A survey revealed similarities between these two altered states of consciousness.One person felt a sensation of “slowly floating into the air” as images flashed around. Another recalled “the most profound sense of love and peace,” unlike anything experienced before. Consciousness became a “foreign entity” to another whose “whole sense of reality disappeared.”These were some of the firsthand accounts shared in a small survey of people who belonged to an unusual cohort: They had all undergone a near-death experience and tried psychedelic drugs.The survey participants described their near-death and psychedelic experiences as being distinct, yet they also reported significant overlap. In a paper published on Thursday, researchers used these accounts to provide a comparison of the two phenomena.“For the first time, we have a quantitative study with personal testimony from people who have had both of these experiences,” said Charlotte Martial, a neuroscientist at the University of Liège in Belgium and an author of the findings, which were published in the journal Neuroscience of Consciousness. “Now we can say for sure that psychedelics can be a kind of window through which people can enter a rich, subjective state resembling a near-death experience.”Near-death experiences are surprisingly common — an estimated 5 to 10 percent of the general population has reported having one. For decades, scientists largely dismissed the fantastical stories of people who returned from the brink of death. But some researchers have started to take these accounts seriously.“In recent times, the science of consciousness has become interested in nonordinary states,” said Christopher Timmermann, a research fellow at the Center for Psychedelic Research at Imperial College London and an author of the article. “To get a comprehensive account of what it means to be a human being requires incorporating these experiences.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A nearly 2,000-year-old stash pouch provides the first evidence of the intentional use of a powerful psychedelic plant in Western Europe during the Roman Era.In 2011, archaeologists in the Netherlands discovered an ancient pit filled with 86,000 animal bones at a Roman-Era farmstead near the city of Utrecht. It fell to Martijn van Haasteren, an archaeozoologist at the Cultural Heritage Agency of the Netherlands, to sort through them.Deep into the cataloging process, Mr. van Haasteren was cleaning the mud from yet another bone when something unexpected happened: Hundreds of black specks the size of poppy seeds came pouring out from one end.The specks turned out to be seeds of black henbane, a potently poisonous member of the nightshade family that can be medicinal or hallucinogenic depending on the dosage. The bone — hollowed-out and sealed with a tar plug — was an ancient stash pouch that had kept the seeds safe for some 1,900 years.Researchers determined that the bone was deposited in the pit somewhere between A.D. 70 and 100 — a time when the Netherlands represented the Roman Empire’s northern border. Parts of the container were smooth, suggesting frequent handling.This “very special” discovery provides the first definitive evidence that Indigenous people living in such a far-flung Roman province had knowledge of black henbane’s powerful properties, said Maaike Groot, an archaeozoologist at the Free University of Berlin and a co-author of a paper published in the journal Antiquity last month describing the finding.At the time that the original owner stuffed the container full of seeds, the properties of black henbane were already well known in Rome. Writings by Pliny the Elder and others testify to the medicinal use of black henbane seeds and leaves, but warn that an overindulgence will result in mind-altering effects.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Like many captive elephants, Nidia suffered from chronic foot problems. Fissures had formed in the 55-year-old Asian elephant’s foot pads, and her toenails had cracked and become ingrown. Painful abscesses lingered for months. Nidia had lost her appetite and she was losing weight.Dr. Quetzalli Hernández, the veterinarian in charge of Nidia’s care at a wildlife park in Mexico, was desperate. She decided to try cannabidiol, or CBD, the nonintoxicating therapeutic compound found in cannabis.For help, Dr. Hernández reached out to Dr. Mish Castillo, the chief veterinary officer at ICAN Vets, a company engaging in veterinary cannabis education and research in Mexico. To Dr. Castillo’s knowledge, no one had purposely given an elephant medical cannabis. But he and his colleagues hoped it would reduce Nidia’s pain and stimulate her appetite, as they had seen the drug do for cats, dogs and other species.They started low and eventually settled on a dose of 0.02 milligrams of CBD per pound of Nidia’s weight, which she took daily with a chunk of fruit. Calibrated by weight, the dose is one-tenth to one-fortieth of what Dr. Castillo gives to dogs or cats. Yet it worked.The first sign that the treatment was effective was when Nidia developed a serious case of the munchies. Within days of starting CBD, she went from finishing just one-third of her food to virtually all of it, and sometimes even went for seconds. Within five weeks, she had gained 555 pounds.After Nidia began eating, her demeanor changed. “She was always known as the grumpy one — she used to kick doors,” Dr. Castillo said. “Within the first week to 10 days of her treatment, she started coming out of her enclosure quicker and was in less of a bad mood.