Set, Setting, Forgetting: Silence on Abuse in Psychedelic Therapy Histories

“Lying is done with words and also with silence.”
–Adrienne Rich, as quoted by Catherine Nugent in “Blaming the Victims: Silencing Women Sexually Exploited by Psychotherapists”

In August 2024, the FDA rejected a new drug application for MDMA-Assisted Therapy (MDMA-AT) submitted by the Multidisciplinary Association of Psychedelic Studies (MAPS), the leading psychedelic advocacy group in the US. MDMA—also known as ecstasy—is an illegal substance that has long been popular not just for recreational uses but for trauma healing, creativity, and spiritual purposes. The new drug application for MDMA-AT submitted by MAPS would have allowed MDMA legal use solely within MAPS’ proprietary psychotherapy protocol and only for individuals with a PTSD diagnosis.

In their rejection of MDMA-AT, the FDA cited questions about research integrity, as well as concerns raised about historic and contemporary sexual abuse of patients by therapists. Psychedelic therapy advocates consistently dismiss these concerns as exaggerated or isolated incidents that are inevitable in any therapy. For example, following the FDA decision, prominent drug documentarian and one-time Joe Rogan guest Hamilton Morris complained, “If people are saying nobody’s talking about [the risk of sexual abuse], first of all, give me a f—king break. It’s pretty much the only thing anyone ever talks about.” We examined the high-profile cases of sexual abuse in the early years of MDMA-AT and noted how these cases were omitted from the considerations around risks communicated to the public, participants, and the FDA in MAPS contemporary MDMA-AT clinical trials. A very different picture emerges.

The case most relevant to the MAPS FDA application started around 2015 at a Phase II trial site in Canada. The two therapists, Richard Yensen and Donna Dryer, were described by a University of British Columbia psychology professor as “legendary psychedelic psychotherapists” with “impeccable scientific credentials training.” The couple had many decades of experience as leading figures in the field, with close ties to MAPS and other prominent MDMA and psychedelic researchers. Yensen went on to sexually abuse the trial participant in the course of continuing treatment. Yensen exploited the theory that past trauma can be “healed” through “restorative” experiences that disregard boundaries between patient and therapist and pathologize client resistance as blocks to overcome. Yensen’s wife, Donna Dryer, continued to treat the participant while aware of her husband’s exploitation of the participant. In 2023, Dryer resigned her medical license.

Philip Wolfson, long-time psychedelic clinician and researcher in the same circles as Yensen and Dryer, discovered the misconduct of his former friends. Writing about the case of abuse, however, Wolfson argued that the incident should not detract from FDA approval of the drug:

“Regarding the woman who was sexually abused while still a subject in a MAPS Phase 2 study at its Canadian site, it was me and my partner who discovered the sexual misconduct. We were visiting our long time friends, a female psychiatrist and her husband, an unlicensed near 70 year old psychologist of renown…We were shocked and made an immediate intervention to have them stop and insisted on the care of the patient being transferred. They did not and the patient stayed in the relationship for some time after, before breaking it off, moving away and eventually filing a complaint…While this incident is intolerable and has ruined lives, it is a singular event in MAPS’ history. It should not mar the approval process.”

Wolfson neglects to mention that Yensen was not the first of his colleagues implicated in sexual abuses related to MDMA-AT. In 1985, with a ban on MDMA looming, Wolfson was part of a small conference of 35 experts who gathered at Esalen to discuss ‘‘MDMA in Psychotherapy.” Among the 35 attendees were psychiatrists Rick Ingrasci and Francis DiLeo. A few years later, both Ingrasci and DiLeo were exposed for sexually abusing patients. Igrasci gave up his medical license and moved to Cortes Island—the same remote Canadian island Wofson was visiting when he discovered Yensen and Dryers’ misconduct.

Wolfson is not the first person to minimize or neglect to mention cases of sexual abuse in MDMA-AT. While looking at accounts of the early years of MDMA-AT, we noticed a pattern: abuses committed by Ingrasci and DiLeo were either totally unacknowledged or acknowledged but later scrubbed from records. The omission of these ethical violations from the history of MDMA-AT has erased the connections between known cases of abuse and understanding of the risks associated with the therapy. Ultimately, this obscures how the underlying theories associated with the MAPS MDMA-AT therapy manual can facilitate abuse.

