The Great Entactogen - Empathogen Debate David Nichols

Richard Yensen

Ralph Metzner

William Shakespeare Dr. David E. Nichols

Profession, Medicinal Chemistry and Pharmacology

Purdue University Dear Rick, I write to respond to the letter from Ralph Metzner regarding the name empathogen versus entactogen [for drugs such as MDMA]. I did tell Ralph that I believed that the pronunciation em-PATH'-o-gen would create a negative impression in the mind of a psychiatric patient, because of the distinct embodiment of the word 'pathogen' within the name. Indeed, this was not even my own observation. I was discussing possible names for a new drug class several years ago with individuals who were not familiar with the MDMA literature. It was they who pointed out this parallelism between empathogen and pathogen. This was thus not my speculation, but an actual observation. However , there were two other important reasons to coin the term entactogen. First of all, within the medical profession, it seemed much more likely that some term other than empathogen would gain acceptance, since the later might be viewed by hard-line clinicians as being rather trite. Second, MDMA and related substances do more than simply increase empathy. In addition to their ability to produce, as Ralph states, "a feeling of connectedness...with others...," in the context of therapy they also produce a powerful anxiolytic state which is accompanied by what could be described as a sort of chemically-induced hypnosis. This latter, as in hypnosis itself, manifests as a state of increased suggestibility, with heightened powers of concentration and mental focus. As is also true with hypnosis, this state facilitates the recovery of repressed memories and allows age regression techniques to be used. Thus, empathogen is also a restrictive term because it fails to take into account these important properties of the drug class. I would also argue that it was not the drug-evoked "empathic resonance" that made MDMA such as "outstandingly valuable therapeutic tool," but rather the actions I describe above. The "empathogenic" effects, if you will, were what made MDMA such an outstandingly popular drug. Perhaps a need may exist to draw a distinction between the properties of the drug that make it pleasurable and those that make it valuable for medical/therapeutic uses. On a philosophical level, I object to the use of the term empathogen in a medical context, since the therapist should be able to develop feelings of empathy for the patient in the absence of taking the drug him/herself. To talk about MDMA in the context of helping the therapist develop "conscious attunement with another's emotional state, together with understanding," is to state, actually rather explicitly, that the therapist will self-medicate with the drug. To underscore this point, consider whether a patient generally has the need to "tune in" to the therapist's emotional state. I am well aware that a good deal of MDMA use has occurred when "therapist" and client both take the drug. I am sure that there are many who would even advocate this as the best paradigm. However, the main thrust of my efforts has been to make these drugs acceptable to the medical community at large, following generally-accepted standards of practice. In that context, MDMA would not be administered to the therapist, and any discussion of drug-induced enhancement of empathy in the therapist is completely irrelevant. We spent a long time trying to develop a term that would be descriptive of what these drugs do; one is faced with the problem of a treatment in search of a disease. If MDMA were useful for treating a specific pathological condition, a name would have been easy to find; consider names such as antidepressant, antianxiety, or antipsychotic. Based largely on a belief that the ability to access repressed or unconscious material would ultimately prove to be the effect of these drugs most widely exploited in medical practice, we tried to develop a term that would reflect the drug's ability to facilitate the retrieval of "inner" material and enhance introspective states. Hence, the term entactogen, meaning essentially "to produce a touching within." While this term may be no more precise than many others, I still feel that it is to be preferred over empathogen, at least when discussing it in a legitimate scientific or medical context. Sincerely, David E. Nichols