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Results of a new study may offer regulators enough evidence to allow the psychedelic, also known as Ecstasy, to be considered for use as a PTSD treatment.MDMA-assisted therapy seems to be effective in reducing symptoms of post-traumatic stress disorder, according to a study published on Thursday.The research is the final trial conducted by MAPS Public Benefit Corporation, a company that is developing prescription psychedelics. It plans to submit the results to the Food and Drug Administration as part of an application for approval to market MDMA, the psychedelic drug, as a treatment for PTSD, when paired with talk therapy.If approved, “MDMA-assisted therapy would be the first novel treatment for PTSD in over two decades,” said Berra Yazar-Klosinski, the senior author of the study, which was published in Nature Medicine, and the chief scientific officer at the company. “PTSD patients can feel some hope.”PTSD affects about 5 percent of the adult population of the United States each year. But conventional therapies and medications only help, at best, around 50 percent of patients, said Dr. Stephen Xenakis, a psychiatrist and the executive director of the American Psychedelic Practitioners Association, who was not involved in the study.“My clinical experience is that too many men and women have lost hope with conventional treatments and therapies and feel the only ‘out’ for them is committing suicide,” Dr. Xenakis said. “We need to do something more to help them, and MDMA-assisted therapy offers a new, potentially lifesaving option when done thoughtfully and professionally.”MDMA, also known as Ecstasy or Molly, has been an illegal substance since 1985, when the Drug Enforcement Administration classified it as a Schedule 1 drug, placing it in the highest category for controlled drugs that the agency deems of no medical use and that have a high potential for abuse.Before that, MDMA was administered by an estimated hundreds of therapists in North America and Europe for couples counseling, personal growth and to address trauma.“The big tragedy to point out is that it was pretty clear in the late 1970s and early 1980s that MDMA had incredible therapeutic potential,” said Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit group that owns MAPS PBC. “All the suffering since then, because MDMA was criminalized, is enormous.”Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies.Tony Luong for The New York TimesMAPS has been advocating the legalization of MDMA-assisted therapy since 1986, and supporting research of its use in treating PTSD since 2001. The Heffter Research Institute, another nonprofit group, has been doing the same for psilocybin, the active ingredient in magic mushrooms, since 1993.The F.D.A. in 2017 granted “breakthrough therapy” status to MDMA-assisted therapy as a treatment for PTSD. The designation allows the development of promising experimental drugs to be fast-tracked. Psilocybin-assisted therapy for treatment-resistant depression was granted breakthrough status in 2018.The 104 participants in the new study had been diagnosed with moderate to severe PTSD and had lived with the condition for an average of 16 years. They included victims of childhood trauma, combat veterans, survivors of sexual assault and others. Many had a history of suicidal thoughts and also suffered from comorbidities such as depression and alcohol use disorder.Each participant worked with a two-person therapy team and received three 90-minute preparatory, talk therapy sessions followed by three treatment cycles, spaced one month apart. Each consisted of an eight-hour experimental session in which the participant took either MDMA or a placebo paired with talk therapy, and then attended three 90-minute talk therapy sessions.During the experimental sessions, 53 participants were given MDMA and 51 were given an inactive placebo. Neither the therapists nor the participants were informed which patients had received the MDMA.The participants in the group that were given MDMA experienced significantly greater reductions in their PTSD symptoms compared with those in the group that were given a placebo, according to the research article.By the end of the study, 86.5 percent of people in the MDMA group achieved a measurable reduction in severity of symptoms, researchers reported. About 71 percent in the MDMA group improved enough that they no longer met the criteria for a PTSD diagnosis. Of those who took the placebo, 69 percent improved and nearly 48 percent no longer qualified for a PTSD diagnosis.The findings were similar to the results of the first Phase 3 study of MDMA-assisted therapy for PTSD, published in Nature Medicine in 2021. For the 90 participants in that study, 67 percent in the group given MDMA no longer qualified for a PTSD diagnosis two months after treatment, compared with 32 percent in the placebo group.One notable difference in the most recent study was the diversity of participants, said Jennifer Mitchell, a neuroscientist at the University of California San Francisco and the lead author of both studies.More than a quarter of the participants in the new study were Hispanic or Latino and about 34 percent were nonwhite, whereas about 9 percent of participants in the 2021 study were Hispanic or Latino and 22 percent were nonwhite.