Rewinding to the 1980s

Before MDMA was made illegal in 1985, a relatively small network of therapists in the US used the drug in therapy sessions with patients. Many of the therapists had worked with LSD in the 1950s-1970s and were connected to the human potential movement centered around the Esalen Institute. Much of the therapy was conducted underground by therapists seeking to keep their practices shielded from the authorities. Boundary-crossing relationships were commonplace as these pioneers saw themselves as cultural revolutionaries existing outside of social and legal norms and fueled by the magical powers of psychedelics as they ushered in a spiritual New Age.

In a talk at the California Institute of Integral Studies, Richard Yensen (before being exposed for abusing a trial participant) discussed the issue of sexual boundary violations in the early years of MDMA-AT. Yensen admitted that in the 1980s, he knew of “large numbers of people where there was sexual acting out and difficulties and where therapists would be involved with multiple patients sexually.” Yensen went on to say he thought sexual “acting out” was “a particular thing with phenethylamines [the class of psychedelics that includes MDMA]… and so it’s another reason why I think these drugs that seem so relatively innocuous or easier to handle than the classical psychedelic drugs are in fact the opposite; they really take very, very profound training and they need constant supervision.” Donna Dryer, added, “There are abuses that I’m sure can happen because people become so vulnerable.”

Despite the seemingly common knowledge amongst core MDMA-AT researchers about sexual abuses in the 1980s, Torsten Passie’s 2023 Oxford University Press book The History of MDMA makes no mention of this. The book draws from Passie’s earlier academic work, including his 2018 journal article “The Early Use of MDMA (‘Ecstasy’) in Psychotherapy (1977–1985).” Most of this 2018 article appears nearly word for word in chapter 5 of The History of MDMA, with one notable omission: the section titled “Physical Abuse in MDMA-Assisted Psychotherapy,” which covers abuses committed by Ingrasci and DiLeo.

Ingrasci and Sexual Abuse in MDMA-AT in the 1980s

Ingrasci, one of the first physicians to offer MDMA-AT in the 1980s, was a prominent figure in the early psychedelic community. An author and influential researcher, Ingrasci was well-known in the holistic health and alternative spirituality conference circuits. In The History of MDMA, Passie describes Ingrasci amongst the “psychedelic luminaries of the time”, alongside contemporaries like Rick Doblin (founder and director of MAPS), Sasha Shulgin, and Stan Grof. Ingrasci was also editor of New Age Journal, the largest magazine of its kind, and co-founder of Physicians for Social Responsibility. He appeared widely in the media as a go-to respected advocate of MDMA therapy, with appearances on leading outlets, including CBS News and the Phil Donahue Show.

Doblin and Ingrasci were featured alongside each other in media coverage when they testified before Congress on the safety and efficacy of MDMA in clinical practice, in hearings that led to the scheduling of MDMA as a controlled substance, effectively shutting down legal MDMA therapy.

Ingrasci’s impact on the field cannot be understated. Passies’ book The History of MDMA and his 2018 journal article feature a laudatory section titled “Rick Ingrasci: MDMA in Couples and Patients with Life-Threatening Illnesses.” However, in the book, Passie leaves out an important detail about Ingrasci: he sexually abused multiple patients.

A few years after testifying at the 1985 FDA hearings alongside Rick Doblin of MAPS, Ingrasci was in the news again. Multiple former patients came forward with accounts of Ingrasci sexually abusing them during therapy sessions with MDMA and ketamine (see also: Psymposia reporting in 2019). Ingrasci used his position as a doctor and “a leader in the movement to consider the body as a whole in healing” to validate his claims that sex with him was “healing” and “necessary”.  He also told patients he practised a form of energy-balancing bodywork called Rolfing that he claimed required internal vaginal massage. The nature of his abuses reflected a therapeutic ideology that entitled him as a doctor to determine what was “healing”—including crossing boundaries.

When one woman receiving Rolfing questioned the sexual nature of Ingrasci’s therapy, she said that Ingrasci “told her to trust him” and that “having sex with him was an integral part of her cancer therapy.” She told The Boston Globe, “He said cancer was about fear and that if I ran away from him, I was running away from fear.” Another woman, given ketamine, explained how Ingrasci gradually eroded boundaries. “It started out very subtly—like he would put his hand on my arm when we were talking […] at first, I thought he was just a warm person,” she said. Facing licensing board censure, Ingrasci gave up his medical license and moved to Cortes Island in Canada.

Ingrasci’s abuses were nationwide news, with his photo appearing on the cover of The Boston Globe. The New York Times also reported on Ingrasci’s case and how it prompted greater recognition of the severe harms of sex between patient and therapist, leading to more restrictive legislation.

