell them "There is something I have felt that is not mine, can it be yours?" Then the person can go into their inner space and find out. As soon as they become aware of their feeling of sadness and express it, my sadness goes away. That is how I help them to become conscious of their feelings.

Do you use a video camera or tape recorder?

No, but sometimes they bring their own tape recorder. If they go on talking and talking I say "OK, you can use your tape recorder and continue, then I will listen to it later".

You don't encourage that as a technique then. Do you think recordings can be useful?

For some patients it might be quite useful, yes. I have one patient who always talks a lot about his childhood memories. For him this talking is also a defence mechanism, because he doesn't really get into his feelings. Afterwards he forgets most of what he said, including the important things. So I encourage him to use the tape recorder.

I think it is important to mention that I don't use any techniques in MDMA sessions. I make use of my soul, body and intuition. My main intent is to get into feeling contact with the patient and then see what emerges. Sometimes I ask a question, or give some nurturing touch; sometimes nothing. The other person always responds to my presence.

Do you ask people to bring things with them to the session?

Yes, sometimes I ask people to bring objects they like. One patient likes to bring stones, small things like that. Last time I asked them to bring a photo of themselves up to the age of three. This opened up the possibility to work with this period of life. With some patients I used it, others not, it really depends what they are about. I just give a suggestion and if it comes up it's OK.

What came out of that?

We looked at the photos together, and then they started to talk about their early childhood, because it brought up forgotten memories of that period. It stimulated memories of that part of their life.

Is MDMA useful for bringing back memories from childhood, or memories that have been suppressed because of pain, or just generally getting in touch with feelings?

All of those. With one patient I mentioned it brought back this incest problem, with another it brought back very early memories that as a child he had been sick very often, which he had forgotten. The emotional stuff of childhood came up, and he relived it again. Another patient realised for the first time with MDMA "Oh I have a heart, there is my heart beating. I never before could feel my heart beating" It was important for him to feel inside his body, he said "Aaaarrrh! Now I feel inside." For others it is important to get into their aggressive feelings. It's different for each patient.

Can it be too much sometimes, the sudden getting in touch with aggressive feelings?

I have never had any problems with it being too much.

That leads to another question. Have you ever had problems using MDMA and wished you hadn't used it with a patient?

I once had a problem with one woman, and that was when the drug was beginning to take effect. She was overwhelmed by the feeling of opening up. She was overcome by fear, and she screamed and yelled and then it was important that she had some body contact with me. That gave her enough support, and then she was able to go through this period of fear, and after that it was OK.

After what, half an hour?

It started half an hour after taking the drug, and lasted for ten minutes. It was really just when the drug started to take effect, the opening up. She was completely confused. Body contact with me made it OK.

You only use MDMA with a very few of your clients. Apart from legal restrictions, would you still not use it on some clients, and if not why not?

I would only use it with the more difficult ones. The ones I can't really get through to using holotropic breath work. I really don't see why I should use a chemical drug if I can achieve the same result without it.

Can you get the same result as easily without MDMA?

I would say with some, yes.

Is it that you believe the drug is somewhat toxic or habit forming, or by using a drug the result is not going to be as permanent?

I am just against drugs. I mean, in my practice I don't use medication unless necessary. I don't see why I should use drugs if I can get the same result without. I can't really say that MDMA speeds up the therapy that much. The patients who I use MDMA with are those who I have already tried treating with other methods, but I was unable to open them up so deeply. I would just be stuck, I would have to say "OK. That's it. You have to go".

Are there some people who are so armoured that MDMA makes no difference? Or will MDMA always go to a deeper stage with them, even when your other methods have failed?

I would say there are some patients with whom I'm not using MDMA because I'm scared they can't handle it.

What would happen if they could not handle it?

