I Feel Love: MDMA for Autism and Social Anxiety
Dateline: San Francisco, CA
This is a guest post from Rachel Nuwer (@RachelNuwer), an award-winning science journalist who regularly contributes to the New York Times, National Geographic, Scientific American, and many other publications. Her reporting for the New York Times broke the news globally about the MDMA Phase III clinical trial and was highlighted by me, Michael Pollan, and Ezra Klein, among others. In 2022, Nuwer was among the inaugural recipients of the Ferriss–UC Berkeley Psychedelic Journalism Fellowship. She holds masters degrees in applied ecology and in science journalism. Her first book, Poached: Inside the Dark World of Wildlife Trafficking, took her to a dozen countries to investigate the multibillion-dollar illegal wildlife trade.
What follows is an excerpt from her new book, I Feel Love: MDMA and the Quest for Connection in a Fractured World.
Enter Rachel…
One group of people who are particularly at risk of missing out on social benefits—and who serve as a sort of canary in the coal mine for the insidious effects of increasing disconnection—are autistic individuals.
Autistic adults are more likely to experience high levels of loneliness than their neurotypical peers. While 7 percent of the general adult U.S. population meets the diagnostic criteria for social anxiety disorder, one in four autistic adults do. Autistic people are also four times more likely to suffer from depression and eleven times more likely to have suicidal thoughts—problems that frequently both stem from and exacerbate social isolation—and they are 2.5 times as likely to die early.
Despite the serious setbacks that many people on the spectrum face due to living in a society that discriminates against those who are different, social anxiety, loneliness, and lack of connection are not inevitable parts of being autistic. According to a 2022 meta-analysis of thirty-four scientific papers, autistic adults are less likely to be lonely if—somewhat obviously— they have relationships, experience fewer difficulties with social skills, and have positive views and acceptance of themselves. While there are many different ways to achieve these things, some autistics have gravitated toward a certain particularly potent molecular tool.
Aaron Paul Orsini grew up in the suburbs of Chicago, and as a teenager he remembers oscillating between being on the periphery of social gatherings and being “overly performative and needing to take over a situation.” At parties or at professional conferences as a young adult, he’d often feel overwhelmed by the bombardment of incoming sensory information.
When he was twenty-three, Aaron started seeing a psychologist for depression, anxiety, and what he described as “feeling that I would never ‘get it,’ and not really having any answers about how or why that might be.” During one session, the psychologist handed him a questionnaire to fill out without really explaining what it was for. After evaluating Aaron’s answers, the psychologist announced that Aaron was autistic.
In some ways, this news came as a relief. Knowing that he was autistic provided Aaron with a new way to conceive of his specific challenges and potential strengths. Yet even with this revelation—and to his distress—his lifelong habit of focusing on his deficits and limitations proved stubbornly resilient to change. “Even though I could tell myself, ‘Oh, I have superpowers,’ I was still feeling down and feeling a bit like, for the rest of my life, I wouldn’t be able to do things,” he said.
When Aaron was twenty-seven, he experienced something of a quarter-life crisis and wound up on a train from Chicago to the West Coast with only a backpack in hand. He befriended a group of free-spirited fellow travelers who gave him a tab of LSD—a chance encounter that changed his life. Sitting on a tree stump in a forest, Aaron felt his mind go still; his awareness widened, and his sensory issues suddenly seemed manageable. The LSD also bestowed him with an ability to better read between the lines of social interactions and emotions in ways “I quite literally could never have imagined,” he writes in Autism on Acid, a book he published in 2019.
Aaron discovered MDMA shortly after LSD, when he was invited to a gathering of artists, musicians, and other creative types. By this time, he was an old hand at classic psychedelics, but MDMA was unique, he found, in that the experience never strayed beyond the realm of his own narrative, “with my ego fully intact,” he said. “It was like taking a crystallized form of intuition.”
MDMA’s use as a tool for reducing social anxiety was also made clear to Aaron that night, when he sat down next to a stranger and unhesitatingly struck up a conversation. He felt comfortable, he found, not only chatting but also just being silent with the other person and enjoying the shared moment. “In that instance, I struggled to feel like I had a problem, and I struggled to feel like, if a problem came up, it would be bad,” Aaron recalled. “Everything seemed endurable, just because of how much love I felt for being alive. And for the other people with me as well.”
Aaron has taken MDMA around seven times since then, adhering to a general rule of giving himself at least three months in between sessions. “I’ve intentionally kept myself at a distance from something that can be so great,” he noted. But even the handful of times he’s tried it, he said, it “feels like a lot of learning,” especially with regard to social situations. As he explained, “I’ve been able to witness myself being social, rather than just contemplate why I am socially anxious.”