“We worked long and hard to get a study population that’s more in line with the general population with PTSD,” Dr. Mitchell said. “This isn’t just privileged people with lots of time and resources.”Jennifer Mitchell, a neuroscientist at the University of California San Francisco.Anastasiia Sapon for The New York TimesThe increase in participant diversity coincided with an increase in the number of therapists of color, to 28 percent in the new study, up from 11 percent in 2021. MAPS PBC said it also offered participants transportation to and from study sites as well as stipends to make up for lost wages or to cover child or elder care.The diversity of participants is “certainly an improvement over prior studies,” said Albert Garcia-Romeu, a psychopharmacologist at the Johns Hopkins University School of Medicine who was not involved in the research. But he added that “it will be critical to see more Black and Indigenous folks enrolled, considering the substantial health disparities these groups face.”As in previous studies of MDMA-assisted therapy, the treatment was generally well-tolerated, according to the data presented about adverse events. Common side effects, primarily for those in the MDMA group, included muscle tightness, nausea, decreased appetite and sweating.Two participants in the MDMA group and one in the placebo group experienced serious suicidal ideation during the study, but no suicide attempts were reported.“People in both groups had certain adverse events that would be concerning, like suicidality, at comparable rates, though it’s notable that most people in the study were already struggling with those challenges beforehand,” Dr. Garcia-Romeu said.Seven participants overall also experienced cardiovascular issues, including faster heartbeats. According to Dr. Paul Summergrad, a professor of psychiatry at Tufts University School of Medicine who was not involved in the research, while these events “were generally not severe,” they might indicate that a cardiologist should evaluate older patients or ones with known heart problems before treatment with MDMA.MAPS PBC said it had worked closely with the F.D.A. to determine the study methods and the number of participants needed to assess the safety and efficacy of the new treatment.Most participants correctly guessed whether they had received a placebo or MDMA. This is a typical challenge across psychiatry research and is something “the authors acknowledge and did everything possible to mitigate,” said Dr. Steven Zalcman, chief of the adult pathophysiology and biological interventions development branch at the National Institute of Mental Health, who was not involved in the research.The researchers are now working on a follow-up study examining the long-term durability of the effects of MDMA-assisted therapy. Findings from Phase 2 studies sponsored by MAPS indicated that the benefits lasted at least 12 months for most participants who received the drug.MAPS PBC plans to submit a new drug application to the F.D.A. seeking approval for MDMA-assisted therapy. The agency, which does not comment on pending drug reviews, could reach a decision within a year.Some outside experts said they did not believe the study’s results would meet the F.D.A.’s criteria for approval.“The benefits in the active group were really not much greater than the benefits in the placebo group,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke University. “MDMA treatment would add huge costs to the treatment system while providing only a small, specific benefit — and thus result in a massive misallocation of already very scarce resources.”Dr. Akua Prieto Brown, the medical director of Alchemy Community Therapy Center in Oakland, Calif., who also was not involved in the study, criticized this “scarcity mind-set,” however, and said that the focus for health care professionals should instead be “on increasing treatment options for a condition that is notoriously difficult to treat.”Disagreements among mental health practitioners are to be expected, Dr. Xenakis said, adding that “tectonic shifts of this dimension are disruptive and can produce more fractures among the professionals than agreement.”Federal approval for MDMA-assisted therapy would also mean the drug would have to receive a less serious ranking for controlled substances by the D.E.A. and from states.Therapist training is another potential bottleneck. The company already oversees its own therapist education program and is working with other partners, including universities, to increase training.The specific standards and requirements that the F.D.A. might seek from prescribers, and what the agency would outline for the labeling instructions of MDMA-assisted therapy, are still open questions, said Amy Emerson, the chief executive of MAPS PBC.“Drug-assisted therapy hasn’t been approved before, so there’s not a lot of precedent,” she said.The company has not yet set a price for the drug, Ms. Emerson said, and it will not manage how much the therapy component will cost.But it is contacting insurance companies, Medicaid and Medicare to try to secure coverage, Ms. Emerson said. The group is also working on patient access programs to help those who do not have coverage and who cannot pay out of pocket to receive discounts or even free treatment.Given the hurdles that still lay ahead, “it feels a bit too early to really celebrate,” Dr. Doblin said. “But it’s been a long, long process, and it’s amazing that we are this far.”

