Authors: Steven Kotler
Mara drops mushrooms for the first time on a muggy day in early August. An hour passes. Two hours pass. Maybe they’ve given her too mild a dose, maybe it’s her own emotional resistance, but not much is happening. Mara wants more mushrooms, but Allan has a different suggestion. He’s also brought along marijuana, which can enhance the effects of psilocybin. Mara decides to try it, but can’t tolerate hot smoke in her feeble lungs. So Marilyn becomes her daughter’s “water pipe.” She takes sips of cold water, breathes marijuana smoke into her mouth, then puts her lips onto Mara’s and blows. Suddenly, for the first time since their last MDMA session, Mara’s pain is gone.
“There is some pain,” she says, “but I don’t feel so uptight about it. It’s there, but it’s not me.”
Then Allan asks about her disease.
“There’s a snake in my house,” is her chilling response.
The rest of the session passes without incident. Mara is disappointed. She wants more, wants to try LSD, but Allan has to go back out of town. Mara will have to wait until he gets back for that session. The waiting is difficult. There is, after all, a snake in her house.
8.
It took ten years for Doblin and his associates to convince the government that Ecstasy might have therapeutic potential. That victory came in 1992 when the FDA approved the first basic safety and efficacy study in humans. At roughly the same time, Doblin had more ambitious plans. He’d teamed up with Michael Mithoefer, a psychiatrist with a specialty in trauma and an interest in psychedelic therapy, to explore a still radical idea. “Therapists had already figured out that MDMA helps people confront traumatic memories — memories with a deep component of fear and anxiety — and get past them. Michael already had experience with PTSD, and PTSD is exactly that kind of problem. It seemed like a perfect fit.”
To help prove he was right, Doblin wrote the first paper to appear in the scientific literature about MDMA and PTSD. It ran in the
Journal of Psychoactive Drugs
in April 2002. That was also the year Mithoefer received permission to begin his formal study — which is how he met John Thompson (not his real name).
Thompson, forty, now lives in Missouri, but in his younger days was an Army Ranger. During Gulf War II, he was on patrol, chasing insurgents in Iraq, when an IED blew up beneath him. He broke his back and both of his feet and suffered traumatic head injury. “I’ve been in fights,” he says. “I’ve been shot before, but the trauma of getting blown up — it’s a soul shaker.”
Almost immediately, Thompson developed PTSD. He had nightmares every night. Every piece of trash on the road was enough to set off an episode. After about a year, with no respite,
Thompson was searching the Internet for cures and found a link on the MAPS website to upcoming studies, including Mithoefer’s PTSD trial. “I’d never done MDMA before,” says Thompson. “I smoked a little pot when I was younger, and when I was in my early twenties tried acid once. At the time, I was already a Ranger, already a well-trained, hardened killer, but on LSD I thought I was a disciple of Christ — that was pretty unusual.”
Mithoefer’s study was nothing but intensive. Patients were given lengthy pretrial counseling. This was followed by three eight-hour MDMA sessions, each with two therapists present (most psychedelic therapy involves two therapists, one male, one female). Between sessions, for integration purposes, there was daily phone contact and a weekly in-person meeting.
“Almost immediately,” Thompson says, “I was shocked by the access I had to my memory. I started recalling parts of the experience that I didn’t remember. I really went deep. It was completely cathartic. The next day [after just one session], the nightmares were gone. I was glowing and extroverted — for the first time since getting blown up. MDMA gave me back my life. I hesitate to use the word ‘miracle,’ but I’d definitely call it a ‘sacred molecule.’ ”
And Thompson wasn’t the only subject to find relief. Mithoefer’s patient population included war veterans, crime victims, and child abuse victims. While he has yet to publish his data, it has already been presented at conferences, so he will say, “With MDMA (instead of placebo) we had a very clear reduction of PTSD — well into statistical significance. And it’s been a year or more after the last MDMA session — in some cases up to five years — so the effects appear to last. I think the treatment holds a lot of promise.”
Doblin will go further. “Eighty-five percent of our patients saw their PTSD vanish. It took twenty-two years to get this study done, but if that’s all MAPS ever does, it’s enough.”
Thompson, though, goes the furthest. “I think MDMA is a gift to mankind. I think every vet, when they leave the service, should go through MDMA therapy. I think it should be part of the formal discharge process.”