Perhaps they could not differentiate between the outer reality and their inner world, or they might mix the two states. For example, they may not be able to differentiate between myself as the bad mother of their inner world and myself as the therapist who wants to help them, and fight against me. Maybe I would try it in an inpatient psychiatric setting, but not when the patients have to go home afterwards and I can't follow them up closely. I'm not willing to do overtime. I only choose patients who I believe will be able to handle MDMA. I have my limits. I know someone who uses the drug with far more critical patients and he invests more of his time and effort, but I am simply not willing to do so.

Going back to your groups, what happens towards the end of the session?

After four and a half hours we have a break and I say, "OK, now we can go into another room where you can have some food and drink tea. Then afterward s you can go back and lie down again."

Do people want to eat? What do they like eating?

Fruit, and bread with honey. That brings them down from their altered state of consciousness into the real world again.

Do they stay quiet?

Very quiet. Very often no-one talks. Then they come back and lie down for half an hour. They see if there is anything else, any further effect of MDMA. And afterwards they all have to draw a mandala, a drawing of their experience.

When you say a mandala, can they draw anything, or has it got to be according to a structure?

Yes, we give a piece of paper with a circle on it and say "Draw a mandala." Of course they can also draw outside the circle. But it's also significant who goes over the limits and who keeps within the circle. They are used to doing this following the holotropic breath work, it's a method used by Stan Grof.

Afterwards we form a circle again and they just put their mandala in the middle, and then each of the patients talks about their experience. And maybe they give some explanation of the mandala. They also bring it to their next therapy session.

So what time does a group finish?

Usually it's around 5 o'clock. They go home by bus. They are not allowed to drive.

Is their next appointment the next time you see them?

Yes. Mostly it's within the next week, except for some who come fortnightly.

When you do MDMA sessions individually, with one client, is it very different?

It's different in that the person has constant contact with me and really doesn't have the experience of 'mother' going away. All those feelings of jealousy or whatever produced by the group setting are missing. Of course, they may gain in other ways such as having more body contact.

What sort of bodywork techniques do you use?

Massage, and I give some touch, nurturing touch. I also do some crania sacral work with them.

And do you get people to hit a cushion with a tennis racket, that sort of thing?

I use these hard techniques only in individual body therapy sessions in order to produce a feeling state. But with MDMA I never use any hard techniques because the feelings get opened up by the drug. If a patient gets into an angry state on MDMA, then I ask them to express the feeling by movements with arms and legs on a mattress.

Do you think the things that come up on MDMA can sometimes be misleading for a client?

What do you mean?

Well, they might have a realisation - such as the cause of some problem is that they were abused as a child or something - but actually it's become much more important than it is really. Perhaps they can see very clearly something that isn't right.

It can happen that sometimes the interpretation goes in a wrong direction, one that is not really the cause or the real root of the problem.

Do you think the real root of problems and true feelings come up more often with MDMA than without it?

I would say yes, MDMA definitely produces more real feelings, but I would say it is still possible on some level to project. And it is so important for me as a therapist to realise when the patient is projecting. I then feel an uneasiness in my body and I have to continue interacting with the person until I feel that the problem has reached its root or the projection has been resolved.

Do you think you are more sensitive to the patient as a result of your own experience with MDMA?

Yes, definitely.

Do you think you would be even more sensitive if you were taking it with the patient?

Probably. But I wouldn't dare to do so, because I also have to be able to react in a clear way. I would never do it.

However, I just realise that I have become more and more sensitive through my own therapy with psycholytic substances, and I guess this will continue, and maybe at some time I will not even need it any more because this openness might be a normal state for me.

Is the intensity of feelings increased under MDMA, or does it just increase general awareness?

It depends. I have one patient who doesn't have any feelings in real life. Only with MDMA can he get into his sadness or his aggression. It's not only the awareness, with him it's really the capacity to feel. He's so stuck in real life.

With someone like that, presumably he feels very good on MDMA?

Yes.

Is there a tendency for him to go and find it on the black market and take it at home?

No, he is too straight. I couldn't imagine him buying drugs on the black market!

