History of LSD Therapy
Stanislav Grof, M.D.
Chapter 1 of LSD Psychotherapy, ©1980, 1994 by Stanislav Grof.
Hunter House Publishers, Alameda, California, ISBN 0-89793-158-0
THE DISCOVERY OF LSD AND ITS PSYCHEDELIC EFFECTS*
LSD-25 (or diethylamide of d-lysergic acid) was first synthesized
in 1938 by Albert Hofmann in the Sandoz chemical-pharmaceutical
laboratories in Basle, Switzerland. As its name indicates, it
was the twenty-fifth compound developed in a systematic study
of amides of Iysergic acid. LSD is a semi-synthetic chemical product;
its natural component is Iysergic acid, which is the basis of
all major ergot alkaloids, and the diethylamide group is added
in the laboratory. According to Stoll, Hofmann and Troxler(98),
it has the following chemical formula: [molecular diagram omitted
in this hypertext reproduction]
Various ergot alkaloids have important uses in medicine, primarily
as drugs that can induce uterine contractions, stop gynecological
bleeding, and relieve migraine headache. The objective in the
Sandoz study of ergot derivatives was to obtain compounds with
the best therapeutic properties and least side effects. After
LSD had been synthesized, it was subjected to pharmacological
testing by Professor Ernst Rothlin. (88) It showed a marked uterotonic
action and caused excitation in some of the animals; at the time
these effects were not considered of sufficient interest to be
further explored.
The unique properties of the new substance were brought to the
attention of the researchers by a series of events involving a
fortuitous accident. In 1943 Albert Hofmann was reviewing the
results of early pharmacological tests on LSD and decided to investigate
the stimulating effects on the central nervous system indicated
in animal experiments. Because of its structural similarity with
the circulatory stimulant nikethamide, LSD seemed promising as
an analeptic substance. Feeling that it would be worthwhile to
carry out more profound studies with this compound, Albert Hofmann
decided to synthesize a new sample. However, even the most sophisticated
experiments in animals would not have detected the psychedelic
effects of LSD, since such specifically human responses cannot
be anticipated on the basis of animal data alone. A laboratory
accident came to the help of the researchers; by a strange play
of destiny Albert Hofmann became an involuntary subject in one
of the most exciting and influential experiments in the history
of science. Working on the synthesis of a new sample of LSD, he
accidentally intoxicated himself during the purification of the
condensation products. The following is Albert Hofmann's own description
of the perceptual and emotional changes that he experienced as
a result: (38)
"Last Friday, April 16, 1943, I was forced to stop my work
in the laboratory in the middle of the afternoon and to go home,
as I was seized by a peculiar restlessness associated with a sensation
of mild dizziness. On arriving home, I lay down and sank into
a kind of drunkenness, which was not unpleasant and which was
characterized by extreme activity of the imagination. As I lay
in a dazed condition with my eyes closed, (I experienced daylight
as disagreeably bright) there surged upon me an uninterrupted
stream of fantastic images of extraordinary plasticity and vividness,
accompanied by an intense kaleidoscope-like play of colors. This
condition gradually passed off after two hours."
After he had returned to his usual state of consciousness, Hofmann
was able to make the hypothetical link between his extraordinary
experiences and the possibility of accidental intoxication by
the drug he was working with. However, he could not understand
how the LSD had found its way into his body in a sufficient quantity
to produce such phenomena. He was also puzzled by the nature of
the effects, which were quite different from those associated
with ergot poisoning. Three days later he intentionally ingested
a known quantity of LSD, to put his suspicions to a solid scientific
test. Being a very conservative and cautious person, he decided
to take only 250 micrograms,[1]
which he considered to be a minute dose judging by the usual dosage
level of other related ergot alkaloids. At that time he had no
way of knowing that he was experimenting with the most powerful
psychoactive drug known to man. The dose he chose and ingested
without any special preparation, or any knowledge about psychedelic
states, would at present be considered a high dose and has been
referred to in the LSD literature as a "single overwhelming
dose." If used in clinical practice it is preceded by many
hours of preparatory psychotherapy and requires a trained and
experienced guide to handle all the complications that might occur.
