While James Hardin was on MDMA at his therapist's office, he closed his eyes and saw open books scattered around the room. Each one contained images and stories almost too horrible to tell: bodies blown apart, near misses from improvised explosive devices, a barrage of mortar fire from unseen insurgents in the Iraqi desert.
Hardin thumbed through the books and read a few passages. Then he closed them one at a time and put them on a shelf.
An Army veteran who served in Iraq and Afghanistan, Hardin suffered from Post-traumatic Stress Disorder (PTSD) for years before he learned about an experimental treatment being tested at the Mt. Pleasant office of psychiatrist Dr. Michael Mithoefer. In the study, each patient undergoes three intensive psychotherapy sessions with Mithoefer and his wife, psychiatric nurse Annie Mithoefer. At the start of each session, the patient is given a capsule containing MDMA, a Schedule 1 drug known more for its abuse in nightclubs (and sometimes mixed with adulterants and sold under nicknames like "Molly" or "ecstasy") than its utility as a therapy aid. In fact, as a Schedule 1 drug, MDMA has been defined by the Drug Enforcement Administration as having "no currently accepted medical use and a high potential for abuse."
- Jonathan Boncek
First synthesized by a Merck chemist in 1912, MDMA (3-4 methylenedioxymethamphetamine) causes neurons in the brain to release serotonin and serum oxytocin. It's known to cause feelings of euphoria, safety, and trust — results that have been borne out for decades at raves and electronic music festivals, but which could also prove useful for psychotherapists trying to make a breakthrough with a patient. If the study is successful, Mithoefer envisions a day when government-sanctioned clinics will provide PTSD sufferers with MDMA-assisted therapy sessions. He stresses that MDMA won't be used as a "happy pill" that patients can take at home, but rather as an occasional aid to traditional psychotherapy.
"Most of the therapies involve revisiting the trauma in a therapeutic setting to re-process it, bringing memories up in a different way and re-consolidating them," Mithoefer says. "So, since MDMA is known to decrease fear and defensiveness and increase trust and openness without clouding the sensorium, without interfering with people's memory or ability to think clearly, it seemed like a logical thing to investigate."
Researchers in Israel, Switzerland, Colorado, and Vancouver are conducting similar studies to Mithoefer's. The team's research is funded by the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit organization that has also funded a study on the use of ayahuasca, a psychedelic brew of the Banisteriopsis caapi vine, to treat drug addiction. MAPS also supported the development of a protocol to explore the use of psilocybin mushrooms in the treatment of end-of-life anxiety.
An initial MDMA study conducted with 20 sexual abuse and assault victims who suffered from PTSD supported Mithoefer's hypothesis. The results of a long-term follow-up study of the 20 patients was published in 2012 in the Journal of Psychopharmacology, showing how patients fared 17 to 74 months after their therapy was completed. Using questionnaires and the Clinician-Administered PTSD Scale (CAPS), psychiatrists found that most patients still experienced statistically significant relief compared to a control group who took placebos before therapy. Two patients relapsed, but none of the patients reported harm or physical dependency on the drug.
To participate in the Phase 2 study at Mithoefer's office, which focuses on veterans, police officers, and firemen, test subjects have to suffer from what is known as "treatment-resistant" PTSD, which cannot be managed by traditional psychotherapy or medications. Hardin certainly fit the bill; he had tried everything the VA offered him and felt no relief.
"I could tell myself, 'I'm safe, I'm safe, I'm safe,' but my body was like, 'Oh no you're not,'" Hardin says.
- Hardin served multiple tours of duty in Iraq and Afghanistan
Since his second Iraq tour ended in 2006, Hardin had felt crippling anxiety, suffered from flashback dreams that robbed him of sleep, and even considered suicide, despite the antidepressants and anti-anxiety meds that military hospitals prescribed him. He sat in a few group therapy sessions for soldiers, but he says the participants only tried to one-up each other's war stories. "It turned into a dick-measuring contest, essentially," Hardin says. "Everybody's like, 'Oh, that's it? Well, when I was there...'"
When the prescriptions didn't take the edge off, Hardin self-medicated. Toward the end of his Army career, while stationed in South Korea in 2010, he says he downed a bottle of liquor and a dozen beers after work every day, then took Ambien to sleep and a blood pressure medication to keep himself from dreaming. When dreams came, they were always either flashbacks to war or premonitions about getting re-deployed on active duty, and the terror jolted him back awake.