But as a general point, if you have people who only feel good on MDMA then won't it become an addictive drug for them? What do you think about that?

It's astonishing, but I've never had this problem at all.

Don't any of your patients sometimes take drugs outside the sessions?

One of my patients used to take LSD when he was younger, but he says he would never do this any more outside sessions. He is much more afraid, more aware of what could happen. No, there are no drug users among my patients.

One thing that bothers me is that, well, bodywork is not completely accepted as straightforward psychotherapy, is it, and that if people are making body contact at the same time as taking a drug which is normally illegal, I can see that the picture of it from a politician's viewpoint may be that it is all rather dodgy. Do you see this as an obstacle to this type of therapy becoming officially accepted?

I think so, because for a psychiatrist trained in psychoanalytic therapy, well, this is really crude. Most psychiatrists are still not trained in body therapy. This is why it is not more institutionalised, besides many psychiatrists are afraid of body contact. So I don't think they will choose this method.

What sort of reaction do you have from the psychiatric community in Switzerland?

They show interest in hearing about it. I would also be prepared to work with my colleagues with MDMA, but it is all too frightening for them. They are too scared to use it on themselves.

Dr. Roth said he believed that MDMA was not worth using because the results didn't justify the time and effort involved. What do you feel about that?

For me it has been worthwhile with the patients I have used it on. Otherwise I wouldn't use it any more.

Have you taught any other psychotherapists to use it? Are they interested in learning from you?

No, I gave a speech at the Luzern Psychiatric Association, and I talked to them about Psychotropic breath work and about MDMA sessions. They said they were interested and there was an animated discussion about psychoanalytic and Psychotropic training, and about the ethic of opening patients up in such a quick way. Meditation has the goal of opening up people towards spirituality, and MDMA has a similar kind of effect, to bring people more in contact with their spiritual being. So these psychiatrists discussed whether it is acceptable to use these type of drugs for spiritual enlightenment, or only meditation.

So they were more interested in the intellectual analysis of the method than actually getting involved with it.

Yes, they were not interested in experiencing it themselves; they were not really interested in doing anything, only in discussing it.

What do you really feel the basic effect of MDMA is?

I would say it takes away fear, it takes away the superego of the patients - they allow themselves to feel more, to be themselves, to act the way they are; it also helps them to get more into contact with their body, into their physical body, to have more body awareness, and to get closer to their feelings. And simply to feel their needs. I mean, very often they have been totally unaware of their primal needs - needs of closeness, needs of touch, needs of heart contact.

In the groups, is the atmosphere happy, or is it mainly feeling pain?

When you take MDMA the first time it's beautiful. It opens up everything and you feel "Ah! That's great!", but later on it's much more difficult for the patients because they get into their sadness, into their pain, they realise where they are closed up, that they can't open their heart. So I feel the deeper you get, the more difficult it is with MDMA. This beautiful feeling of happiness goes away and you really get down to your deep problems, and then you can work psychotherapeutically.

Have you ever come across bad effects such as paranoia?

No, I never have. Perhaps because I choose my patients carefully.

What about physical bad effects? Unpleasant effects that get in the way?

Sometimes their jaws get tense. But it doesn't bother them.

Do they ever suffer from difficult aftereffects?

One patient felt she had some energy running through her body for a while. She could not stop the energy flow, she felt nervous and restless for about six weeks. That was the most difficult aftereffect I have ever seen.

Once a patient suffered for about a week from nausea. In the following individual session I discovered that the nausea had to do with unexpressed feelings of anger. When this was resolved, the symptoms went away.

Did she have a particular character type? Do you think you could recognize the type and avoid giving the drug to them in the future?

I would say she is not at all in the body. It was the first time and she couldn't really handle this feeling of being in the body. It was so new to her, and it was stress-producing. She couldn't handle the feeling of energy flow.

Do you relate MDMA to energy flow, such as the Chinese 'Chi' or Reich's 'Orgone Energy'?