Critically endangered species and ones banned from international trade are among the hundreds of types birds, reptiles and mammals that researchers identified at 142 animal cafes.In Japan, it’s possible to enjoy a coffee while an owl perches on your head, or to sit at a bar where live penguins stare out at you from behind a plexiglass wall. The country’s exotic animal cafes are popular with locals as well as visitors seeking novelty, cuteness and selfies. Customers can even buy animals at some of the cafes and bring them home.But visitors of these venues may not realize that many of these cafes put wildlife conservation, their own and public health, and animal welfare at risk.In an exhaustive survey of Japan’s animal cafes published earlier this year in the journal Conservation Science and Practice, researchers found 3,793 individual animals belonging to 419 different species, 52 of which are threatened with extinction. Nine of the exotic species they found, including endangered slow lorises and critically endangered radiated tortoises, are strictly banned from international trade.“Some species we saw are of very questionable origins,” said Marie Sigaud, now a veterinarian and wildlife biologist at the National Museum of Natural History in Paris, who conducted the study as a postdoctoral researcher at Kyoto University. Many of the animals are “most likely caught in the wild, and this has implications for their long-term survival.”The potential for transmission of disease from animals to humans is also worrying, Dr. Sigaud said.At a typical cafe, individual animals of different species are crammed together in a small room where people are allowed to touch them while having a drink, said Cécile Sarabian, a cognitive ecologist at Nagoya University and co-author of the findings. Many of the animals are under stress and “it’s an excellent interface for the exchange of potential pathogens,” she said.The laws governing animal cafes are “quite weak,” Dr. Sarabian added — and the researchers are calling on Japan’s government to strengthen them.In Japan, exotic animal cafes are popular with locals as well as visitors. Customers can even buy some of the creatures.Noriko Hayashi for The New York TimesAn owl brought to the table for customers so that they can touch it an animal cafe in Tokyo, Japan.Noriko Hayashi for The New York TimesA customer touches a ferret inside an animal cafe in Tokyo.Noriko Hayashi for The New York TimesOfficials at Japan’s Ministry of the Environment did not respond to requests for comment.Exotic animal cafes are not uniquely Japanese. Since the first known animal cafe opened in Taiwan in 1998, featuring cats and dogs, the concept has rapidly spread across the region. A 2020 study identified 111 such businesses in Asia, primarily in Japan but also in China, Thailand, Taiwan, Indonesia, South Korea, Vietnam, the Philippines and Cambodia. Japan, however, seems to have become “the epicenter of the phenomenon,” Dr. Sigaud said.The researchers visited some cafes in Japan in person and also searched online and across social media in both English and Japanese for keywords such as “pet cafe,” “otter cafe” and “petting zoo.” They found 142 exotic animal cafes across the Japanese archipelago and made a list of all the species they observed in photos posted on the cafes’ websites and social media accounts, excluding insects.The number and diversity of animals came as a surprise, Dr. Sigaud said. Birds accounted for 62 percent of species, and 40 percent of them were owls. But the researchers also recorded dozens of reptiles and mammals.Thirty-eight of the cafes also offered options for buying the animals they displayed — owls, primarily, but also species as diverse as sugar gliders for $150 to $300; ball pythons for $455 to $1,290; secretary birds for $20,500; and red-tailed black cockatoos for $23,250.Some of the species were of particular concern, including critically endangered ones such as the pancake tortoise and the Central American river turtle. Others were of questionable origin. Bengal slow lorises and Sunda slow lorises, for example, are endangered species from South and Southeast Asia that are frequently the victims of poaching and are strictly banned from international trade. They are difficult to breed in captivity, Dr. Sigaud said, and no professional facilities for these species exist in Japan.“So where are they coming from?” Dr. Sigaud said. “It’s hard to believe they’re legal.”The international trade of 60 percent of the species the researchers identified in cafes is regulated by the Convention on the International Trade in Endangered Species of Wild Fauna and Flora, or CITES, and most of these animals were registered as coming from captive breeding facilities when they were imported into Japan. Only 14 percent were marked as coming from the wild, though the researchers say this is likely an underestimate, because no records exist for the 40 percent of species not regulated by CITES. Wild animals such as otters are also known to be laundered as captive bred to make their trade legal, they point out.The laws governing animal cafes are “quite weak,” said Cécile Sarabian, a cognitive ecologist at Nagoya University.Noriko Hayashi for The New York TimesFor this study, researchers looked at the 142 exotic animal cafes across the Japanese archipelago.Noriko Hayashi for The New York TimesA staff member cleans the space of African spurred tortoise at Funny Creature Forest in Kyoto.Noriko Hayashi for The New York TimesIn a CITES database search spanning 1975 to 2019, the researchers also found no records of any imports into Japan of seven species whose trade is strictly controlled but that are present at animal cafes, including the Bengal slow loris, spotted pond turtle and barred eagle-owl.