Professor, Medicinal Chemistry and Pharmacology

Purdue University

1333 Robert E. Heine Pharmacy Building

West Lafayette, Indiana 47907-1333 Dear Rick, Congratulations on the 50th Anniversary of LSD issue of the MAPS newsletter, I think it is the best ever! I would like to comment on Ralph Metzner's letter concerning entactogen & empathogen as possible names for a novel drug class to describe MDMA and related compounds. My Ph.D. dissertation examined the use of another amphetamine/mescaline-like phenethylamine, MDA, in the treatment of neurosis. I believe that characterizing a psychedelic as having a specific emotional property as though it were a chemotherapeutic effect is a misunderstanding. For example, when MDA hit the streets it was immediately called a "love drug." MDMA seems to have replaced MDA to become the love drug of the 90's. These are lay descriptions and confusions, researchers need to be more precise. I believe that clues to the unique properties of the phenethylamine family can be garnered from the structural similarity between MDA/MDMA and amphetamine/methamphetamine as well as their similarity to mescaline in another aspect of their molecular structure. I see both drugs has having varying amounts of classical psychedelic, i.e. mescaline-like, activity. What is unique about this family is that unlike classical major psychedelics the mind- manifesting properties of these two compounds are colored by the euphoric properties of the stimulant/euphoriant side of their molecules. MDA seems to have a stronger classically psychedelic property which is modified by the moderate euphoria induced by the amphetamine-like side of its molecule. MDMA appears to have a quite modest psychedelic property and a very pronounced euphoric property due to the methamphetamine-like side of its molecular structure. Many observers and commentators on MDMA appear to confuse its propensity to induce a profound sense of well-being with the complex experiences of love and empathy. What is most amazing is that even an experienced psychedelic raconteur like Ralph Metzner, who helped pioneer the set and setting hypothesis, is quite willing to discard his hard won insights about the pivotal role of set and setting by characterizing MDMA as an empathogen. The research on MDA done at the Maryland Psychiatric Research Center in the early '70's characterized its effects in a preliminary way: Dynamically, the drug seems to reduce the need to defend or aggrandize the ego. In this state of enhanced well-being, the subject seems more able to accept and integrate concepts emanating either from the unconscious or provided by the guide or therapist., In substance, many of the subjects indicated that MDA seemed to "invite" inner exploration in contrast to LSD which demands it. The state of consciousness which MDA facilitates would seem to make the acquisition of new insights an easier process. This type of experience may be especially helpful in breaking through obsessive, anxious and depressive patterns of thought and feeling. Another possibility is its application in group therapy settings to facilitate interpersonal interaction, enhance sensitivity to feelings and promote emotional expression. (Turek et al. 1974) A reduced need to aggrandize or defend the ego is another way of describing the amphetamine-like euphoric effect on the subject's self-esteem. I find that MDMA has at once a stronger euphoric and a milder psychedelic action than MDA. The feeling of well being becomes more pronounced and the preoccupation with emergent inner material is less absolutely compelling than either MDA or a classical psychedelic such as LSD. Thus the pharmacological properties of MDMA can lead to greater openness in the interpersonal sphere. Empathy and experiences of deep love and transcendence are possible with MDMA as with all psychedelics, but a specific drug action, i.e. that of methamphetamine, is a part of its pharmacology that is often confused with these deep experiences. A reduced need to defend or aggrandize one's self can lead to empathy and greater contact, but this depends on non-drug factors (set & setting) and is not a pharmacological property. For these reasons David Nichols' term entactogen seems a more correctly conceptualized word. I wish I liked the way it sounds, I don't. It's too staccato for my tastes. Ahh, the joys of splitting hairs amongst friends! Sincerely, Richard Yensen, Ph.D. Dear Rick, I don't know whether the debate over "empathogen" or "entactogen" has much significance in the larger scheme of things, or even for the future potentials of drugs such as MDMA. Was it the Mad Hatter or the Queen of Hearts who said to Alice: "When I use a word I use it to mean whatever I mean it to mean"? Nevertheless, since my remarks in your MAPS newsletter elicited comments from my esteemed friends and colleagues Richard Yensen and David Nichols, perhaps I can be permitted a brief response. Richard Yensen refers to me as a "psychedelic raconteur", perhaps to contrast my opinions with his, presumably more scientific, based on his Ph.D. dissertation on MDA therapy. While I am happy to take on the role of a "story- teller" when requested, I would like to point out that my remarks about drug terminology are actually based on my more or less direct participation-and- observation of several thousand sessions, group and individual, with psychoactive and psychedelic drugs and plants, over the last thirty years. More specifically, my suggestions about MDMA resulted from my work on the book Through the Gateway of the Heart, for which I pored over several hundred detailed first-person accounts of MDMA, from the files of a dozen or more therapists. Nor