As a body therapist I work a lot with energy, and I realise that with MDMA there is opening up especially of the block here [she put her hand on her heart]. It opens the chest block, then of course the energy flow is better, and it also affects the whole body.

So the energy flow is liberated. And do you think MDMA works by relaxing the muscles that store the neuroses?

Probably, it just opens up the blocks. Usually patients have held back feelings. When you have a block in the body it is because it is too painful to allow the feelings to flow. MDMA is able to open up the blocks because it also releases the feelings - or releases the feelings and then the blocks open, you can say it either way.

So it works on a physical level in the same way as bodywork?

Definitely for me, yes.

But I also use MDMA because of its spiritual value. MDMA is the drug that really opens up the heart, and in normal therapy I also work with opening up the heart. That, for me, is the main goal. For me it's not important that people are totally de-armoured, but that they get in contact with love; love for themselves. That is why I really like to work with MDMA.

Do you think this is a separate effect to the release of neurotic tensions?

For me MDMA is the drug that opens up the heart, and is much more specific than LSD. This is my main goal, to open up the heart and then to work from the space of the heart.

So that's the goal of your therapy, or do you think it should be the goal of all therapy?

That's my way.

So the goal of your method of working is to get in touch with the heart. Does that mean helping people to be able to express love, or to feel love, to know love in a non-sexual way?

Yes, I mean love for another person, love for themselves, love for the universe. I would say it is my way of doing psychotherapy to get them in touch with their heart. And whenever they are lost in some sort of anxiety or some sort of struggle, then I bring them back to their heart and say "Can you still feel your love in yourself?" This is just my way of binding them back to themselves. If you are in harmony with yourself, then all your neuroses just drop. If you are in the meditative state, then your problems just go, you don't even have to solve them. I try to work so as to make these neurotic things lose their value. And they very often get in contact with this state with their first MDMA experience. "Oh, that's how it could be. I could be open, I could be loving." And then I tell them "Do you remember how it was on MDMA, how all the other things dropped away?" I try to get them to be in touch with their heart again and with their feelings when they have difficulties in their life. They become more centred, they have more connection with their inner self.

Do you ask people to project into the future, for example if they have a particular problem with their mother, do you ask them to visualize being in that situation?

Sometimes, yes. I first put them in a good state, and then I say "OK, now see how it would be confronting your mother in this state".

I've heard it said that you can't feel love until you have learned to love yourself. Do you believe that?

I think so, yes. I believe in it. That only when you are really in contact with yourself, are you open enough to let love flow out.

Do you have clients in the group sessions who fall in love, or get very involved with each other? Is that a problem with MDMA?

It has never been a problem. Of course in the sessions they may have very good feelings for each other, but they have never had affairs. Maybe it's to do with the setting. There are only two women on the group, and they are very much preoccupied with themselves and do not mix very much with the others.

Do you think that people are suggestible on MDMA?

Not at all. I think they see things as they are more clearly. For instance, the Bulimic client I mentioned had thought she had invented being abused by her father, but on MDMA she saw it was true. She saw it very clearly.

Are there other problems with using MDMA? Perhaps patients get too close to you?

The transference problem is the same as with body therapy, but the situation of transference becomes more clear to a patient on the drug. They can see their projections more easily. When they come up to me during the MDMA session and say, "I love you so much!", I respond by saying, "See whether this love is something to do with you. Could it not be your newly discovered love for yourself?"

Dr. Styk

Dr. Juraj Styk is president of the society and has a private practice. His MDMA groups are similar to Dr. Bloch's, but his clients meet on Friday evenings before the Saturday session. He believes this is valuable preparation for reducing anxiety, and is especially useful for integrating new members. His wife assists him in the group, and he feels that to be seen as a couple is important when he is working with women. He also has one or two young psychotherapists assisting the group who are undertaking training with Dr. Widmer. There are usually eight to ten in his group. Dr. Styk goes around giving out the drug in ritual fashion to create an atmosphere "more like being in a church than a hospital", although he adds that he tries to avoid being seen as either a priest or doctor who can absolve or solve problems for the clients. While waiting for the drug to come on, he plays soft music and sometimes reads poetry. He asks members to close their eyes, breathe and let go. In order to make the group cohesive, he reports what he observes, such as some members being tense.