Ingrasci never expressed any public remorse or accountability for his violations. Instead, he continued his career as a leader among psychedelic and New Age colleagues, as co-founder of the Hollyhock Retreat on Cortes and running annual leadership retreats. Ingrasci continues to use ‘‘M.D.’ after his name in public identification​.

Passie’s 2018 article quotes researcher Deborah Harlow, who “interviewed 20 psychotherapists who administered MDMA between 1980 and 1985.” Harlow “called the Ingrasci case ‘a huge wake-up call’ to be countered by the antidote of ‘really stringent rules.’” Yet despite this acknowledgment, there is no mention of Ingrasci’s abuses—or any risk of sexual abuse in MDMA-AT—in Passie’s 2023 book, The History of MDMA.

A Closer Look at the 2018 Article

After noting that the risk of sexual abuse was completely absent from Passie’s book, we revisited his 2018 article. While Passie’s 2018 journal article acknowledges Ingrasci’s ethical violations, Passie first dedicates a section to Ingrasci’s pioneering work with couples and patients with cancer. By breaking up the sections that discuss Ingraci favorably from the sessions that describe his abuses, Passie obscures how the theories Ingrasci used in all of his patient work were at the core of his abuse of patients. By creating a disjointed narrative, Passie makes it seem as though Ingrasci’s abuse was incidental to the theories and ideologies of MDMA-AT, instead of directly facilitated by them.

In the article’s section on “physical abuse,” Passie references a 1986 study suggesting that “more than 5% of psychiatrists admitted they had had sexual relations with patients.” The study’s actual figures were 6.4% of all psychiatrists and 7.1% of all male psychiatrists. The study also signaled important insights into the rationale and conditions surrounding psychiatrists who sexually exploited patients that are absent from Passie’s account. Most notably, the researchers found that “18% of the offenders reported the use of sexual contact as a therapeutic intervention during treatment sessions.” This means that in about a fifth of all cases, psychiatrists told patients that sexual contact with them would treat their mental health condition. Research into therapists who abuse clients, therefore, highlights how therapeutic models and ideologies are themselves driving and justifying abuse beyond the personal interest in self-gratification.

Passie goes on to present the two cases of Ingrasci and DiLeo, writing, “In both cases, the therapists initiated intimate body contact, sexual touch, and intercourse during the MDMA sessions.” Without further explanation, Passie writes that “the case of Francesco DiLeo serves to illustrate both,” leaving Ingrasci’s misconduct absent from the article.

Passie’s Account of DiLeo’s Abuses

Passie first mentions Francesco DiLeo as one of the “veteran psychedelic research” attendees of the 1985 “MDMA in Psychotherapy” conference at Esalen. “Among the 35 participants were veterans of psychedelic research (Grof, Naranjo, Yensen, Lynch, DiLeo) and psychotherapists using MDMA in their practices (Greer, Downing, Wolfson, Ingrasci).” We now know that at least a third of the leaders listed have sexually abused patients in the course of MDMA-AT, suggesting a far deeper pattern of misconduct that Passie and the field as a whole have ignored.

Similar to how Ingrasci’s abuse is separated from his status as a leader, Passie only mentions DiLeo’s misconduct in the section on “physical abuse”:

“He began twice-weekly psychotherapy sessions with the patient in 1981. In summer of 1985, ‘a therapeutic impasse’ was reached because the patient was ‘unable to verbalize feelings she has for her therapist.’ DiLeo asked her if a MDMA session would be beneficial to her. In late 1985, he initiated the session and they ‘lay down on a mat together, and [DiLeo] began caressing and fondling her.’ In the third drug session, the therapist initiated sexual intercourse. After the sessions, the patient immediately terminated treatment. Shortly thereafter, she suffered from panic attacks and had difficulties functioning. Her physician diagnosed PTSD and anxiety neuroses.”

Passie leaves out that DiLeo’s tried to claim sexual contact was a valid interpretation of psychoanalytic theory. Court documents indicate that DiLeo “explained that he had been trying to ‘modify a negative introject’ of hers and that what he had done was a ‘way of partial fulfillment of [her] oedipal wishes.’ At trial, one of appellee’s experts countered appellant’s rationalization for his treatment technique when the expert testified that to do anything of a physical nature with a patient is totally unacceptable, counter-therapeutic, and forbidden by the American Psychiatric Association.”

DiLeo was unrepentant and challenged the court’s judgment after he refused to testify in the first trial. DiLeo also argued that since the patient had expressed her own uncertainty about how well the “treatment” (i.e., sexual contact with DiLeo) would work, she should not be allowed to claim she relied on or followed her doctor’s advice. This argument was dismissed by the court.