Aaron isn’t the only autistic person to have serendipitously discovered MDMA’s usefulness for overcoming social anxiety. “We’re a diverse bunch, but one of the traits that seems to be fairly universal for us is how curiosity-driven we are,” said Nick Walker, a professor of psychology at the California Institute of Integral Studies. “A lot of autistic people do end up experimenting with psychedelics,” she added. “I’ve certainly encountered people in the autistic community who have said they’d gone to a party, done MDMA, and felt much more comfortable than usual.”
In 2012 Walker was presented with an opportunity to dig more deeply into these intriguing anecdotal accounts when Alicia Danforth—then a clinician at the Lundquist Institute at Harbor-UCLA Medical Center, and a colleague of Charles Grob—reached out to her about collaborating. Danforth was also in communication with MAPS, which had received some funds from a donor earmarked for research on MDMA and autism. Based on published data showing that MDMA could increase empathy in typically developing individuals, the MAPS team had originally thought about carrying out a study to test whether MDMA could also help autistic people feel more empathy. Both Danforth and Walker pointed out that for autistic people, however, this was misguided. As Walker said, “It’s starting from false premises that the autistic community has been pushing back against for a couple decades now.” Indeed, since autism became a diagnosis in 1943, mainstream psychology and academia have pathologized autism and cast autistic individuals as being emotionally deficient, including lacking in empathy. Those flawed assumptions spring in part from neurological and behavioral differences that can exist between autistic and nonautistic people, creating communication difficulties. Because neurotypical people are in the majority, though, misunderstandings have traditionally been blamed entirely on autistic people, Walker said, and autistics have also been expected to shoulder the full burden of trying to fit into a world not built by or for them. While a rising tide of autistic academics such as Walker are working to change this—as is the autistic community at large—for now the dominant discourse still treats autism as a disorder in need of curing.
Danforth is not autistic, but her PhD research includes an analysis of data she collected from autistic individuals who had used MDMA. The hundred accounts shared with her revealed a wide array of benefits people perceived from taking MDMA, such as increasing their courage, communication skills, and feelings of connection. Many people also reported lasting healing with regard to trauma and social anxiety. Given Danforth’s dissertation findings and Walker’s real-world experience, they proposed that MAPS pursue a study trying to address something that autistic people themselves tend to identify as a problem and that MDMA seemed to have a high likelihood of being able to help with: social anxiety. While social anxiety isn’t an intrinsic aspect of autism, Walker emphasized, it is “something a lot of autistic people have because they have a lifelong history of social rejection.”
The twelve autistic adults who wound up taking part in the MAPS-sponsored double-blind, placebo-controlled study all had very severe social anxiety, and most also had a history of trauma—a common occurrence for autistic people. Working in an autism-friendly space that Walker helped design, Danforth and Grob oversaw two eight-hour therapy sessions with participants who were given either a placebo or MDMA (75 to 125 milligrams, sourced from the original David Nichols batch). During the active sessions, Danforth and Grob guided participants through various methods for exploring and communicating their feelings, including art therapy and the use of a deck of around fifty cards that visually depicted emotions. After each active treatment session, participants received daily phone calls for a week and three in-person integration meetings.
As Danforth, Walker, Grob, and their colleagues reported in 2018 in Psychopharmacology, at the end of the trial, participants who had received therapy paired with MDMA had significantly greater reduction in their social anxiety symptoms compared to those who had received therapy and a placebo. In a six-month follow-up after the sessions, the social anxiety scores for people in the MDMA group had either remained at the same lowered level or improved slightly—results, Walker said, that “fit our most optimistic hypothesis.”
Berra Yazar-Klosinski, MAPS PBC’s chief scientific officer and a coauthor on the social anxiety study, said she was most heartened to hear personal stories from participants about how their lives had improved in the months and years after the trial. One individual who initially presented with obesity lost eighty pounds after treatment; another moved out from their parents’ house, got married, and had kids; and another joined a soccer club and finished their college degree. One participant even attended a scientific conference with Danforth and gave a presentation about their experience in the trial. “The fact that this person went from having severe social anxiety to talking onstage is amazing,” said Yazar-Klosinski, who has a brother on the autism spectrum. “It’s really those kinds of events that are the true measure of improvement.”
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Aaron already credits MDMA and other psychedelics with dramatically changing and improving his life. After his book came out, and as he continued to post about his experiences online, he began receiving more and more emails from other autistic people looking to compare notes and share their own stories about psychedelics. In response, in 2020 Aaron cofounded the Autistic Psychedelic Community, an online group for people interested in the intersection of psychedelics and neurodivergence. The group sponsors weekly Sunday Zoom discussions that have attracted some eighteen hundred attendees, including people from as far away as Australia, Kenya, and Israel. Around four thousand people have participated on the group’s messaging forums, and Aaron also maintains an “Autistic Psychedelic Wiki” of peer-reviewed literature pertaining to psychedelics and autism. While education is important, Aaron’s main goal, he said, “is really bringing autistics together to accept one another and to demonstrate radical acceptance outwardly, because most of us are acclimated to radical rejection.”