does calling MDMA an "empathogenic" means that I "discard...the role of set and setting." Quite the contrary: the role of set and setting is quite obvious to anyone who has worked with psychedelics or similar compounds. Who can doubt that the experience of the thousands who consume "XTC" at a "rave" are having a different kind of experience from those who take it in a therapeutic or meditative context? At the same time, even the ravers report feelings of emotional oneness and connectedness. Researchers and experiencers consistently report consistent differences between the MDMA-type drugs and the LSD-type drugs. The terminological problem is: how best to describe this difference? Richard first castigates me for the "misunderstanding" of "characterizing a psychedelic as having a specific emotional property as though it were a chemotherapeutic effect". He then proceeds to write about the "euphoric properties of the amphetamine/euphoriant side of their molecules", and the "euphoric properties induced by the amphetamine-like side of its molecule". Molecules with euphoriant sides? Talk about confusing levels of reality. What happened to set and setting here? Amphetamines as "euphoriants"? -- most people regard them as stimulants (not quite the same). I don't know who is confusing MDMA's propensity to induce a "profound sense of well-being with the complex experience of love and empathy." I do know that the most frequently reported characteristic that distinguishes MDMA from LSD-type experiences is the emotional communion, the oneness, relatedness, emotional openness -- in short empathy or sympathy, or something to do with affect. LSD can produce it too, but it does a lot of other things as well, and MDMA does it consistently. It seems to me that if you are trying to describe an experience most effectively, you should use the language that most people use when describing the experience; not draw on pharmacological theories about euphoriant molecules, or transitory psychological theories of "reduced need to defend the ego" etc. Of course, as David Nichols observes, the medical profession (like other academics) likes to have its own terminology for objects and processes known to the lay public as well, so it can discuss them in a "legitimate scientific or medical context" -- and I certainly have no objections to doctors or anyone else using words in any way they want. But my question would be -- what does this term really communicate and to whom? Is empathy really such a "trite" experience, that you have to disguise it as something else? Like Richard, David too has a theory about MDMA, that the empathy is really some kind of secondary or derivative effect. His is that MDMA produces an "anxiolytic state...accompanied by chemically-induced hypnosis". As if we knew what hypnosis did or how it worked. And just because hypnosis, and MDMA, can be used to facilitate age-regression, this does not make age-regression a property of the drug, or of hypnosis. And anyway, why do all the possibilities of the drug experience have to be included in the descriptive label? And does "entactogenic" include references to age-regression, empathy, euphoria, "reduced ego defense" and all the other suggested "properties" of MDMA? Of course not: and the reason is that it is a newly-coined technical term, which doesn't communicate anything to anyone unless you explain in detail what you mean. At least, "empathogenic" (or "sympathogenic" , which German therapist Constance Weigle uses in her recent book on MDMA therapy) has the virtue of using commonly understood terms. And how does "entactogenic" -- "reflecting the drug's ability to facilitate the retrieval of inner material and enhance introspective states" in David Nichol's terms -- distinguish this class of drugs from the LSD-type psychedelics? It doesn't -- in fact "touching within" or accessing inner states is pretty much what "psychedelic" means; and LSD and the tryptamines could be considered highly effective entactogens, in that sense. One last point: David's insertion of a diatribe about self-medicating therapists into this discussion is both irrelevant and unfair. I never suggested, nor do I support, the practice of therapists taking MDMA with their clients. I said that the kind of empathic response characteristic of MDMA experiences is the same as psychotherapy training institutes spend years trying to inculcate in their trainees. Empathy, conscious emotional attunement with another's feeling-state, is a complex response that can be learned; and of course it can practiced, and learned, without drugs of any kind. What I was (admittedly) implicitly suggesting in my comments was the often-discussed potential value of MDMA and similar drugs in the training of therapists. In my opinion, the three potentially most valuable applications of MDMA in psychotherapy are: one, for working with traumatic memories; two, for interpersonal communication and openness; and three, for the empathy training of the therapists. In the end, perhaps it all comes back to the Mad Hatter; -- or is it the Queen of Hearts? We can use words to mean what we want them to mean. My esteemed friends Richard and David will use "entactogenic" as they wish; I now have a better idea what they mean by that term. For my part, I shall continue to use "empathogenic" -- it doesn't take as long to explain for one thing. On the other hand, I really like "Adam", the term coined by our revered master Leo Zeff. This means something like "primordial being", "original nature", "primal parent", "great ancestor"... Thanks for allowing me to comment. Ralph Metzner ... a rose by any other name ... William Shakespeare

Romeo and Juliet