Catherine Nugent, who filed the suit against DiLeo, went on to serve as vice-chair of the Maryland Task Force on Sexual Exploitation by Health Professionals and chair of the Committee to Implement the Recommendations of the Maryland Sexual Exploitation Task Force. In 1994, Nugent published “Blaming the Victims: Silencing Women Sexually Exploited by Psychotherapist” in The Journal of Mind and Behavior. The article is a remarkable indictment of the broader problem of “oppressive androcentric bias in psychiatry’s ideology, epistemology, and discourse.”

In her paper, Nugent described how the narrative of a “sexual relationship” is still used to minimize and scandalize it:

“Members of the public and the professions frequently misconstrue psychotherapist-patient sexual exploitation, particularly between a male therapist and female patient, as a love or sexual “affair” […] By definition, a patient is vulnerable […] A psychotherapy patient willingly lowers her normal social defenses as part of the treatment; she opens herself because the therapist gains her trust and offers assurances that her openness is a necessary condition of psychotherapy.”

Nugent then unpacks the late 1980s-early 1990s debate between feminist scholars and male psychiatrists who argued that “borderline” patients “possess the ability to […] seduce, provoke, or invite therapists into boundary violations.” Nugent observes that the men “reduce the sincere and appropriately offered objections of the feminist-advocates to the uncritical following of a trendy, fashionable ‘politically correct’ position […] By subjugating her voice to their rhetorical control, they make it sound trivial, ridiculous.” The relevance of Nugent’s analysis to the present day is striking, with a similar backlash leveled at those who have raised concerns about sexual abuse in contemporary MDMA-AT.

In a 2019 civil suit brought against MAPS phase II therapists, Yensen invoked stereotypes of borderline personality disorder, saying the participant had a “history of certain psychological problems” and was “a forceful and skilled manipulator.” In an email sent by Yensen to the trial participant he sexually exploited, he wrote, “you are a powerful storyteller […] Now you’re telling them about me. I do not experience them as related to reality […] Frankly, I feel enticed, rejected, and condemned.” Yensen and Dryer both remain unrepentant and hosted training programs for psychedelic therapists in 2018 and 2019.

The Forgotten Origins of the Male-Female Therapist Dyad

The co-therapist model developed by MAPS originated as a safeguard against potential boundary violations. “According to Harlow (2013), the case of Ingrasci led to the installation of a male and female co-therapist team as a rule in later scientific studies,” writes Passie in his 2018 article. MAPS founder Rick Doblin also states in his PhD dissertation that “one method of reducing the opportunities for sexual abuse is to require that therapists work in teams, with two treatment professionals required to be present in the room with the patient during the active phase of the treatment session.”

More recently, a different version of its history has emerged. A paper published by MAPS therapists in November 2024 on “The Conceptual Framework for the Therapeutic Approach Used in Phase 3 Trials of MDMA-Assisted Therapy for PTSD” includes a section on the co-therapist model:

“The co-therapy model empowers the participant to autonomously engage each therapist in support of their own inner-directed process […] The co-therapy model also facilitates each therapist’s professional development (e.g., taking time for debriefing, case consultation, and mutual support between sessions), and allows therapists to hold one another accountable for practicing with care and integrity, maintaining exquisite ethical and professional boundaries.”

The section makes no mention of the risk of sexual abuse despite referencing Passie’s 2018 article, which indicates that Ingrasci’s abuses were a key reason for the co-therapist model.

MDMA-AT advocates often suggest that sex with patients is a problem in any psychotherapy and that MDMA adds no unique additional risk. Yet, as Passie himself pointed out in his 2018 journal article: “The possibility of intimate physical relationships between therapist and patient occasionally occurs in standard psychotherapy, but its risk may be higher in drug-assisted psychotherapy, where the client has lower defenses and altered emotions and cognition. Clients may be less able to form and assert their will.”

In Passie’s 2023 book, this concern has disappeared.

Talking to Passie

In a 2020 email exchange between one of the authors of this article (Will Hall) and Torsten Passie, Hall asked Passie about the exclusion of details about Ingrasci from his 2018 journal article, leaving the DiLeo account to represent both. Passie replied, “the article does not allow for more details” and clarified that the general outline did not allow for more space of the two cases. There are no strict guidelines regarding word count in Drug Science, Policy and Law. The journal’s editor, David Nutt—a prominent UK psychiatrist—has consistently rejected concerns about sexual abuse in MDMA-AT therapy, claiming the risks are comparable to any other form of treatment.

