How MDMA Assisted Psychotherapy Could Change How We Perceive Autism Forever

MDMA assisted psychotherapy is far from a novel concept. Way back in the 70's when “the godfather of ecstasy”, Alexander Shulgin, a genius chemist who spent his life synthesising and researching over 230 psychedelic drugs, rediscovered MDMA he instantly noted its medicinal value and spread it among the underground psychologist community to which he was closely connected.

As with every psychedelic drug he fell in love with (“love” being his own word), he never viewed MDMA as a “party drug” but rather as a way to explore the mind with great therapeutic potential, in this case one that enhanced empathy and therefore human connection. A chemical that held the power to help people introspect and, most of all, connect with others.

“My mood was light, happy, but with an underlying conviction that something significant was about to happen. There was a change in perspective both in the near visual field and in the distance. My usually poor vision was sharpened. I saw details in the distance that I could not normally see. After the peak experience had passed, my major state was one of deep relaxation. I felt that I could talk about deep or personal subjects with special clarity, and I experienced some of the feeling one has after the second martini, that one is discoursing brilliantly and with particularly acute analytical powers.”
– Alexander Shulgin, documenting one of his first MDMA experiences in PiHKAL (Phenethylamines I Have Known And Loved)

What does this have to do with changing the perception of autism? Quite a lot. First of all it is vital to note a few basic things.

Most importantly, no medical treatment currently exists for autism. Comorbid disorders that commonly overlap with autism – such as depression and anxiety – can be treated, but by far the most common treatments for those conditions involve the use of pharmaceutical drugs such as SSRIs (antidepressants) and benzodiazepines or pregabalin (anxiolytics, “downers”). These medications are often prescribed to autistic people in an attempt to help manage symptoms of comorbid conditions frequently seen in those with autism.

Diazepam is the most commonly prescribed benzodiazepine in the UK.

Some doctors will additionally use certain medications “off-label” in an attempt to treat autism symptoms, despite the fact absolutely no prescription drug on the market today has undergone clinical trials or been approved to do so. The drug I was offered to ostensibly treat my autism had very serious side effects – the potent antipsychotic quetiapine, commonly known under the trade name Seroquel and only licensed for treatment of severe mental illness such as schizophrenia, lists “sudden cardiac death” as one of its many side effects.

Although not as severe as antipsychotics, all of these medications I have mentioned often cause dependency and withdrawal symptoms among other side effects. SSRIs often cause suicidal ideation and erectile dysfunction. And despite being very commonly prescribed, the efficacy of SSRIs, particularly when the side effects are considered, is a topic of dispute within medicine:

SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.

Doctors (in the UK, at least) don't like to prescribe benzodiazepines such as diazepam (Valium) due to their addiction potential, but pregabalin (Lyrica) was readily prescribed by GPs around the country until just a couple years ago and is at least as addictive as benzos if not more so.

This is not to say I am anti-pharma or anything like that, don't get me wrong. Plenty of people have their lives improved by the meds I just slagged off and I have a couple of prescriptions that greatly improve my own functioning too. But over-prescription of SSRIs and antipsychotics does concern me and the way so many drugs are either over-prescribed or under-prescribed without much room for a sensible middle ground has never made much sense to me, nor has the fact that many prescription drugs are more harmful than illicit drugs such as MDMA which, it turns out, isn't as dangerous as people tend to think according to actual science from a peer reviewed medical journal.

Alcohol is by far the most harmful drug.

However for autism, not even a single approved, clinically proven treatment exists. There are SEN departments aiming to provide extra support to autistic children in school, but there is no tried and tested evidence based treatment available for autism itself. This leads to the perception of autism as a life-long curse by parents, wider society, and in some cases the autistic individuals themselves.

Other conditions such as depression, anxiety, and ADHD have established treatment paths. People suffering from these conditions are increasingly encouraged to ask for help and seek treatment for them. If an individual with autism is having a hard time coping they can speak to friends and family – that is, if they are not afraid of the stigma – but as far as treatment goes, there is thus far none to seek out.

Therefore one is needed, and autism is relatively high up on the list for treatments considered “experimental” specifically because no established treatment yet exists for the condition.