9.
It is late August. The phone rings. Allan is back in town, has a free afternoon and quite a cocktail in mind. The next day Mara, Marilyn, and Allan are again assembled in the green room. Allan has brought LSD, MDMA, and marijuana. LSD is one of the most powerful mind-altering substances ever discovered, and the fear is still a bad trip increasing Mara’s anxiety. But Allan explains that “when MDMA combines with LSD, it can soften the experience, smooth out the overwhelming visuals, and help maintain a train of thought.” He also says that marijuana deepens the trip, allowing them to use a lower dose of the psychedelic. Mara is game. At 4:20 p.m. she swallows 300 micrograms of LSD.
By 6:00 p.m., Mara says, “not much is happening.” At 6:30, she wants to try more LSD, but 300 mgs is already a substantial dose. Allan decides to go with the MDMA instead. An hour later Mara’s pain has diminished slightly, but is still not completely gone. At 8:00, Mara smokes pot. Within minutes, she begins to shake. Tremors are now ripping through her body.
“The pain,” she says, “it’s burning, it’s burning . . . but it’s amazing how good the rest of my body feels.”
Not much happens after that. At 9:00 p.m., Mara wants to go to sleep. The session is over. Marilyn can’t hide her disappointment.
“No glorious cure,” she says, “no dramatic end to the pain, no spark of enlightenment, and no talk of what to do next.”
A week later Mara tells her nurse she’s losing her resolve. “I’m worried about my parents,” she says, “I suck at good-byes.” A week after that, her will has broken. “I can’t do this any more. I want to go fast.” But there was one thing she wanted to do before she goes fast — more MDMA.
That session takes place in early September. At 2:35 p.m., Mara lies down in bed, stares up at the angels, and swallows 135 mgs of MDMA. An hour later she doubles down and takes another pill. Soon afterwards, her breathing calms, spasms subside, and then her pain is gone. By 4:30, Mara is alert.
“Call Dad,” she says.
Marilyn and David Howell divorced years ago, but David lives in the area and has always been close to his daughter. Most nights, he comes by and reads to her. Most nights, Mara worries about him, worries about him more than she worries about her mom. Tonight, the moment he arrives, she starts to well up.
“It’s so special,” she stammers, “I get to have my mother and father with . . .”
But Mara can’t finish that sentence.
Instead, she decides, if there was ever a time for indulgence . . . She sends her father to the store for chocolate. Marilyn goes to the kitchen for a moment. With her parents are out of the room, Mara looks at Allan and starts to cry.
“I’m their only child . . .” but she still can’t finish that sentence.
David returns with Dove bars. Such a glorious indulgence. The music is lively. The Temptations are singing “My Girl,” and Mara wants to dance. Her mother lifts one arm, her father takes the other. They move her body to the beat, swaying in time, one family together, one last dance. Finally, Mara can finish that sentence.
“How beautiful it is to die,” she says, “with my mother and father with me.”
10.
It’s a cold October night in 2009. Rick Doblin is in his kitchen, eating dinner with his wife and their three children. He’s telling a story about the time Lilah, his thirteen-year-old daughter, won a DARE-sponsored writing contest at school (as in, “DARE to Keep Your Kids Off Drugs”). His youngest, Elinore, eleven, was concerned about him. “She thought everything was going wrong in my life,” he remembers. “My teenage son wasn’t doing drugs. My eldest daughter had just won a DARE contest. She took my hand and looked me in the eye and said, ‘Daddy, I don’t want to do it now, but in the future, I promise, I’ll smoke lots of pot.’ ”
Then the conversation turns to Mara Howell and her treatment. As the psychedelic community is small, Doblin has heard about Mara’s story. “I wish it was legal,” he says, “but I like the fact they’re doing it in the home, that it’s integrated into her hospice care, that they have co-therapists and are not limited by treatment protocols to one substance at one specific dose. They’re using the entire psychedelic tool kit at the levels the situation demands. That’s the future.”