Dr. Styk and his assistants only attend to people when asked, unless they see that a client is stuck for hours on end: he prefers to allow people to go through the experience without being led. Rather than being goal-orientated, he encourages spontaneity and prefers clients to think in images.

Clients are allowed to go to other rooms during the group session so as to be undisturbed, but Dr. Styk says it's important to avoid the group falling apart through members dispersing.

Towards the end of the session, Dr. Styk will ask each person to report on how they are feeling. Then the group may all go out for a walk together if the weather is nice. At other times they may do a psychodrama in which one client acts out a revelation they have just had during the session, using other group members to play roles such as members of their family.

After the session, at about 7 pm, participants sit around in a circle on cushions and have a light dinner of such things as cheese, radishes and fruit salad, prepared by Dr. Styk's wife. They are not really hungry, but enjoy eating for its own sake. The situation of eating together sometimes triggers further insights. After dinner, at about 10 pm, clients go home and are asked to write a report to bring to their next individual session.

Dr. Styk says he always asks the men about sexual arousal during their next individual session, and that although they may have sexual longings or fantasies, none has ever had an erection on MDMA, although they may do so on LSD. When I told him that men frequently say they have erections on Ecstasy, he suggested it may be that they take amphetamine as well, or that the Ecstasy was unknowingly mixed with amphetamine.

Dr. Widmer

Dr. Samuel Widmer has a background of experience with LSD stretching back to when he was a student. From 1973-78 he was a member of a therapy group which used LSD illegally. As a fully trained psychotherapist, he wanted to use psychoactive drugs in his work, and in 1983 he wrote to the government applying for permission to work with LSD and Mescaline. Permission was not then forthcoming, so he searched for a suitable drug that was legal. He was close to giving up the search when he discovered MDMA in 1986, two years before it was made illegal.

Dr. Widmer works with larger groups than the Dr. Bloch and Dr. Styk, up to 35 people. He believes that large groups work better, and have the advantage of spreading the cost more widely - for the same reason, he avoids individual sessions. He frequently uses both MDMA and LSD in the same session. Sometimes he uses half a dose of MDMA two hours before LSD, and sometimes offers a small dose of MDMA at the end of an eight hour LSD session to provide a smooth come down. At other times, he will give 100 mg of MDMA at the height of an LSD session so as "to bring in the heart aspect."

He believes that LSD has a stronger effect on a transpersonal level, but that it has little or no effect on people who have done a lot of work on themselves and are aware of themselves. He says that working with LSD is tricky; you have to choose clients carefully to protect yourself and avoid those who make problems. By contrast MDMA is good for anyone, as it opens the heart and softens hard personalites. MDMA helps to clarify one's situation in daily life and relationships, while LSD helps on another level with questions such as 'Who are we?' The realisation that problems stem from wider issues comes more readily with LSD.

Asked what kind of clients responded best to MDMA treatment, Dr. Widmer replied that it was always tempting to think of the dramatic breakthroughs, but these tend to occur with clients who need catharsis. Clients who were on tranquillizers often found they could do without the tranquillizers or found they needed lower doses after treatment with MDMA. Other patients benefited by a gradual 'maturing' process. He said there is a category of patients who do not benefit, however, and this includes those who just want to get rid of a particular symptom without being prepared to work through it. He tries to screen out such patients.

When I asked what problems Dr. Widmer encountered using MDMA, he told me that there were few problems directly involving the drug itself. However, there were sometimes problems with negative transference and with clients' partners, who would accuse Dr. Widmer of putting ideas into the client's head rather than accepting that they had had an insight.