In the mornings, he woke at 4 a.m. to shower the booze stench off his skin and made his way in to work, where he repaired helicopters and supervised others while trying not to breathe in anyone's face. He knew the treatments weren't working, and he knew he wasn't the only one.
"There's quite a lot of people that are in the service walking around with PTSD, and they know it," Hardin says. "And you can tell the ones that have it. First of all, they have a combat patch, and secondly you can tell. They're the ones that are out drinking with you and trying to forget about it too."
Hardin's interest in the military started in high school with the Civil Air Patrol and Junior ROTC. He joined the North Carolina National Guard in 1997, and after the terrorist attacks of Sept. 11, 2001, he enlisted for active duty.
In the Army, he worked as a technician on AH-64 Apache Longbow attack helicopters with the 101st Airborne Division. He was deployed to Qayyarah Airfield West in northern Iraq from 2003 to 2004, Forward Operating Base Speicher outside Tikrit from 2005 to 2006, and Baghram Airfield in Afghanistan from 2007 to 2008.
Hardin can't name any single event that triggered his PTSD, just an accumulation of horrors. His unit was responsible for the on-base morgue, and he says the images of the bodies have stayed with him. He was also sent out on convoys in Iraq and Afghanistan, and an IED nearly detonated under his vehicle once. One time in Tikrit, he was hit by a bullet fragment from friendly fire, and as blood streamed down in his eyes, he thought he had been shot in the head.
In Iraq, he picked up a two-pack-a-day cigarette habit to soothe his nerves as mortar rounds and rockets flew in seemingly at random from outside the base. In Tikrit, insurgents would prop up a mortar in the desert at night, put ice inside of it, and place a round on top of the ice. When the ice melted, the ammunition dropped in and fired. Lookouts would scan the horizon, but by the time the shot had been fired, the enemy combatants were long gone.
"There was a general unease, and any second — you could be taking a shower, sleeping, taking a shit — and then boom, you're dead," Hardin says. "You never were safe, and unfortunately that switch never got turned off when I got back to the States."
After 2008, Hardin stayed out of combat roles for the rest of his military career, bouncing back and forth between Camp Humphreys in South Korea and Fort Bragg in North Carolina. While in Korea, his marriage dissolved and a commander referred him to Alcoholics Anonymous. "It was like I was a robot and I was the pilot of the robot," Hardin says. "The purpose of the robot was to get through life."
- Jonathan Boncek
Hardin left the Army in 2010 and returned to Marshall, N.C., a tiny mountain town on the bank of the French Broad River, where he started smoking marijuana heavily and collecting unemployment benefits. He briefly held down a nighttime job at a bakery, spending days holed up in the house and nights indulging his vices while kneading dough. "I was pretty much non-employable," Hardin says. With a bottle of Captain Morgan in his belly and a cloud of weed smoke over his head, Hardin wasn't cured, just numb enough to function.
The first time Hardin heard about MDMA-assisted therapy was at — of all places — Playa Del Fuego, a Burning Man-inspired event in Delaware with a reputation for recreational drug use. A friend at the festival told him that the drug was being tested out on patients with PTSD, and shortly after he got home, Hardin submitted his application for the study. Why not? Nothing else had worked.
Mithoefer has been conducting studies with MAPS funding since the mid-'90s and today estimates that his work is 75 percent research, 25 percent psychotherapy. He says the idea of using psychedelics for therapeutic purposes is still "far from mainstream" in the psychiatric research community, but it is gaining support.
"Certainly there's been a noticeable shift over the years, mainly now that we have published data that's promising. The whole conversation seems to have changed," Mithoefer says. "I've given a lot of talks around the world and around the country about this, and it's really been striking the last few years how many medical students, psychiatric residents, psychology graduate students, as well as young psychiatrists and psychologists, have told me they want to get involved in this. I think there's a lot of interest and it's much more recognized as an important area of research, not something to do with the rave culture."
- Jonathan Boncek
- Dr. Michael Mithoefer envisions a day when trauma victims can receive mdma-assisted therapy in clinics
Pure MDMA is not known to produce as many wild hallucinations as other psychedelic drugs, but sensory perceptions can be elevated and some patients report seeing shafts of radiating light. Mithoefer says the experience is "quite variable" from one patient to the next.
"In people with PTSD, quite often there's some anxiety in the very beginning as they're getting used to the fact that it does increase blood pressure and speed up the heart rate. People can kind of get anxious when they feel something changing," Mithoefer says. "And then it's usually a combination of some affirming, pleasurable experiences and some difficult but useful experiences of revisiting the trauma. We had several people in the first study say they don't know why they call this ecstasy."