When Hall suggested that the details were worthy of discussion, given the Ingrasci case impacted all MDMA therapy research for decades, affected nationwide US legislation, and was covered in the leading newspapers, Passie replied by minimizing the importance of the Ingrasci case. Passie wrote, “I would not think that one little article in the Boston Globe makes evident a ‘huge impact.'” (The article and accompanying photo of Ingrasci were on the cover of The Boston Globe.)

Hall wrote, “I can only reach the conclusion that your essay is not representing MDMA therapy history accurately—on a crucial factual point about sexual misconduct.” Passie replied, writing, “It seems to me that you’re puritanic, because you seem to want to kind of destroy these people, sinners in some peoples [sic] eyes […] I don’t think that it is appropriate to damn them and put them somewhere outside of the community.”

Labeling discussions of abuse as “puritanical” or as part of “cancel culture” reflects the belief that inclusion of the abuser is more important than accountability. In New Age communities like Esalen and those connected to MAPS MDMA-AT, there can be a belief that abusive behavior is entirely an outcome of the abuser’s own unresolved trauma and a result of their therapeutic “transference.” This perspective prioritizes the individual’s “healing journey” over addressing the harm they have caused and absolves the clinician of responsibility by pathologizing the patient. Advocates of this view may then further argue that openly discussing an abuser’s actions risks “shaming” them or “damning” them, as Passie suggested. As a result, there is an expectation that others remain silent about the abusive behavior. This approach, as demonstrated by the case of Ingrasci, allows abuse to go unexamined and hinders the ability to prevent similar abuses from happening again, creating a culture of silence that serves to enable and embolden abusers.

Passie fails to make the critical connection between Ingrasci and DiLeo’s abusive behaviors and their broader therapeutic work. Both Ingrasci and DiLeo used the same therapist-knows-best theories of energy healing and reliving experiences to justify sexually exploiting patients. By treating their abuses as isolated incidents rather than inherently tied to their therapeutic approach, Passie diminishes the ongoing implications for the safety of the MDMA-AT. It is essential to recognize how the underlying methods and clinical beliefs of the leading psychedelic therapy researchers facilitated exploitation. Acknowledging and discussing these cases is crucial for understanding how to make psychedelic therapy safer.

Recognized Risks of Abuse in MDMA Therapy

Leaders in MDMA-AT have long known that the field attracts dubious clinicians, while the drug can increase suggestibility and a patient’s risk of exploitation. MAPS founder Rick Doblin points out in his 2001 PhD dissertation that “though extremely rare, there have been incidents in which a psychiatrist delivering psychedelic psychotherapy sexually abused several patients. The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure.”

In a 2001 interview for Julie Holland’s book Ecstasy , Doblin further noted (without acknowledging harms that had already taken place in the field by Ingrasci and others):

“Another issue is preventing sexual abuse of patients. There is a certain willingness on the part of patients under the influence of MDMA toward self-disclosure and trust. There’s a long-established awareness in psychotherapy that the intimacy of the relationship sometimes shades into sexual relationships between patient and therapist that are not to the advantage of the patient. That particular problem is relevant to the regulation of MDMA psychotherapy because MDMA helps people open up in very intimate ways. I think that safeguards need to be established so that MDMA is not used in that way.”

Despite long-standing awareness of the increased risk of abuse with MDMA-assisted therapy, as acknowledged by Doblin, MAPS failed to prevent abuse that bore striking similarities to cases in the 1980s. When Doblin learned about the sexual abuse in the MAPS Phase II trial, he refused to make a public statement about it until researchers, clinicians, and academics forced him to do so.

Getting Worse Before Better

Psychedelic therapy has a long and disturbing history of authoritarian “challenging” or “breakthrough” imperatives, dating back to attempts to brainwash and control people using psychedelics. Currently, all of the known cases of abuse in MDMA-AT are associated with therapists who uphold the idea that patients must endure challenging or ”corrective” experiences presented by the therapist and override any patient objections or resistance as symptoms to be overcome.

Ingrasci, Yensen, and other leaders in MDMA-AT are closely tied through personal affiliation and clinical collaboration to a clinical and spiritual lineage going back to Salvador Roquet. Roquet—a Mexican psychiatrist in the 1960s—systematically “pushed” patients past their limits to induce what he considered a psychotherapeutic effect but others have seen as overwhelm and dissociation. Roquet relied on the increased vulnerability, suggestibility, disinhibition, and dissociation induced by psychedelic drugs to “break down” clients, wrapping the technique in the Eastern spirituality allure of “death of” the ego and “breaking through” to enlightenment. Roquet’s critics instead called him a charlatan who tortured a political prisoner with psychedelics and helped open the Mazatec indigenous mushroom tradition of Oaxaca, Mexico to exploitation by psychedelic tourism.

