How MDMA Highs Can Declutter Your Hoarded Brain—and Help Cure PTSD

If you’ve ever seen one of those “hoarder” shows on television, you’re ready to take MDMA. You know the shows I mean, right? There’s a person who has collected crap for years—decades, sometimes—and their house is piled so high with old newspapers and detritus that you can barely navigate the hallways. There’s a narrow path to the toilet, another to a single burner on the stove (if you’re lucky) and behind each tightly closed door there’s an avalanche of personal shit ready to cascade out.

In other words, their hoards are a 3-D model of the human brain, complete with well-worn neural patterns, piles of distractions everywhere and the terror of knowing that behind every door (and underneath every tower of junk) are scary things not dealt with.

These shows always unfold the same way: there’s an intervention by loved ones—Please mom, let us throw the cat pee yarn balls away!—and the ensuing days of unloading the hoarder’s house and putting all their stuff out onto the front lawn and into the sunshine. There’s resistance, anger and pain, but there’s also, often, some real progress. “Why was I afraid of opening this door?” people say. “Why was I carrying all this around all these years?”

And often, joyfully: “Hey! Look at this! I didn’t even know I had this! It was buried under all the crap I’m finally getting rid of!”

The very best MDMA experiences function pretty much the same way. I’m not talking about groovy raves or cuddle sessions with friends—those are fun, of course, and with a little planning can be perfectly safe. The MDMA sessions I’m talking about, rather, are carefully organized experiences with a therapist (or two) in the room, compassionately guiding a person as they root around in their overcrowded brain, open doors to memories and experiences they’ve been avoiding. MDMA gives you the courage to be curious about yourself.

I’ve had a lot of experience with MDMA. Trust me: It’s a pretty amazing drug. MDMA helped me when my father died, and through several big life transitions.

It also unearthed this weird memory—a small thing, but sometimes the small things can really mess you up: Decades after graduating high school, I had dinner with a beloved English teacher. He had been hugely influential in my life, both as a reader and a writer. We had stayed in touch after I graduated and had made the transition from adoring student and demanding teacher to friends. I thought so, anyway.

But midway through dinner, he took a sip of his wine and said, “Please don’t take this the wrong way, Rob, but you haven’t made it as big as I thought you would.” Don’t take this the wrong way? There really wasn’t any other way to take it, I thought at the time. For the record: I was then in my mid-thirties and a successful author, journalist, television writer and producer.

What he said wounded me, not because I disagreed but because the minute he said it I thought Yes, you’re right. I haven’t, I’m not, I didn’t, I won’t, I can’t.

And then I locked that thought behind a door in my hoarder-house brain and tried to forget it. But of course you never forget it. MDMA, along with a thoughtful guide, helped me drag that memory up, laugh about it—and put it in the discard pile.

Here’s how it works: MDMA (chemistry class name: 3,4-methylenedioxy-methamphetamine) is a synthetic substance that alters mood and perception by increasing the activity of neurotransmitters like serotonin, dopamine, and norepinephrine in the brain. It is often associated with recreational use at parties and raves due to its euphoric, stimulant and empathogenic effects.

The difference between a fun party experience and a deeper dive into your mind isn’t about dosage. Rather, it’s dependent on what psychedelic experts call “set” and “setting.” The “set” is your state of mind and your intention. The “setting” is the physical and social environment of the experience. If your set and setting are to try to figure out why you don’t think you’ve made it big enough and you’re on a couch with the right guide, I’m pretty sure you’re going to figure out it was a dinner in Boston years and years ago that you didn’t realize was rattling around in your head.

Again, that’s the small stuff. But MDMA has also been extensively researched for therapeutic uses in more serious cases of post-traumatic stress disorder (PTSD), especially among veterans and survivors of abuse. Unfortunately, the US Food and Drug Administration recently ruled against approving MDMA-assisted therapy for the treatment of PTSD.

The reasons for the agency’s rejection were (to me, at least) unconvincing. The panel cited a few reporting irregularities, but mostly centered on one objection: Test subjects who were given a placebo instead of MDMA, they complained, realized pretty quickly that they weren’t having the powerful emotional experience they had read about, making a “double-blind” test nearly impossible. Well, yeah.

But this problem was anticipated by the researchers; they and the FDA had jointly designed the test to address the issue. And for the record, the MDMA-assisted therapy Phase 3 trials reported these results: 86 percent of subjects reported a measurable reduction in their PTSD symptoms, and 71 percent improved enough that they no longer met the criteria for a PTSD diagnosis at all. MDMA-assisted therapy works.

The advocates who have been carefully and cautiously navigating the regulatory process are trying to sort out how to address the ossified agency’s concerns and put MDMA-assisted therapy back on track, but it’s going to take another few years—at least—before it’s legal. In the meantime, millions of people will continue to live in misery.

As they say, that’s a hard pill to swallow. People who are suffering with PTSD—and the people in their lives who suffer along with them—should be allowed to opt in to this kind of healing. And honestly, the FDA, which is utterly trapped in a bureaucratic hoarder-house of its own, could use 120 milligrams of MDMA itself. For starters.