How MDMA Affects Empathy

According to lore, in the early 1980s, an enterprising drug distributor in Los Angeles was trying to build a street market for the chemical compound MDMA. It seemed like a promising product— MDMA floods the brain with serotonin, a neurotransmitter associated with feelings of happiness. Users reported feeling euphoric, appreciating lights and music in a new way, and a rush of emotional intimacy. MDMA was starting to catch on as a club drug, but if it was going to be big, it would need a catchier name.

With partygoers in mind, the dealer coined the name “Ecstasy.” “Empathy,” he reportedly said, “would be more appropriate, but how many people know what it means?”

Ecstasy gained a foothold in Texas and took Europe by storm via the clubs of Ibiza, eventually migrating back to the U.S. to fuel the emerging rave scene. MDMA was finally made illegal in 1985, but continued to gain popularity over the following decades, eventually peaking in the 2000s. As the media took notice, cover stories about its dangers proliferated. And as Miley Cyrus can attest, the drug has fully caught on as a mainstream party supplement.

But in the last few years, a less hedonistic feature of the drug—its apparent ability to make people more empathetic—has been receiving sober study from scientists and doctors. The new interest is driven by a question that was first asked by Bay Area psychiatrists experimenting with the drug in the 1970s: Can MDMA, under the right circumstances, be good for us?

“It’s a fascinating time to be studying these types of drug effects,” says Dr. Gillinder Bedi, an Assistant Professor of Clinical Psychology at Columbia University. Bedi first became interested in MDMA as a doctoral student in Australia, where ecstasy use is relatively common. Talking to ecstasy users, she was struck by reports that the drug induced feelings of friendliness and sociability. “When I got the opportunity to work in a lab that could administer MDMA to humans, I jumped at the opportunity to see if we could look at these effects in the lab.”

Over the last decade, Bedi has studied various facets of the drug: its effects on emotion and mood, the role played by a user’s environment (a throbbing club, for example), and unavoidably, its unwanted side effects. Many of the negative side effects of ecstasy use are already well-documented: studies suggest that heavy or even moderate MDMA use can impair memory, cause cognitive problems, or even permanently reduce the brain’s sensitivity to serotonin. Bedi’s research has also contributed to our knowledge of these effects, and how to possibly minimize them in therapeutic users.

In a 2010 study, Bedi tested the effects of ecstasy against methamphetamine and a placebo to see if MDMA really does increase empathy. After taking a dose of one of the substances, each subject reported on his or her emotions and mood, and performed tasks that involved identifying emotions in other people from pictures of their faces, or voice recordings.

“One finding that is very consistent is that MDMA generates feelings related to sociability—things like feeling loving, trusting, friendly, playful, and sociable.” This might not be news to the recreational ecstasy user, but research like Bedi’s is bringing a new level of scientific rigor to the study of the subject. “It’s been fascinating to see how these effects, which were once just anecdotal drug folklore, show up in blinded, placebo controlled studies,” says Bedi.

These experiments are providing new evidence for doctors who think MDMA could be used as an aid in therapy. In South Carolina, Dr. Michael Mithoefer has been conducting small, government-approved studies to explore whether the emotional effects of MDMA can play a role in therapy sessions with war veterans suffering from severe post-traumatic stress disorder. His initial results suggest that MDMA could be more effective in these cases than Zoloft, one of the most frequently prescribed antidepressants. Mithoefer’s studies are part of an $18-million effort by a nonprofit called the Multidisciplinary Association for Psychedelic Studies to make MDMA an FDA-regulated prescription medicine by 2021. MAPS has also funded studies of MDMA-assisted therapy for autism spectrum adults with severe social anxiety and terminal cancer patients.

Researchers believe empathy to have two main components. “Cognitive empathy” is the ability to perceive what other people are feeling; “affective empathy” is the ability to actually share in those feelings on a visceral level. In full-fledged empathy, both of these abilities are working in tandem. But the effects Dr. Bedi sees in the lab—the increased friendliness and sociability—don’t seem to add up to an across-the-board increase in both kinds of empathy.

In Bedi’s studies, subjects on MDMA seem to be better at channeling positive emotions themselves. But they actually get worse at accurately identifying fear in other people, based on their facial expressions. “Even if you feel very ‘empathic’ on MDMA, you may actually not read other people’s emotions very well, particularly negative emotions,” Bedi says. In other words, even if it increases an individual’s affective empathy, MDMA may actually reduce cognitive empathy. Part of the drug’s ability to make users feel more friendly and sociable might actually derive from a decreased sensitivity to negative cues that would otherwise rein them in.

The results of Bedi’s studies complicate the conventional wisdom about ecstasy and its relationship with empathy, but they don’t necessarily imply that MDMA doesn’t have medical benefits. Therapists like Dr. Mithoefer aren’t just invested in MDMA as an overall empathy enhancer—their interest is in whether the drug has therapeutic value, as measured by patient scores on objective tests like the Posttraumatic Symptom Scale or the Hamilton Anxiety Rating Scale. Reducing cognitive empathy and turning down the volume on fear could actually be part of what makes MDMA effective as a therapeutic adjunct for traumatized or severely anxious patients. But building the case that ecstasy has a place in mainstream therapy might take some time.

As with many other psychiatric drugs, MDMA’s effects will probably be understood long before the exact mechanism by which it works. This shouldn’t be surprising: after all, we still have only a vague understanding of how the brain operates. For now, it is at least becoming clear that MDMA is potentially much more than just a party drug, and its effects on sociability, empathy, and cognition are subtle and complicated. Serious MDMA research is just starting to find its groove, and it’s set to be an interesting trip.