None of this is to say autism is a “disease” that requires a “cure”, in fact this is exactly the type of perception I hope will become outdated when MDMA assisted psychotherapy treatment becomes the norm. Instead it ought to be highlighted that autism comes with both difficulties and strengths and those strengths can shine through when the difficulties are correctly managed.

This brings me onto MAPS; the Multidisciplinary Association for Psychedelic Studies. They are a US based non-profit organisation leading the way in MDMA research. They are currently conducting phase III clinical trials into the use of MDMA for the treatment of PTSD with the aim of getting the drug FDA approved for this indication by 2023.

While there are already treatments used for PTSD, many patients find them ineffective and it's not uncommon for a PTSD patient to find themselves hooked on SSRIs or benzos – particularly in the US, where sertraline (Zoloft) and alprazolam (Xanax) are two of the most commonly prescribed drugs in the whole country.

Certainly, it would appear that introspecting, facing your demons, and feeling connected to others is likely to be more emotionally healthy than numbing yourself with antidepressants or downers.

Xanax or Pills? The past vs the future?

But as lofty as their goals already are, MAPS are only just getting started. They believe there is a clear scientific basis for MDMA therapy assisting in the treatment of many other conditions as well.

They have also conducted successful pilot studies into the medical use of LSD and psilocybin (“magic”) mushrooms. However, the bulk of their research is focused on MDMA as it can provide many of the same medical benefits as a full on trip without having to actually go through a full on trip – an experience that may be daunting and intense for those inexperienced with psychedelics. With MDMA there's no risk of a bad trip because you're not tripping, you're rolling. This is why MDMA falls under the broad umbrella of psychedelic medicine despite being an empathogen rather than a psychedelic.

MDMA is also well suited for use in a therapy session as, at the doses used medically, you will still be very lucid and able to stay on topic and communicate your thoughts clearly, while deep emotional issues will be communicated even more clearly than they would in a sober state. At therapeutic doses you'd likely be much less mentally impaired than you would be if you were drunk. A full trip is more difficult to control to this level, particularly for a novice. Consider also that an acid trip typically lasts around 12 hours while a roll typically lasts around 3-4 hours.

MAPS has already conducted a pilot clinical trial in which MDMA was studied for the treatment of autism related social anxiety in adults. The full paper has been published and it concludes that the results were very positive and further research is warranted:

This pilot trial demonstrated rapid and durable improvement in social anxiety symptoms in autistic adults following MDMA-assisted psychotherapy. Initial safety and efficacy outcomes support expansion of research into larger samples to further investigate this novel treatment for social anxiety.

At the time of writing, MAPS is raising money to continue conducting this research into MDMA as a treatment for autism.

Unlike conventional pharmaceutical treatments, MDMA is not to be taken daily – indeed, this would be very counterproductive and potentially harmful. Instead, MDMA is given every few months during therapy. The patient comes to realisations and is able to conceptualise and communicate them clearly and freely. It is this experience the drug facilitates that helps the patient overcome their issues. This sticks with the individual long after the drug has worn off.

“Everyone must get to experience a profound state like this. I feel totally peaceful. I have lived all my life to get here, and I feel I have come home. I am complete.”
– Alexander Shulgin again, PiHKAL

Top up sessions can be given later on if required, but there is no need for daily use of pharmaceutical drugs if MDMA therapy is successful. At the very least, reliance on traditional pharmaceuticals can be reduced.

I can personally attest to the efficacy of MDMA in the treatment of autism, as can autistic friends of mine. To me this is a bit of a no-brainer. MDMA is a drug whose primary effect, aside from making techno music sound bearable, is increasing empathy, sociability, emotional introspection, and open communication. These are all things autistic people tend to find difficult.

There is a common misconception that autistic people are in some way cold and unfeeling. Rarely is this true, but we tend to have a hard time expressing our emotions and we're often too anxious even when we do know how. Often we're unsure of what it is we're even feeling or why. This may be because we're so used to inventing a socially acceptable persona to show the world while hiding our true selves. This is known as “masking”, a term used within the autistic community to describe the persona – or multiple personas – we must create to “act normal.”

On come on, you know I just had to...

