Q: So do you ask them questions? Let them talk it out themselves?

A: Well, a lot of it is nonverbal. You check in every now and then and you also guide them back to things that they’re still dodging, or you ask them to share with you what’s happening, but there’s a certain respect for the wisdom of the unconscious. That things will come up that they are working on or need to work on.... It’s not like you have an agenda, y’know: at two hours you have to cry and say you’re horrible and you’ve hurt everybody. It’s not like a specific sequence. But the idea is that they’ve then had this very powerful experience that is the emergence of things that they’ve suppressed.

Then you let them rest, you probably spend the night in the same place, they don’t have to move, and you turn it into a several-day experience. The next day you come to them and they often will do drawings to try to express in art what happened. There’s this process of integration the next day where you go over it, you talk about it.... And then you support that by meetings every week for several months or so after, so that really it’s an inspirational experience.

The mistake of the ’60s, of the psychedelic era, was [to think] that the experience itself was what you need and that will do all the work. But you really have to just get inspired from it and then you have do the work yourself and then move in little steps. Maybe after a couple months you’ll do another session. And then maybe after another couple months you’ll do another session. But there’s lot of heavy emphasis on the preparation and the integration. And then, also, you try to join people in groups so they can support each other and help each other. That’s the general approach.

Q: I know you’re doing a study in Spain. How has it been going?

A: It’s the first scientific study of MDMA ever approved. It’s going slowly [chuckles]. Slowly, slowly. We have really just very preliminary results. It looks promising, but the way the study is designed in Spain, we have to start at low doses. So we start at 50 milligrams. And then a group of women — it’s women survivors of sexual assault with PTSD [post-traumatic-stress disorder] who’ve failed with one other treatment. And so we have to give a group of women 50 milligrams and another group 75 and another group 100, then another group 125, and then the final group gets 150. And we think the real therapeutic dose is starting at 100. So we’re a long way from really being able to get at that level, but preliminarily we’re going to show safety.

Q: How do these doses work? How does it relate to what a typical kid would take at a party?

A: One pill is somewhere in the neighborhood of 80 to 100 milligrams. And some pills are as much as 125 milligrams. We’ve found that after you get one pill, it takes about 45 minutes or so for people to really get into the experience, they plateau from like one hour to three hours, and then they start to come down. But at around two and a half, if you take half the dose that you originally took, it extends the plateau. So that’s how the underground therapeutic use of MDMA is done. Somewhere like 125 milligrams first, then after two and a half hours something like 60 milligrams. And that will give you a therapeutic window of about four hours.

Q: Are you completely convinced that ecstasy isn’t dangerous?

A: I’d say that I’m completely convinced that ecstasy is dangerous. The government likes to say, “The proponents of MDMA say that it’s completely harmless. But it’s not! Here are the risks ... ” And therefore it’s got to be illegal because we’ve got some risks. So what we’re trying to say is that it’s not so simple. We never said that [there are no dangers]. Nothing is completely risk-free. But the relative risk of MDMA, compared to heroin or cocaine or other drugs, is much, much lower.

Taking MDMA in a rave, dancing all night and not resting and not drinking fluids, can lead to overheating, and people can die from it. But MDMA taken in a clinical setting, where people are taking it lying down, with their eyes closed, for an inner experience, where they occasionally will drink some fluids — nobody has ever died from overheating in a clinical study. So the context really has a lot to do with the risk.

Q: What about the charges that it affects serotonin levels, that it could permanently affect mood?

A: First of all, I believe that’s vastly over-exaggerated.... I’ve known hundreds of people over the last 19 years that have been doing MDMA. I’ve known thousands of people. And I don’t see it, in terms of this cognitive decline.