“These gaps trigger more questions than answers,” Dr. Sarabian said.She and her colleagues also flagged welfare concerns at cafes. Animals can become stressed through constant handling, birds of prey are chained to perches and nocturnal species are made to interact with visitors throughout the day, Dr. Sarabian said. Nearly all species are kept in small cages and artificial environments, and are looked after by people with no specific training or qualifications to work with wildlife.Kohei Kimura, the owner of Funny Creatures Forest, an animal cafe in Kyoto that specializes in reptiles, said he often heard criticisms like the ones raised by the new study, including that cafes keep protected species and that the animals there are mistreated. Mr. Kimura — whose cafe exhibits around 40 types of reptiles, plus three owls and some tropical fish — said he took extra care to ensure he was not contributing to these problems. He sources all of his animals from wholesalers in Japan or breeds them himself. He forbids customers from touching the owls while they are sleeping, he said, and has built his own specialized cages for the reptiles because “the commercially available cages are too small.”Mr. Kimura, who has loved coldblooded creatures since he was a child, said he opened his cafe to share “the charm of reptiles” with others. “A big lizard can make you feel like you’re raising a dinosaur.”Exotic animal cafes are not uniquely Japanese. The first known animal cafe opened in Taiwan in 1998.Noriko Hayashi for The New York Times“In Japan, reptiles are often disliked and thought to be scary, but in reality, many of them are gentle,” he added.Timothy Bonebrake, a conservation biologist at the University of Hong Kong who was not involved in the research, said that the new study demonstrated the need for stronger regulations and oversight for Japan’s exotic animal cafes. “Overall, I think the analysis makes clear that there is an alarming number of threatened species in these cafes with questionable origin,” he said.But he noted that with proper regulation, it may be possible for animal cafes to play an active role in conservation, much as many zoos do: by raising public awareness and fondness for wildlife. “I do wonder often about the possible benefits,” he said.

Nigel McCourry removed his shoes and settled back on the daybed in the office of Dr. Michael Mithoefer, a psychiatrist in Charleston, S.C.“I hadn’t been really anxious about this at all, but I think this morning it started to make me a little bit anxious,” Mr. McCourry said as Annie Mithoefer, a registered nurse and Dr. Mithoefer’s colleague and spouse, wrapped a blood pressure cuff around his arm. “Just kind of wondering what I’m getting into.”Mr. McCourry, a former U.S. Marine, had been crippled by post-traumatic stress disorder ever since returning from Iraq in 2004. He could not sleep, pushed away friends and family and developed a drinking problem. The numbness he felt was broken only by bouts of rage and paranoia. He was contemplating suicide when his sister heard about a novel clinical trial using the psychedelic drug MDMA, paired with therapy, to treat PTSD. Desperate, he enrolled in 2012. “I was willing to do anything,” he recalled recently.PTSD is a major public health problem worldwide and is particularly associated with war. In the United States, an estimated 13 percent of combat veterans and up to 20 to 25 percent of those deployed to Iraq and Afghanistan are diagnosed with PTSD at some point in their lives, compared with seven percent of the general population.Although PTSD became an official diagnosis in 1980, doctors still have not found a surefire cure. “Some treatments are not helpful to some veterans and soldiers at all,” said Dr. Stephen Xenakis, a psychiatrist and retired U.S. Army brigadier general. As many as half of veterans who seek help do not experience a meaningful decline in symptoms, and two-thirds retain their diagnosis after treatment.But there is growing evidence that MDMA — the illegal drug known as Ecstasy or Molly — can significantly lessen or even eliminate symptoms of PTSD when the treatment is paired with talk therapy.Last year, scientists reported in Nature Medicine the most encouraging results to date, from the first of two Phase 3 clinical trials. The 90 participants in the study had all suffered from severe PTSD for more than 14 years on average. Each received three therapy sessions with either MDMA or a placebo, spaced one month apart and overseen by a two-person therapist team. Two months after treatment, 67 percent of those who received MDMA no longer qualified for a PTSD diagnosis, compared with 32 percent who received the placebo. As in previous trials, MDMA caused no