In 2014, Philip Wolfson interviewed Yensen about Roquet. Yensen provides a confusing account of Roquet’s “freewheeling” and “sensory overload” sessions. “He appeared to be breaking many of the rules established for successful psychedelic therapy, and yet he was reporting and illustrating remarkable results,“ said Yensen. Again, the problems here are in plain sight, but Yensen breezes past them. At one point, Yensen describes Roquet injecting him and his boss with ketamine, saying, “As far as we knew, at that time, we were the first in the USA to have the experience of ketamine intentionally administered as a psychedelic drug rather than an anesthetic. I was concerned as Roquet injected our chief with this, until then, unknown psychedelic drug. Usually poised and thoughtful, almost contemplative, our leader was blithering.”

Roquet also shaped the work of Aharon Grossbard and Francoise Bourzat. Grossbard and Bourzat are prominent international trainers of psychedelic therapists around the world. In incidents covered by Psymposia and Inverse, they are accused of leading a therapy cult that exploited and sexually abused clients using the same “therapeutic” authoritarianism espoused by Ingrasci and Yensen, allegations that have withstood legal threats by the couple. Both Grossbard and Bourzat studied under Roquet protege Pablo Sanchez, who is also accused of sex with multiple clients. Bourzat continues to work as a trainer and advisor for Mind Medicine Australia’s psychedelic therapist training program. Despite media accounts of sexual molestation of clients, Grossbard remains licensed in California and continues to supervise psychotherapy trainees, as survivors have faced extraordinary difficulty coming forward, struggle with complex loyalties to the teacher and therapist they trusted, and encounter a psychedelic industry that remains resistant to and discouraging of whistleblowers.

Abusive and cult-like dynamics between clinicians and patients reach back to the origins of medicalized psychedelic therapies in the 1950s. Prominent LSD researcher and psychiatrist Sidney Cohen even warned that psychedelic therapists “included an excessively large proportion of psychopathic individuals.” After initially supporting clinical LSD use, Cohen was the first psychiatrist to raise concerns about medical research on the drug. In 1963, Cohen said, “The trouble is, LSD attracts unstable therapists as much as it does the neurotic patient. It gives them an intoxicating sense of power to bestow such a fabulous experience on others.”

In his exchange with Hall, Passie acknowledged that therapy abuse was a potential MDMA risk and noted that it deserved attention, writing, “I realize that this is as [sic] a potential side effect of MDMA. And people at that point of time we are [sic] not aware of these potential side effects so we kind of have to forgive them in a way.” He added, “this is not a way to avoid these kind [sic] of problems. we have to analyze them and make sure that these kinds of things will not happen as often anymore.” Despite this, Passie’s new book offers no discussion of the abuse. Nor does the book offer any opportunity to analyze the problem to “make sure that these kinds of things will not happen as often anymore.” Instead, Passie removed the incidents entirely and discarded the entire topic he claimed to consider important.

Misrepresenting MDMA’s Scheduling History

Passie’s book also contributes to distorting the history of the Drug Enforcement Administration (DEA) scheduling of MDMA as a Class 1 controlled substance in 1985. The prevailing narrative, shared by leading psychedelic advocates such as Michael Pollan in his book How to Change Your Mind, is that mainstream regulatory bodies were just too unenlightened and fear-based to recognize the consciousness-expanding powers of psychedelics. This psychedelic revival narrative pits open-minded scientific pioneers against the atavistic bigotry of the Nixon-era of prohibition when psychedelics were growing as a club drug and in the “recreational” use scene. In his book, Passie villainizes the DEA as heedless to all scientific reason and hell-bent on criminalization. While the DEA’s arguments for criminalization relied on exaggerated claims of MDMA neurotoxicity (relying for example on high-dose intravenous studies and conflating MDMA with a similar substance, MDA), hearing transcripts suggest a history deserving more nuanced examination—including of the role of psychedelic researcher zealotry in criminalization.

