MDMA 255
recreational abusers, effects occur without hallucinations and without causing
apparent mental cloudiness while intoxicated. Before being banned by the U.S.
Drug Enforcement Administration (DEA), doses were given to encourage pa-
tients to participate more freely in psychotherapy discussions—a usefulness
that still found advocates in the 1990s—and to facilitate understandings
among patients, understandings that helped reduce their problems. Under-
ground knowledge of psychiatric usage persists despite an absolute legal pro-
hibition against using the compound: Medical literature reports someone
illegally taking the drug for self-medication of posttraumatic stress disorder.
In the history of abused drugs, psychological benefits claimed by propo-
nents have often been deflated by scientific investigation. MDMA is no excep-
tion. Psychological tests have compared polydrug users who have or have not
taken MDMA and also persons who have abstained from any illicit drug.
These tests find no difference among these groups in anger, anxiety, or mood.
Whatever feelings of peacefulness that recreational MDMA users experience
while intoxicated, those results do not seem to persist afterward. Indeed, ex-
perimenters who gave these tests found the MDMA group to have more psy-
chological trouble than the nondrug group. In such findings a key question is
whether the drug caused psychic problems or whether problems caused the
drug use. Staff members at a Spanish hospital’s psychiatric service reviewed
a substantial amount of medical literature about MDMA users and observed
that the case reports did not sustain a conclusion that MDMA was the primary
cause of users’ psychiatric problems.
One significant exception exists in findings about MDMA’s limited value in
promoting personal insight and healthy integration with the world. That ex-
ception comes with persons using the drug for spiritual purposes rather than
recreationally. Here the all-important influence of set and setting are dem-
onstrated. Spiritual users tune in to certain kinds of psychic effect promoted
by the drug and apparently are able to focus their attention so intensely that
they can disregard and be unaffected by psychological effects that trouble
recreational abusers. This situation appears to demonstrate a principle familiar
to historians of drug use, who find that a substance can be beneficial in a
particular cultural context and yet have catastrophic consequences when used
by someone who disregards that context. Any spiritual purpose for which
MDMA may be used will, of course, have no impact on the drug’s physical
actions, although persons who seldom use it may be spared various hazards
documented by scientists.
MDMA is legally classified as a hallucinogen, but it is pharmacologically
classified as an entactogen—a type of drug with both stimulant and hallucin-
ogenic qualities. MDMA is recreationally used more for its hallucinogenic ac-
tions than for stimulant actions. It is an analog toMDAand related toMDEA,
amphetamine,methamphetamine, andmescaline. MDMA is described as
mellower than MDA, and some users experience MDMA as less potent than
mescaline. MDMA can alter perceptions of time and space and induce feelings
of peacefulness. Users typically understand that MDMA hallucinations (such
as floating in midair or seeing geometrical designs) are unreal; users normally
do not undergo a temporary psychosis in which the sensations are misper-
ceived as objective reality.