serious side effects.Mr. McCourry was among the 107 participants in earlier, Phase 2 trials of MDMA-assisted therapy; these were conducted between 2004 and 2017 and sponsored by the Multidisciplinary Association for Psychedelic Studies, or MAPS, a research group that has led such studies in the United States and abroad. Fifty-six percent of Phase 2 participants no longer met the criteria for PTSD after undergoing several therapeutic sessions with MDMA. At least one year after participation, that figure increased to 67 percent.A decade later, Mr. McCourry still counts himself among the successes. He had his first MDMA session in 2012 under the guidance of the Mithoefers, who have worked with MAPS to develop the treatment since 2000. He shared the video of that session with The New York Times. “I was suffering so badly and had so little hope, it was inconceivable to me that doing MDMA with therapists could actually turn all of this around,” he said.The second Phase 3 trial should be completed by October; FDA approval could follow in the second half of 2023.“We currently deal with PTSD as something that needs to be managed in an ongoing way, but this approach represents real hope for long-term healing,” said Rachel Yehuda, a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York.“What makes this moment different from 20 years ago is the widespread recognition that we should leave no stone unturned in identifying new treatments for PTSD,” said Dr. John Krystal, the chair of psychiatry at Yale School of Medicine, who was not involved in the research. Although data from the second Phase 3 trial are needed, he says, the results so far are “very encouraging.”A need for new treatmentsDr. Michael Mithoefer and Annie Mithoefer have used MDMA doses in their therapy sessions. Though PSTD is a common diagnosis among veterans, there is no catch-all cure or treatment.Travis Dove for The New York TimesMr. McCourry, 40, lives in Portland, Ore., and comes from a military family. He joined the Marines in 2003 because he wanted to make a positive difference, he said: “When I went over to Iraq, I felt like we were there because it was for the overall good.”Understand Post-Traumatic Stress DisorderThe invasive symptoms of PTSD can affect combat veterans and civilians alike. Early intervention is critical for managing the condition.Removing the Stigma: Misconceptions about how PTSD develops and its symptoms, can prevent people from seeking treatment.Psychedelic Drugs: As studies continue to point to the therapeutic value of substances like MDMA, veterans are becoming unlikely advocates for their decriminalization.Seeking Peace: Mission Within is a Mexican retreat that uses hallucinogens to treat PTSD. Some female U.S. veterans and veteran spouses have turned to it to heal from trauma.Virtual Reality: A treatment using new technology to immerse patients in a simulation of a memory could help them overcome trauma.But he soon became disillusioned. Rather than fighting for freedom, he guarded convoys of oil. He regularly saw civilians killed. He survived an explosion that knocked him unconscious, and he suspected it may have caused lasting traumatic brain injury. He never received a diagnosis because the symptoms of traumatic brain injury — problems with thinking, sleeping and mood — overlap with those of PTSD, and the Army lacks tests that can objectively distinguish between the two conditions, Dr. Xenakis said.“I just felt like I put my life in harm’s way really for nothing,” Mr. McCourry said. “I watched friends die really for nothing.”Two months into his deployment, Mr. McCourry was caught in a firefight. Amid a hail of bullets and mortar rounds, he spotted a white truck approaching from the opposite direction. Despite signaling the truck to stop and firing a warning shot, it kept approaching.Mr. McCourry began shooting at it. Later, he learned that the people in the truck were a father and his two daughters. The father survived, but the girls did not. “The death of those girls, it haunted me,” Mr. McCourry said.In 2005, between tours of duty, Mr. McCourry sought help from a battalion medical officer for his sleep and anxiety issues. When the doctor dismissed his concerns, “I kind of lost my mind and started yelling at him,” Mr. McCourry said. Shortly after, he was honorably discharged on the basis of a personality disorder — a diagnosis that was not legitimate grounds for discharge and that Mr. McCourry vehemently disputed.At first, Mr. McCourry felt overjoyed to be home, but he soon noticed that something felt off. He was tense around friends and family. He was easily offended by any hint of perceived disrespect and found it increasingly difficult to control his anger. When he learned that nearly his entire former squad had been killed by a roadside bomb, he felt an unsettling mixture of numbness and guilt. “At that point, things spiraled,” he said.Veterans frequently struggle with the readjustment process after returning from war, but they often do so quietly. “By and large, soldiers don’t like to reveal that they have any problems, so they tend to minimize their symptoms,” said Dr. Elspeth Cameron Ritchie, the chair of psychiatry at MedStar Washington Hospital Center and a specialist in military and veterans’ issues. “Many don’t like to talk about their feelings.”Some veterans, including Mr. McCourry, also experience a phenomenon