In the therapy sessions, which last from approximately 9 a.m. to 5 p.m., patients are encouraged to spend long stretches of time without talking. Mithoefer provides headphones, music, and eye shades to help.
Part of each therapy session involves talking about "trauma cues," the events or stimuli that trigger their PTSD symptoms. When patients take MDMA before therapy, Mithoefer says he often doesn't have to prompt them to bring up the topic. The drug, it seems, can help people show themselves a little mercy.
"Usually people with PTSD have a lot of self-judgment about what happened — 'It was my fault,' 'I should have done something different' — or survivor's guilt in the case of war especially," Mithoefer says. "I think self-compassion leads to a more accurate perspective about 'I was in a really tough situation, shit happened, and I did the best I could.'"
Hardin says he felt an immediate difference after his first therapy session in December 2013. "It gave me that safety that I had not felt," he says.
He says he had actually used MDMA twice before. A friend in the Asheville area had tried to help him sort through his problems in an MDMA-assisted meditation session, but without a trained psychiatrist in the room, it ended up being just another trip. But in Mithoefer's office, with gentle prompting from the doctor, Hardin says he was able to talk through stories that made him anxious before. He says that when he started fidgeting or breathing heavily, Mithoefer would instruct him to use breathing exercises to relieve the tension.
"I didn't feel uncomfortable at the time talking about it. It was like I was talking about somebody else's story," Hardin says.
- Jonathan Boncek
Back home in North Carolina, Hardin says he slept easily and soundly for the first time in years. He didn't quit drinking, but he felt a decreased desire to drink. The suicidal thoughts ceased. Even his appetite improved.
Hardin's girlfriend, Erin Krouse, had been one of the first people back home to suggest that he get help. A gentle-voiced woman with a purple streak in her hair, she pulls up a chair on the back patio of their West Ashley condo.
Krouse says she saw a mighty change in him after the sessions with Mithoefer. Before therapy, she says, "He might immediately react as if the worst thing had happened ... Now, he can step back and say, 'I'm going to let things cool off and see where this is going.' "
One other effect of the therapy: For the first time in nearly 10 years, James Hardin sees beauty around him.
Before the treatments, Hardin says he would go to concerts with his girlfriend and focus on everything that could go wrong: the bar running out of alcohol, a loudspeaker blowing up and killing the singer, an electrical fire burning the place to the ground. He would leave at the end of the night and realize he hadn't heard a single note.
In one therapy session, Hardin remembers that Mithoefer had set a vase of red roses on a table. Hardin kept an eye on the flowers throughout the session, and for the first time he could remember, he noticed the moment when they bloomed.
"That's one of the things I didn't do before. There really wasn't much beauty in my life," Hardin says.
Hardin still drinks — in moderation, he says — but now he actually tastes it on the way down, and he's gotten into craft beer recently. He cooks food that he actually enjoys. And once in a while, he stops to take in the view of the wetlands from his own back door. Hardin and Krouse moved to Charleston about a month ago so he could start classes at Trident Technical College, where he's studying aviation maintenance on the G.I. Bill.
"I still know that I'm different than many people," Hardin says, "but it's more of a conscious decision at this point to do exactly what I want to do and be who I want to be."
Out on the patio, a splashing sound comes from the water behind Hardin's back and he whips his head around to see what happened, tensing up immediately. It's just the sort of thing that would have set him on edge a mere nine months ago.
"Oh, there's a snake," he says.
Hardin shuffles over to the edge of the water and cranes his neck to see that one snake has fallen into the water while another remains coiled on the branch of an overhanging oak tree. It looks like they were fighting, maybe, or mating. He stops talking and takes in the scene for a moment: the snake writhing away in the spartina grass, the breeze stirring up a windchime hung from the branch, the gray morning light on a river by the sea.
He still has a sketch he made during therapy. It's of a pair of bookshelves, one with a neat row of books labeled "Past." The other shelf has a flower, a pen, and an open book with blank pages.
"That story is done," Hardin says of his past. "I can put it away. I can take the book off the shelf and show you, but then I put it back, because it's mine."
An earlier version of this story indicated that MAPS had funded research on the use of psilcoybin mushrooms to treat end-of-life anxiety. MAPS supported the development of a protocol that would have explored the topic, but the project was later canceled. Current research on the topic is being carried out by the Heffter Research Institute. We regret the error.