Personally, without any information of pre-existing medical conditions, I'd say it was probably psychological.
Couple of points for clarification:
1. Was it an MDMA pill that he took for his first time? Are you sure, was it tested?
2. Had he ever had other kinds of drugs before, or is he new to altered states of mind (besides, say getting drunk)?
If it was a speedbomb, then chances are he'll have felt nothing because it was a crap pill. If it was MDMA, sometimes people just don't know what to expect. I've talked to people before who've never had pills, and then taken whole pills that would sit me on my arse no question asked, and felt nothing. The difficulty with this situation is the person then thinks "oh there's nothing to it, these things are so weak, you must have to take about 3 or 4 to get going I must just have a high natural tolerance..." or some such other naive assumption which invariably leads them into trouble.
[*] If he wants to try pills again, try them in a safe and comfortable environment, with friends.
[*]Be relaxed, don't let him pressure himself into worrying about the situation. If he doesn't peak, he doesn't peak, it's no big deal.
[*]Also, start with a half because the setting of the experience can really change the effects. Where last time he felt nothing, this time could be totally different.
[*]Test the pills or use something you've had in the past which was a good quality pill. Attempting to educate someone on the feeling of MDMA with a speedbomb is doomed to failure...
BigTrancer