Asked about trends in psycholytic therapy, Dr. Widmer told me that the effect of the drugs was to open people up to greater awareness of their personality. This leads to 'growth work', where clients have no major psychiatric problem but wish to develop their personality, and so improve their quality of life.

Dr. Widmer has written two books on his work in German, but which he hopes will be translated into English.(96)

Here are the outlines of some case histories from one of Dr. Widmer's books:

1 Dr. Widmer was asked to treat a 14-year-old anorexic girl. Her father showed no feelings, and her mother hardly existed for herself, only appearing to live through other members of her family. The whole family only communicated to one another on a rational level, never expressing emotion except for the youngest son, who the parents regarded as the 'difficult one'.

Dr. Widmer and his wife treated the girl and her parents, first in separate sessions with Dr. Widmer treating the parents and his wife treating the daughter. In spite of her young age, they decided to hold an MDMA session with parents and daughter together, attended by both therapists.

During the MDMA session, father and daughter talked about their feelings for one another for the first time, while the mother became aware of the fear she had of herself. For the daughter this was a breakthrough: having focused on the cause of her problem she accepted becoming a woman and put on weight, ending her treatment shortly afterwards. However, for the parents this was the beginning of ongoing therapy.

Dr. Widmer commented that the breakthrough facilitated by the MDMA would probably have occurred anyway, but that the drug speeded up the process.

2 A lifelong alcoholic came for treatment, a sensitive man of 44. During an MDMA session, he experienced deep regression and found himself 'back in the womb'. He felt neglected and deeply hurt, and realised that this pre-birth longing was the basis of his addiction. The insight was realised so clearly that his 'addictive personality' was dissolved, allowing him to build a new personality based on love.

3 An intellectual working in the medical profession came for an MDMA session out of curiosity. He did not see himself as having psychological problems, despite the recent break-up of his marriage.

However, the effect of the MDMA was to uncover hidden narcissistic feelings of which he had not been aware, including hatred for his parents. The result was that he became more in touch with himself, but also to realise that he could benefit from therapy.

Training Group

Dr. Widmer runs a group for training other psychotherapists in the use of psycholytic drugs. Students all have to be fully trained psychotherapists with clinical experience, and must be in individual therapy themselves. The course lasts 3 years, and costs 6,400 Swiss Francs. In each year trainees attend four weekends plus one week, which includes 15 sessions using various drugs. They also have to assist in at least 10 group sessions with Dr. Widmer's and Dr. Styk's clients.

Most of the students are German. The first group finished their training last August, but none of them has yet obtained permission to use psychoactive drugs in their practice. However, one is lecturing on the use of psycholytic therapy at Tubingen university, although without actually using drugs.

Dr. Roth

Dr. Jorg Roth is licensed to use LSD and MDMA, but has decided not to do so any longer. I went to interview him in the hospital where he works to find out why.

Could you tell me about the background to your use of psychoactive drugs in psychotherapy?

Since 1977 I have been searching for the ideal drug to use as a tool in psychotherapy - mescaline, DMT, LSD and MDMA. Now I have found it - Chinese medicine.

Did you find that MDMA doesn't work, or did it have negative effects?

No, I have had some success using MDMA with major depression. I think MDMA is a good tool, especially for non-chronic problems, although it is no miracle cure - some revert just as with other kinds of therapy. I have nothing against MDMA, but in my work the output is simply not justified by the input. I always work with individual patients and the time required is too long, and that means the method is usually too expensive for the patient. And they can't drive afterwards, so they had to pay for a taxi too. It simply wasn't cost effective.

Do all your patients have to pay the full cost of their treatment themselves?

Some have insurance that pays for part of the cost, but they have to pay at least two-thirds themselves.

Chinese medicine has the advantage that it fits in with 50-minute sessions, and can result in change even without the will of the patient.

Did anything else put you off using psychoactive drugs? Are they dangerous?