In DEA testimony, medical experts argued that studies in favor of MDMA efficacy “make interesting reading, [but] their lack of scientific design, methodology and controls makes them scientifically unsound.” They concluded that methodological problems in MDMA research “make any reasonable inference regarding the efficacy of MDMA for enhancing the therapeutic efficacy of the psychotherapy impossible,” including lack of control groups, therapists taking the drug with the patient, mild psychopathology tending to improve on its own over time, and the efficacy of talk psychotherapy without MDMA. The transcripts from the 1985 DEA hearings indicate MDMA’s criminalization may have been driven at least in part by enthusiasts trying to advance their cause with flimsy science. (Access to MDMA may be more justified on grounds of safety as a substance relative to other drugs, alcohol for example, rather than solely as part of an expensive, proprietary psychotherapeutic treatment for mental health disorders.)

A Pattern of Neglecting the History of Abuse

Passie’s book is the first scholarly history of MDMA endorsed by a university press, but it follows a long line of MDMA books by psychedelic insiders that also omit the abuse of patients.

In Bruce Eisner’s popular 1993 book Ecstasy: The MDMA Story, Eisner wrote about Ingrasci as a heroic crusader for safe MDMA-AT. Eisner included a photo of Ingrasci captioned “Boston therapist who used MDMA in couples therapy.” Despite being published just four years after Ingrasci was on the cover of The Boston Globe for abusing patients, there is no mention of his abuse. Psychiatrist Julie Holland’s 2001 book Ecstasy: The Complete Guide also featured Ingrasci in flattering terms, with no mention of his abuses.

In 2016, the same year he was sexually abusing a Phase II participant, Yensen co-authored the journal article “Psychedelic Medicine: A Re-emerging Therapeutic Paradigm” alongside Kenneth Tupper, Evan Wood, and Matthew Johnson. The review included a section titled “Historical Lessons” yet made no reference to cases of sexual abuse.

In 2016, UK psychiatrist Ben Sessa also wrote on the history of MDMA. Sessa, a prominent researcher and advocate of psychedelic therapy, recently received a 12-month suspension for an unethical sexual relationship with a former patient. In his review of the history of MDMA, Sessa described Ingrasi as “having conducted 150 MDMA sessions with 100 patients with overwhelmingly positive results.” Sessa made no mention of any sexual abuse or potential for patient exploitation.

Pollan’s 2018 book How to Change Your Mind also contained no mention of sexual misconduct by psychedelic therapists. Pollan also narrowed the focus of his book to leave out MDMA and ayahuasca—the two substances most associated in media accounts with abuse. Pollan said he decided to “focus primarily on the [drugs] that are receiving the most attention from scientists,” despite MDMA research’s huge media attention.

Rick Strassman’s 2022 The Psychedelic Handbook: A Practical Guide to Psilocybin, LSD, Ketamine, MDMA, and Ayahuasca is one exception to the trend of total silence on psychedelic therapy abuse. In a brief section on ‘”unscrupulous practitioners,” Strassman wrote:

“Whether in group or individual settings, some who administer psychedelic drugs do not have the best interest of their charges in mind. They may manipulate, abuse, or otherwise take advantage of someone in a psychedelically induced, vulnerable and suggestible state […] One factor making it so hard to sound the alarm is the charisma of the perpetrators, their standing in the psychedelic community—spiritual, academic, or therapeutic—and the gaslighting and blame projecting that they often invoke as their first line of defence. ’It’s nothing, you’re overreacting.’ ’You’re imagining it.’ ’It must be some problem you have.’ ‘They seduced me.’ ‘I was only doing it for their benefit.’ And so on. We are now witnessing a welcome frankness of discussions of this phenomenon.”

Although his warnings are strong, it’s unclear where the “frankness” is that he claims to witness in his book. Strassman failed to name any specific cases and thus cannot make the underlying connection to theories that enabled their abuse.

In David Nutt’s 2023 book Psychedelics: The Revolutionary Drugs That Could Change Your Life: A Guide from the Expert,  there are no mentions of the abuses from the 1980s (Nutt is the editor of the journal that the 2018 Passie historic essay appears in). The abuse in MAPS Phase II is described by Nutt in a brief section titled “What happens if the therapy goes wrong.” In this section, Nutt acknowledged that the “video of one [clinical trial MDMA dosing] session shows the two therapists [Yensen and Dryer] pinning the patient to the bed, cuddling and blindfolding her.” Inexplicably, Nutt said that “the fact that the therapists acted unethically and unprofessionally doesn’t make the study results invalid,” ostensibly suggesting this constituted valid treatment.

Nutt also incorrectly suggested that sexual contact was within the context of a “relationship” between the therapist and participant and that this started after the trial concluded. Public reporting on the case indicates Yensen admitted to sex with the participant “while she was still enrolled in the clinical trial.”