MDMA removes these barriers entirely. It lets us – and excuse the cliche – but it lets us finally “be ourselves.” We no longer feel the need for masking. I'm unsure if it's the masking or the autism that causes us to suppress our emotions to begin with – it's a bit of a chicken and egg scenario, maybe it's a bit of both. But either way, the outcome is the same:

Overwhelmingly, autistic people reported mental, emotional and physical exhaustion as a result of masking (Hull et al 2017). Masking takes a huge amount of sustained effort and control, all while managing discomfort and trying not to let this show. The longer a person is expected to mask, the harder this can become. Participants reported needing time alone to recover from periods of masking. And if this is not possible, it is more likely a shutdown or meltdown will be experienced.

We learn to mask from childhood onwards in an attempt to fit in with our surroundings. Not only our peers but even our own families. While it is true everyone experiences some pressure to conform to social norms, we break those norms simply by existing and we're expected to “get better” by fundamentally changing every aspect of our personalities.

Imagine if everyone thought there was something wrong with you if you smiled and the only way you could get by in life was to train yourself to stop smiling. This is very analogous to autistic people flapping our hands when we're happy or excited. It's an expression of positive emotion. We can't show it, we're shamed and mocked for it, so we stop doing it unless we're behind closed doors and become very self-conscious and insecure about something as natural to us as smiling is to you.

It's a necessary evil to function in the outside world but it is stressful and I believe that masking is possibly the biggest cause of stress, anxiety, and even depression for many of us. Not autism itself, but the pressure put on us to always be masking. And as Future teaches us, if there's one thing MDMA is good at, it's removing your proverbial mask.

You've heard the quote: “Give a man a mask, and he'll show you his true face.” I remember reading a satirical response: “Teach a man to mask, and he'll show it for a lifetime.” My take would be: “Give a man MDMA, and he'll show you what's under the mask.”

In this way MDMA also gives us a nice bit of a break from this daily reality. Especially when we're rolling with other aspies. We can finally be ourselves. I flapped my hands in front of someone – my girlfriend – for the first time ever in my life because we were on MDMA at the time. It was a truly magical moment when I finally felt accepted for who I am.

Being able to do this every few months with a therapist is something I truly believe would do a world of good for many of us. It's a bit like hitting the “reset” button every now and then and getting in touch with who you actually are rather than who you're “supposed” to be.

Even doing it with a fellow aspie or a group of fellow aspies is something I have found to be a genuinely insightful and therapeutic experience. Not only do we naturally get to know each other better and effortlessly unmask, but being able to fully be yourself around someone who usually has to mask the same (or at least similar) behaviours to yourself is extremely liberating for all involved. I have become closer to my friends afterwards. Once again, the experience sticks with you long after the chemicals leave your body.

And this to me is the magical part that I believe will change perceptions for the better. As stated above, I believe autism will no longer be seen as some type of incurable disease, but instead as a neurological difference with both pros and cons, where the cons can be managed effectively with occasional chemically assisted psychotherapy sessions and the positive side is given a fair chance to shine.

“I feel absolutely clean inside, and there is nothing but pure euphoria. I have never felt so great, or believed this to be possible. The cleanliness, clarity, and marvelous feeling of solid inner strength continued throughout the rest of the day, and evening, and through the next day. I am overcome by the profundity of the experience, and how much more powerful it was than previous experiences, for no apparent reason, other than a continually improving state of being. All the next day I felt like 'a citizen of the universe' rather than a citizen of the planet, completely disconnecting time and flowing easily from one activity to the next.”
– Alexander Shulgin one last time, PiHKAL

Please note: Although I base my views on scientific data such as clinical trials as well as my own experiences, the experiences of others, and the extensive journaling of Shulgin himself, I am not a medical professional and nothing written here should be construed as medical advice or a recommendation. If you are curious about trying MDMA or any other psychoactive substance please do your own research first, particularly regarding trusted sources, safe doses, testing kits, and other harm reduction practices. Erowid is a great place to start. And always remember, when using any mind altering substance, set and setting is vital. This is especially true if you try tripping on a psychedelic. The correct set and setting is key to avoiding bad trips.

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