Not MDMA. LSD can be dangerous, but MDMA is always safe.

There are cases in England of people becoming psychotic or paranoid as a result of taking MDMA.

I do not believe that psychosis could be triggered by MDMA except when used it is used with alcohol or other drugs. I have never come across paranoia. But it's possible there are some people who cannot metabolise it, just as there are some who cannot manage alcohol.

Dr. Hess

Dr. Peter Hess is a German psychotherapist who used MDMA in 1984-5 (before it was outlawed) at a German hospital at Frankenthal, Mainz, where he was head of the psychiatric department.

Dr. Hess said that some of his patients were very difficult to treat because they were caught in a vicious circle of low self-esteem, which they reinforced by blaming themselves. "There was a hard core of about twenty patients who failed to respond to any of the treatment available", he says. "I tried MDMA with them, individually, and was astonished with the results. They immediately found solidity and trust in themselves and made steady progress. For most, a single dose was enough, although some had two sessions."

Dr. Hess followed the patients up for two years after administering the MDMA and, apart from three with whom he lost contact, found that none of them had had a relapse.

When the drug became illegal, he tried - without success - to conduct a pharmocological study of MDMA at the University of Tubingen. He also applied to the German government for a license to use MDMA but without success. He now uses musical techniques, such as drumming, to produce altered states of consciousness in group psychotherapy. He says the effect is similar to LSD but does not overwhelm the patient.

I asked whether there were any psychotherapists using the drug in Germany. "Only illegally. There is a lot of interest but no-one has permission. However, I have heard of it being used by a small number of therapists." Dr. Hess did not approve of this. "I think that is stupid: you only have to get one client going through a negative transference to report you, and your career is ruined," he said.

Dr. Helmlin

Dr. Hans-Jorg Helmlin is conducting a pharmocological study of MDMA at the University of Bern.

The study involves monitoring what happens to MDMA as it passes through the body by taking blood samples. Dr. Helmlin started with a pilot study of two patients in 1992, from whom 20 blood samples were taken over a 9 hour period. In Spring 1993 he plans to conduct a more elaborate study, using blood samples taken from 6 patients on the day they ingested the drug and the following day. Dr. Helmlin has no license to prescribe MDMA, so he performs his tests on patients who have been given the drug by Dr. Styk as part of their therapy.

Provisional results from the pilot study suggest that MDMA has a 'half-life' of six to eight hours, i.e. half is left in the body after that time. I commented that this was surprising since the effects of the drug end after a much shorter time. "Yes, it surprised me too. I can only think that there is some sort of 'threshold' effect whereby the drug only has an effect above a certain level".

By means of this study, Dr. Helmlin aims to provide some basic data on the drug, equivalent to that provided by drug companies seeking government approval for a product. When the full results are available, they could be used by lobbyists to overcome a common objection of governments to licensing the use of Psychotropic drugs, i.e. that it would be irresponsible to do so as the drugs have not been subjected to pharmacological tests.

Dr. Vollenweider

Dr. Helmlin also told me about the plans of Dr. Franz Vollenweider, a researcher at the University of Zurich Psychiatric Hospital. Dr. Vollenweider has been using Positron Emission Tomography, commonly known as PET scans, to study what is going on inside the brain while people are under the influence of psychoactive drugs. A volunteer is given mildly radioactive sugar compounds which enter the blood stream, and this radioactivity is picked up by the scanner. The result is that the blood flow to different parts of the brain can be monitored while someone is experiencing the effects of a drug. The person can relate their experience at the same time as the equipment indicates what is going on in terms of brain activity. Dr. Vollenweider has already done PET scans on subjects taking Ketamine, a veterinary anaesthetic, and Psilocybin mushrooms, and intends to study MDMA in the future.

Dr. Benz

Dr. Ernst Benz has written a dissertation, in German only, on members of the Swiss Medical Society for Psycholytic Therapy and their varied backgrounds.