Aaron is now collaborating as a coinvestigator with researchers at University College London to conduct a qualitative survey with autistic people about their use of psychedelics, and he is also working on an audio documentary on the same topic. Relatedly, in 2021 he published Autistic Psychedelic, a compilation of community essays and survey responses. Some of the stories people shared provided anecdotal support for the research findings about social anxiety and MDMA and mirrored Aaron’s own experiences. Shae, for example, described herself as a twenty-seven-year-old who thinks in colors, shapes, and sounds rather than words. When she tried MDMA, she said, she experienced “effortless and fluid verbal communication” for the first time in her life. Suzanne, a thirty-two-year-old who also has ADHD, wrote that MDMA made her feel “seen and understood by my neurotypical friends in a way that I hadn’t experienced previously and vice versa. I learned more about actively listening to other people and that at the end of the day, neurodivergent and neurotypical people both want to connect, to be understood, and to love and be loved.”
The valuable lessons MDMA can impart about communication, connection, and acceptance can apply just as well to people who are not on the spectrum, too. My neurotypical friend John Allison, for example, is the type of guy who isn’t afraid to go to a bar by himself on a Friday night, because he knows he can just start a conversation with whoever is sitting next to him. He wasn’t always like this, though. John described himself as being “not that well socially calibrated” growing up in Arkansas—a wallflower at parties and the quiet kid at school. “I wanted to be social and be able to make more friends, to have better connections and have a good time with other people,” he said. “But I didn’t really know how to get out of my shell.”
As he got older John pushed himself to be more outgoing, but he still frequently felt anxious and awkward, especially in groups. When he was thirty-four, however, he tried Molly [MDMA] for the first time at a warehouse somewhere in Brooklyn and “just exploded,” he said. “I could talk to anyone and express myself in ways I hadn’t been able to before, and I could empathize more openly with strangers. I was surprised at how many different conversations I had, and how well they went. It was something I’d been trying to do, but I didn’t know how to do it until Molly just brought it out of me.” After the Molly-induced “jolt” to John’s system, he started making a point of trying to access that version of himself in his sober life. When he did, he found that he got the same positive reactions from friends and strangers alike. As these experiences built, so too did John’s confidence. Today, his practiced friendliness comes across as effortless and natural.
MDMA seems to be an especially effective tool for facilitating communication and overcoming social anxiety, Lieberman said, because it “resets your expectations about other people and the reaction you’re going to get from them.” The drug also changes how people express and respond to emotions, a feature that researchers think could help them identify the fundamental components of meaningful connection. “We can use MDMA as a tool to bottle that sense of deep, instant connection and study it in the lab, and also as a tool to directly improve people’s lives,” said Sonja Lyubomirsky, a social psychologist at UC Riverside who specializes in happiness. In 2022 Lyubomirsky published a paper proposing a new field of study, psychedelic social psychology, that would incorporate psychoactive substances like MDMA into research investigating topics varying from how to foster a connection to nature to how to reduce prejudice and intergroup conflict. This “exciting new frontier” is only in its infancy, Lyubomirsky wrote to her colleagues, and she fully expects “an avalanche of ideas for relevant research questions and paradigms to emerge.”
Studies have already shown, for example, that individuals on MDMA are slower to pick up on angry facial expressions, but that they react with extra enthusiasm to happy expressions. The drug also lowers fear of being judged or rejected, freeing people up to experiment with different modes of interacting. There are hints that these lab-based findings might translate for some MDMA users into real-life gains. According to a 2023 analysis of data collected from 214,505 U.S. adults for the National Survey on Drug Use and Health, people who have taken MDMA at least once in their lives, compared to those who have never taken the drug, have lower odds of difficulty interacting with strangers; of difficulty engaging in social activities, such as visiting with friends or going to parties; and of being prevented from being social due to a mental health issue. “A lot of social anxiety is about the idea of, if I put myself out there, I will be shamed, humiliated, and judged, and that’s terrifying to think about,” Lieberman said. “MDMA can move the needle on that by allowing you to have different experiences than you typically do.”
In best cases, he added, the drug can help “transform your understanding of yourself, the world, and your relationship to it, and give you new beliefs moving forward.”
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Excerpted from I Feel Love: MDMA and the Quest for Connection in a Fractured World. Used with the permission of the publisher, Bloomsbury. Copyright © 2023 by Rachel Nuwer.
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