called moral injury, which frequently occurs alongside PTSD and can complicate treatment. According to Dr. Robert Koffman, a psychiatrist and retired U.S. Navy captain, moral injury develops in service members who feel responsible for perpetrating or for failing to prevent an act that violates their deeply held beliefs. The result is often intense feelings of shame and guilt.For years, vivid nightmares and paranoia prevented Mr. McCourry from sleeping properly, and he began having suicidal thoughts. Eventually, he sought help at a Veterans Affairs clinic. He received a diagnosis of severe PTSD, and the doctors recommended conventional treatments including therapy and medications.These treatments bring relief for some patients with PTSD, but they are not effective for all, said Paula Schnurr, executive director of the V.A.’s National Center for PTSD: “My take on the literature is that there is room for improvement.”Some research indicates that conventional therapy for PTSD tends to be less effective for active duty military and veterans, around 40 percent of whom drop out of treatment. “With PTSD, a pathological avoidance of triggers — which can include psychotherapy — is a core feature of the disorder,” said Dr. Joseph Pierre, a professor of psychiatry at the University of California, Los Angeles.Mr. McCourry tried therapy, but it “didn’t help at all,” he said. The medications he was prescribed only complicated his symptoms by causing serious side effects, including disorientation and drowsiness — a common experience.For those who do not find relief through available treatments, PTSD can become chronic, debilitating and even life-threatening. On average, 17 veterans die by suicide every day, Dr. Koffman said.“I just remember wanting the suffering to end,” Mr. McCourry said. “I didn’t see any hope, and there didn’t seem like there was any path to improving. I just really wanted to die.”Finding the inner healerDr. Michael Mithoefer, left, and Annie Mithoefer have been working with MAPS since 2000. Dr. Mithoefer likened MDMA-assisted therapy to immunotherapy for cancer: “We’re stimulating the body’s own capacity for defense and healing.”Travis Dove for The New York TimesWhen Mr. McCourry first heard about MDMA-assisted therapy, he doubted it would make a difference. He met with the Mithoefers for three 90-minute preparatory sessions designed to establish trust and provide guidance on how to respond to difficult memories and feelings that might arise during treatment.The experimental sessions would last eight hours. Although Mr. McCourry knew he would be taking MDMA, under the study’s double-blind protocol he and the Mithoefers did not know what dose he would be randomly assigned. Possibilities ranged from a very low 30 milligram dose to a relatively high 125 milligram dose. Mr. McCourry’s fell in the middle, at 75 milligrams.On the day of Mr. McCourry’s appointment in 2012, as he sought to relax, Dr. Mithoefer reassured him. “We talked about not having an agenda about what should happen,” he said. “But some people find it nice to have an overall intention.”Mr. McCourry’s voice wavered. “If I had an overall intention, it’s basically just to have greater depth of understanding of mental processes and why I think the things I do,” he said. “To try to understand myself better.”Then, he swallowed the pill with a swig of water, put on eye shades and lay back. Melodic, chanting music filled the room.After about an hour, a warm sensation began to wash over Mr. McCourry in intermittent waves, and the music sounded more beautiful than before. He felt himself relax, even as he began to worry about where things were going.Soon, though, the tone of the music no longer felt inviting but ominous. Mr. McCourry considered removing the eye shades and asking the Mithoefers to stop the music. “But then I remembered that if anything uncomfortable came up, I was supposed to breathe into it versus run away from it,” he recalled.The sense of inner conflict mounted and tightened into a knot in his chest. He began remembering with embarrassment all the times he had pushed friends away when they had tried to be kind to him, and he wondered why he had behaved that way. He suddenly felt more connected to Dr. and Ms. Mithoefer and was open to exploring those questions with them.He removed the eye shades and described “this new hardness” he had developed since returning from Iraq.“What if you just let people be nice to you?” Ms. Mithoefer gently asked.“I’d have to give up control of my life in some situations,” Mr. McCourry said.“How would that look, giving up control? If someone’s trying to be nice to you?”“It could be a good experience, but I don’t even consider it before I put up these walls between me and people,” Mr. McCourry said.Trauma can result in enduring changes in genes, hormones and the brain, according to Dr. Yehuda of Mount Sinai. People with PTSD often show exaggerated levels of stress hormones, for example, and tend to have heightened activity in the amygdala, the brain region associated with processing threats and danger.That negative experiences can alter the body so significantly, however, leaves room for the possibility that equally powerful positive experiences could do the same. For many people, MDMA-assisted therapy seems to provide such a transformational reset, Dr. Yehuda said.But taking MDMA on its own, like a traditional medication, does not automatically alleviate PTSD. Rather, when paired with therapy, the drug seems to catalyze a patient’s innate capacity for psychological healing.Dr. Mithoefer likened this process to the way immunotherapy helps to fight cancer. “We’re stimulating the body’s own capacity for defense and healing,” he said.Scientists still do not fully understand how MDMA catalyzes healing. Evidence in mice indicates that the drug opens what neuroscientists refer to as a “critical period,” a window that typically occurs during childhood in which the brain is more malleable and better able to learn.