There’s a couple things that we need to ask. First off, are there serotonin changes? And then secondly, do they matter? Now let’s just look at dopamine and Parkinson’s disease. You can have major declines in dopamine, and you have to have declines in the neighborhood of 90 percent before you get Parkinson’s. Now, MDMA affects serotonin. Serotonin doesn’t decline that much with age. One study I looked at said two and a half to four percent per decade. So the time-bomb theory — this is NIDA’s favorite, because when you look at ecstasy users, most of them seem fine — the time-bomb theory says that even though there may be minor changes now, when people age, this generation of young people, when they get to be 40 or 50, after 20 years of aging they’re going to start manifesting problems. But that really requires serotonin to decline with age substantially, which it really doesn’t. The other question is, does this really happen at human dose levels?

Q: Where does MAPS’s money come from?

A: Donors and MAPS members. But I’d say that the main money actually came from this one guy who I met a month before he died of cancer in the ’70s. He was interested in spirituality and believed in the value of psychedelics ... it was one of those things where the stars align and everything just works out right. We had a mutual friend, he was getting ready to die, figuring out where to put his money. I spent three days with him, and he died three days later and left half a million dollars.

Q: How does the widespread use of ecstasy as a club drug, and the popular perception of it as such, affect your work?

A: It makes it extremely difficult. Once a drug is criminalized for its non-medical use, then subsequent pressure is placed to criminalize its medical use. NIDA’s message is: one drug, serious danger, be careful, don’t ever try it. So the rave movement and the non-medical use has made it much more difficult. The underground therapeutic use of MDMA was going fine until it emerged from those confines into recreational use, and that’s what attracted the DEA.

Q: Can you say a few words about the cover story that ran in the New York Times Magazine on January 21? It mentioned a couple of MAPS-sponsored studies, and quoted someone as saying, “[Batman] ... spends his life fixing the problems of the world. I’ve started to think that a real Batman of today would become a psychiatrist who dispenses ecstasy.”

A: That piece was attacked by Senator Graham, I think, in the Senate hearing where they spent three hours talking about ecstasy. The article was a remarkable success. It was an unusual bleeding through of the wall of propaganda in that it was a balanced article about someone who took ecstasy 15 years ago and is reflecting on it in a positive light. That’s what was attacked. He said he had a good experience with it, but we know that these drugs are dangerous and people are harmed by them! The view of the Senate was: no matter what he said about his experience, he was wrong. It’s like, “You don’t know what happened to you. We have to go to some scientist to tell you that you’re more seriously damaged than you realized.” [It’s also significant that] he had the experience 15 years ago, so if there were these long-term medical problems he hasn’t seen them. We’re still not at a point where we can have honest discussions. I thought that was a very courageous piece.

Q: What are your visions for the future? What would you like to see happen? What do you think will happen?

A: What I would like to see happen is that as a society we understand that we are an anomaly. That most cultures have integrated altered states and psychedelics in some fashion or another. I hope that people will slowly start to be educated more and more about the medical use of marijuana and the fact that they have been, in large part, lied to by the government about the dangers of MDMA. At the same time, we will start to create beneficial uses of psychedelics. The two areas we’re working on are post-traumatic stress and terminal cancer and end-stage AIDS — helping people to deal with dying. So what we’re saying is that this drug is not just for your raver kids. This drug is for everybody. This is not just for the baby boomers, but it’s for their parents who are now at the end of their lives and are scared of dying and are scared of pain and that we can help them. That we, meaning the psychedelic community that’s learned how to work with these substances, have something to offer that our current medications don’t offer. So we have to show that this is something that can be normalized, that can be integrated into society in a beneficial way.

And then we also have to have a little bit of a different understanding about risk. The head of NIDA has said that people can die from MDMA, therefore there’s no such thing as the recreational use of MDMA. But people die from high-school football, people die from skiing, people die from scuba diving, mountain climbing. Dale Earnhardt died from race-car driving. We have to do our very best to do harm reduction and prevent all deaths from MDMA or any other drug. And yet we also have to say that as a society that we can’t prevent all risks.

Mike Miliard can be reached at mmiliard[a]phx.com. Visit the Multidisciplinary Association for Psychedelic Studies at www.maps.org.