How long until we get to the future is another open question. The majority of current research is Phase II trials, but to actually legalize these drugs, Phase III trials are required. These are multicentered trials with large patient populations and will take some time to set up and more time to run. The main reason trials take so much time to set up has nothing to do with the government. “The greatest problem,” says Grof, “has always been recruiting patients.” Doblin points out that while a few scientists may be aware that there has been a psychedelic sea change, that information has yet to trickle down to mainstream doctors. But it will, and soon.
Doblin finishes his dinner in a hurry. He needs to go pack. Tomorrow he leaves for Israel, where he’s consulting on a PTSD/MDMA study, and then to Jordan, where — “Talk about peace in the Middle East,” he jokes — they’re doing more of the same. On his way out of the kitchen, he tells a quick story about an aerobics class he used to attend, where the teacher always showed up stoned and encouraged her students to do the same. His eleven-year old interrupts him.
“But Daddy,” she shouts, “I don’t want to do stoned aerobics.”
Doblin shakes his head and smiles.
“Story of my life,” he says.
11.
An hour after Marilyn and David dance with their daughter, the Ecstasy begins to wear off and Mara’s symptoms return. Everyone
in the green room tries to figure out what to do next. MDMA’s effects can be prolonged, so some psychedelic therapists will administer ongoing low doses during life’s final stages both for pain relief and lucidity. Marilyn and Allan go a different route. They decide to alternate sedation days with drug days, for what they believe is the maximum physical, emotional, and spiritual benefit. On his way out the door, Allan leaves enough MDMA for another session.
Mara spends the next day asleep. She can no longer eat or drink. The following morning, Marilyn can’t wake her, but her daughter’s pain is obvious. At noon, Mara becomes slightly alert. Marilyn asks her if she wants to try more MDMA. It takes Mara a long time to answer.
“Yes,” is all she says.
Marilyn puts a tablet under her tongue. Mara falls back asleep. An hour later her breathing steadies and her muscle spasms cease, but Mara still isn’t awake. Marilyn calls Allan for advice and he suggests giving her a second tablet. Marilyn takes his advice, but two more hours pass and Mara remains comatose. Marilyn calls David and tells him to come over. When he arrives, she says, “I don’t think she’s going to wake up again.”
They spend the next few hours holding their daughter’s hands, telling her stories, not knowing what else to do. Then Marilyn is seized by a peculiar notion. On his deathbed, Aldous Huxley had himself injected with LSD, believing the drug would facilitate a “good death.” His wife, Laura, administered the dose. A few weeks back, Allan had dropped off a copy of Laura Huxley’s
This Timeless Moment
, her posthumous biography about Aldous’s life and his passing. Marilyn picks up the book and begins to read aloud.
All too often, unconscious or dying people are treated as if they were “things,” as though they were not there. But often they are very much there. Although a dying person has fewer and fewer means of expressing what he feels, he is still open to receiving communication. In this sense the very sick or
the dying person is much like a child: he cannot tell us how he feels, but he is absorbing our feeling, our voice, and most of all our touch. . . . To the “nobly born” as to the “nobly dying” skin and voice and communication may make an immeasurable difference.
Later Marilyn learns that
nobly born
is a phrase from the Tibetan Buddhist tradition. She now holds onto the fact that this tradition “places the greatest importance on one’s state of consciousness at the time of death.” Back then, Marilyn didn’t know what to think. She was in the green room, beneath “those fucking angels,” beside her dying daughter. “And for reasons I still can’t fathom,” she says, “I’m reading to her from Laura Huxley.”
And then her dying daughter starts to move.
Mara slides her right hand out from beneath the covers and places it directly inside her father’s palm. Then she lifts her chin and opens her eyes and turns straight toward him. In the past year, she’s lost so much weight that her skeletal aspects have been showing through, but in that moment they vanish. David watches the transformation and can’t believe what he’s seeing.
“She became angelic,” he says later. “She looked radiant.” He also said: “I knew exactly what was going on. She held my hand for about fifteen seconds, and then this look of absolute relief came over her face. Absolute peace. And then she died.”
David had experimented with drugs in his younger days and was never too keen about Mara’s decision to try psychedelic therapy. “I’ll be honest, I had a lot of misgivings about the whole thing.”
But not anymore.
“It was a gift,” he says, “to get to spend that little bit of time with her.”
And her death?
“I don’t know what to say about that. I think her death was a miracle.”
Sympathy for the Devil