MDMA

MDMA occupies an uneasy position in the book’s account of psychedelic therapy: it is not a classical psychedelic, yet some underground guides use it to build trust before a psychedelic session. Its therapeutic appeal rests on a relational effect, while its amphetamine chemistry raises a distinct cardiovascular concern. That tension becomes personal when Michael Pollan considers it for his own journey and his cardiologist advises him to avoid it.

Identity and Pharmacological Distinction

MDMA, or 3,4-methylenedioxymethamphetamine, is described as a psychoactive compound that works on different brain receptors from LSD and psilocybin and does not produce strong visual effects. The book therefore distinguishes it from the classical psychedelics, while noting its reputation as an empathogen: its effects can lower psychological defenses and help a patient form a bond with a therapist. In this account, its significance lies less in producing a particular visionary state than in changing the interpersonal conditions under which therapy can proceed.

The compound was first synthesized by Merck in 1912 but was not marketed. In the 1970s, Alexander “Sasha” Shulgin resynthesized it, and it became a popular adjunct to psychotherapy. In the 1980s it entered the rave scene, where it was sold as Ecstasy, E, and later Molly. In 1986, the United States placed it in Schedule I, classifying it as a drug of abuse with no accepted medical use. The same compound thus acquired sharply different identities: a possible aid to therapeutic trust, a popular recreational drug, and a controlled substance.

Use in Psychedelic Therapy

Several guides interviewed by Pollan described MDMA as part of their therapeutic regimen. They used it to help establish rapport before a psychedelic journey, treating the bond between patient and therapist as part of the preparation rather than as a side issue. In this setting, MDMA was an opening step: it could make a patient more receptive to working with a guide, after which a different substance might be used for the principal journey.

That practice belongs to a wider underground field of psychedelic-assisted therapy, conducted by guides who risked their freedom and professional licenses because the work remained illegal. The guides Pollan encountered included credentialed therapists and religious professionals, as well as practitioners with varied alternative-therapy backgrounds. MDMA’s use in this setting therefore depended not only on the drug itself but also on the treatment relationship and the guide’s approach. The book’s discussion of psychedelic therapy stresses that such contextual factors complicate attempts to isolate a drug’s effects from the expectations and care surrounding its administration.

Leo Zeff was among the first therapists to use MDMA in the 1970s. He did so after the compound had been popularized by his friend Alexander “Sasha” Shulgin and Shulgin’s wife, therapist Ann Shulgin. The history links MDMA’s therapeutic use to a network of practitioners and personal relationships, rather than to a formal medical system. That lineage continued underground after the drug was prohibited, even as the substance’s association with recreational use increasingly shaped public and institutional judgments about it.

A Personal Limit on Its Use

Pollan’s own planned psychedelic work makes the drug’s pharmacological distinction consequential. Because of atrial fibrillation, he consulted his cardiologist about possible risks and interactions with his prescribed medication. The doctor was not especially concerned about most psychedelics, which Pollan’s account describes as having relatively little effect on the cardiovascular system, but advised him to avoid MDMA. Its chemical identity as an amphetamine, rather than a classical psychedelic, was central to that difference: it implicated the heart in a way the other drugs under consideration did not.

The restriction changed the proposed preparation for Pollan’s session with Fritz, an underground guide. Fritz had described a three-day arrangement in which the first afternoon would serve as a warm-up, using either MDMA or breathwork, before an LSD journey the next morning. Pollan explained that his medical circumstances meant the warm-up would have to be breathwork. The substitution preserves the therapeutic sequence—an initial period intended to help the guide observe how a participant handles an altered state—while showing that MDMA was not interchangeable with every other element of the plan from a medical perspective. Pollan was disappointed to lose the option, but relieved that his cardiologist had otherwise given the journey a qualified green light.

Clinical Research and Changing Status

The book also places MDMA within the renewed effort to bring psychedelic treatments back into scientific and cultural respectability. The Multidisciplinary Association for Psychedelic Studies, founded by Rick Doblin in 1986, focused much of its work on MDMA as a treatment for people with post-traumatic stress disorder. In 2016, the organization won FDA approval to conduct phase-three trials for that use; in 2017, the FDA designated MDMA a breakthrough therapy, clearing the way for expedited review. These steps marked a striking change from the 1986 Schedule I classification, though they did not mean that MDMA had already become an approved prescription treatment.

At the 2017 Psychedelic Science conference in Oakland, more than three thousand people gathered to hear researchers from twenty-five countries present findings. MDMA’s phase-three trials formed part of the broader sense that psychedelic research had moved toward institutional recognition. The book presents this change without erasing the drug’s earlier passage through psychotherapy, prohibition, and rave culture. Its status remained contested, and its potential use depended on questions that the history had repeatedly raised: how therapeutic effects relate to the drug, the guide, the patient, and the setting, and how medical institutions assess an experience that cannot be reduced to chemistry alone.