Additionally, Yensen and Dryer moved her to Cortes Island for treatment in June 2015, between the second and third MDMA dosing sessions. The active dosing phase of the clinical trial later concluded in October 2015. The participant also stated that Yensen indicated he had “checked with MAPS” and told her that the trial supervisor, Michael Mithoefer, had similarly continued treatment with patients as part of treatment. Yensen, Dryer, and the participant traveled to Vancouver in October 2015 for the third dosing session of the trial and returned to Cortes Island together afterward.

MAPS claimed that they were “not aware of this complaint or any inappropriate interaction between study subjects and therapists” until the participant forwarded their medical board complaint to the organization on October 15, 2018. MAPS continue to assert they bear no legal liability in the case because “there was no prior indication that Richard Yensen or Donna Dryer would violate this policy [against sexual relationships with participants].” In 2019, MAPS stated that “monitoring of study records throughout the course of the trial and afterwards did not indicate signs of ethical violation.” Two years later, MAPS claimed they only discovered video of Yensen and Dryer engaging in unethical physical contact in the trial sessions when a journalist wrote about it—not from their own review of the study records.

Nutt glibly suggested that the key takeaway from this case is “that therapists do sometimes have sex with clients”. Nutt never acknowledged that this is inherently abusive and cited research indicating that 3% of all therapists (male/female) have had sex with their patients. The study he references actually reported 9.1% of male therapists and 0.4% of female therapists perpetrated abuse.

The persistent failure of scholarly and popular works on MDMA-AT to address therapist abuse perpetuates a dangerous silence that distorts the field’s history and compromises the ethical integrity of future practice.

Another recent example of industry closing ranks came in March of 2024 when this article’s other author, Kayla Greenstien, highlighted concerns in MDMA-AT couples therapy. Greenstien found that research to date did not account for the risk of coercive-control as a component of intimate partner violence in conjunction with MDMA-AT’s enhanced suggestibility. A few days after Greenstien’s article for the Harvard Petrie-Flom bioethics blog was published, MAPS-affiliated researchers claimed the article contained errors. The blog editor took the unusual step of immediately taking the blog post down. Contrary to the researchers’ claims, no inaccuracies were found. Greenstien’s review of the researchers’ criticism actually led to more problems with the design being unearthed. The article was eventually quietly reposted without correction.

Moving Forward…

Professional organizations and practitioners alike have a responsibility to actively prevent abuses through close examination of known cases and the networks and structures surrounding perpetrators. There are other known instances of clinicians abusing patients under the guise of treatment that we must learn from. Former USA gymnastics doctor Larry Nassar used his position as a medical expert, claiming that his abusive practices were evidence-based medical treatment. After being reported to the police in 2004 by a patient, Nassar gave a convincing PowerPoint presentation to the police and was cleared of any wrongdoing. Police and regulators failed to respond to complaints about him for over a decade because Nassar’s position as an expert shielded him from scrutiny. After Nassar’s egregious abuses were finally taken seriously, some authorities admitted their failures: “We missed it […] We were deceived.”

Following Nassar’s conviction, clinicians who ethically use forms of pelvic massage openly discussed how Nassar’s case should serve as an example of the need for proactive safety mechanisms. There were no accounts of clinicians suggesting Nassar’s case was just inevitable—they didn’t cite statistics of abuse in other physiotherapy or say that the public just needs to accept there is a “risk-benefit ratio” for the treatment.

Yet in MDMA-AT, leaders in the field continue to dismiss abuse incidents as inevitable, attributing them to a few “bad apples” rather than examining broader patterns.

On a podcast episode titled “Psychedelics, Sex, Power, Silence,” critical psychedelic researcher Neşe Devenot said in 2020 that  “every time there has been something, there is this attempt to deal with it in private, and to erase the signs of the problem from public view, and there are different reasons for that. This idea that we have to put our best foot forward and present a positive face to the field, but it also allows for things to keep happening.”

In his book, Passie provided a summary of MDMA’s unique safety, saying MDMA “has resulted neither in a spate of medical complications nor in social harm to its users or the community.” The recent FDA decision to not green-light MDMA therapy, however, may serve as a reminder to Passie and the industry as a whole that such denial about MDMA risks by leading authors in the field is no longer possible.

Our thanks to Neşe Devenot and Meaghan Buisson for their contributions to this essay, as well as foundational reporting from Inverse, Psymposia, and Cover Story: Power Trip.

Editor’s Note (12/20/24): The article was edited to clarify that Ingrasci allegedly also violated patients to whom he was not giving psychedelics.