“This critical-period explanation really offers a different way of thinking about it,” said Dr. Gül Dölen, a neuroscientist at Johns Hopkins University and senior author of the findings, which were published in Nature in 2019. “MDMA is allowing you to do a cognitive reappraisal and reformulate all of the personal narrative you’ve written around the trauma.”In the Mithoefers’ office, Mr. McCourry realized that the reason he was shutting people out was because permitting them to get close would require trusting them — and trusting them would mean surrendering control. In Iraq, extreme self-reliance and distrust of others had been protective mechanisms that had helped to keep him alive. Now, those tools had become detractors.“That’s what PTSD is, really,” Dr. Mithoefer said as the three of them talked through these revelations. “You know you’re back, but there’s parts of you that haven’t taken that in yet.”Different paths to healingJohn Reissenweber saw combat in Vietnam but considered PTSD a weakness, until his wife, Stacy Turner, encouraged him to see a psychiatrist.Marissa Leshnov for The New York TimesNot everyone’s experience with MDMA-assisted therapy is as straightforward as Mr. McCourry’s.While serving in Vietnam, John Reissenweber sustained major injuries in a mortar explosion and accidentally killed a 2-year old boy. He came home a different person: always on edge and with “one of the most acid tongues there were,” he recalled recently. Like Mr. McCourry, he felt a constant need for control, and he turned to alcohol for solace.Mr. Reissenweber, now 73, never considered that PTSD might have explained his feelings and behaviors. His previous mind-set held that “to have PTSD, you’re weak.”In 2017, Mr. Reissenweber’s wife convinced him to see a psychiatrist, who diagnosed him with PTSD. Despite regular appointments, his mental health did not improve. In 2019, he enrolled in the Phase 3 MDMA-assisted therapy trial.Entering the first of three sessions with MAPS-trained therapists in San Francisco, Mr. Reissenweber worried that the drug would cause him to “really come undone.” But in the weeks after the session, he felt more connected to himself and others, he said. The second session also went well.“I could take a walk outside and feel the air against my skin,” he said. “I could focus on somebody and imagine what they were thinking.”But in the third and final session, Mr. Reissenweber resolved to directly face his trauma, which took the form of a black pit. “You can’t shy away from it anymore,” he told himself, and jumped in. But rather than passing through the pit into the light, as he expected, he became stuck in the darkness and was terrified.Mr. Reissenweber could not sleep for over a week afterward, and he sometimes began shaking inexplicably. Eventually, his therapist helped him realize that the pit had represented his anger and hurt. “I’m still processing from that thing,” he said.Despite the difficulty, Mr. Reissenweber said his experience with MDMA-assisted therapy significantly changed his life for the better. He now finds traditional therapy to be productive and has been able to deeply connect with others, including his spouse, who he calls his guardian angel.“It made me realize there was a reason for my hurt and my fears, and that I could change the outcome,” he said.Clarity and compassionMr. McCourry with his dog, Kiko, at home. He recently became a father and, after a 10-year struggle, had his discharge order changed to combat-related PTSD.Amanda Lucier for The New York TimesMr. McCourry emerged from his first session of MDMA-assisted therapy with what he described as an aerial map of his mind. “It’s just been so tangled up, I didn’t even know where to start,” he told the Mithoefers.He slept soundly that night, and his sleep problems never returned.In one of his later sessions with MDMA, he revisited the memory of the two girls he had accidentally killed and saw that he had been harboring a tremendous amount of self-loathing for the person he had become in Iraq. He was able to replace the contempt he felt toward “Nigel the Marine,” as he put it, with compassion.Mr. McCourry recently became a father and — after a nearly 10-year long bureaucratic struggle — successfully convinced the Navy to correct his reason for discharge to combat-related PTSD, instead of passive-aggressive personality disorder.He still sometimes becomes overwhelmed in stressful situations and “just starts to mentally shut down,” he said. But he is now able to recognize when this is happening and to better manage his feelings.“It’s really important for me that these experiences I’m sharing are used to show people that there is hope,” Mr. McCourry said. “I’ll keep doing what I can to support this therapy until it’s legalized.”