About forty minutes after the ingestion, Hofmann started experiencing
dizziness and unrest; he had difficulties in concentration, disturbances
of visual perception, and a strong unmotivated desire to laugh.
He found it impossible to keep a written protocol about his experiment
as originally planned. The following is an excerpt from his subsequent
report written for Professor Stoll: (38)
"At this point, the laboratory notes are discontinued; the
last words were written only with great difficulty. I asked my
laboratory assistant to accompany me home, as I believed that
I should have a repetition of the disturbance of the previous
Friday. While we were cycling home, however, it became clear that
the symptoms were much stronger than the first time. I had great
difficulty in speaking coherently, my field of vision swayed before
me, and objects appeared distorted like images in curved mirrors.
I had the impression of being unable to move from the spot, although
my assistant told me afterwards that we had cycled at a good pace.
Once I was at home, the physician was called.
"By the time the doctor arrived, the peak of the crisis had
already passed. As far as I remember, the following were the most
outstanding symptoms: vertigo; visual disturbances; the faces
of those around me appeared as grotesque, colored masks; marked
motoric unrest, alternating with paralysis; an intermittent heavy
feeling in the head, limbs, and the entire body, as if they were
filled with lead; dry, constricted sensation in the throat; feeling
of choking; clear recognition of my condition, in which state
I sometimes observed, in the manner of an independent, neutral
observer; that I shouted half-insanely or babbled incoherent words.
Occasionally, I felt as if I were out of my body.
"The doctor found a rather weak pulse, but an otherwise normal
circulation.... Six hours after ingestion of the LSD, my condition
had already improved considerably. Only the visual disturbances
were still pronounced. Everything seemed to sway and the proportions
were distorted like reflections in the surface of moving water.
Moreover, all the objects appeared in unpleasant, constantly changing
colors, the predominant shades being sickly green and blue. When
I closed my eyes, an unending series of colorful, very realistic
and fantastic images surged in upon me. A remarkable feature was
the manner in which all acoustic perceptions, (e.g. the noise
of a passing car), were transformed into optical effects, every
sound evoking a corresponding colored hallucination constantly
changing in shape and color like pictures in a kaleidoscope. At
about one o'clock, I fell asleep and awoke the next morning feeling
perfectly well."
This was the first planned experiment with LSD, and it proved
in a dramatic and convincing way Hofmann's hypothesis about the
mind-altering effects of LSD. Subsequent experiments with volunteers
from the Sandoz Research Laboratories confirmed the extraordinary
influence of this drug on the human mind.
The next important figure in the history of LSD was Walter Stoll,
son of Hofmann's superior and psychiatrist at the Psychiatric
Clinic in Zurich. He found the new psychoactive substance of.
great interest and conducted the first scientific study of LSD
in normal volunteers and psychiatric patients. His observations
of the LSD effects in these two categories of subjects were published
in 1947. (97) This report became a sensation in the scientific
world and stimulated an unusual amount of laboratory and clinical
research in many countries.
EARLY LABORATORY AND CLINICAL LSD RESEARCH
Much of the early LSD research was inspired and strongly influenced
by the so-called "model psychosis" approach.
The incredible potency of LSD and the fact that infinitesimally
small quantities could profoundly alter mental functioning of
otherwise healthy volunteers gave a new impetus to speculations
about the basically biochemical nature of endogenous psychoses,
particularly schizophrenia. It was repeatedly observed that microscopic
doses of LSD, in the range of 25 to 100 micrograms, were sufficient
to produce changes in perception, emotions, ideation and behavior
that resembled those seen in some schizophrenic patients. It was
conceivable that the metabolism of the human body could, under
certain circumstances, produce such small quantities of an abnormal
substance identical with or similar to LSD. According to this
tempting hypothesis, endogenous psychoses such as schizophrenia
would not be primarily mental disorders, but manifestations of
an autointoxication of the organism and the brain caused by a
pathological shift in body chemistry. The possibility of simulating
schizophrenic symptoms in normal volunteers and of conducting
complex laboratory tests and investigations before, during, and
after this transient "model psychosis" seemed to offer
a promising key to the understanding of psychiatry's most enigmatic
disease.
Much research during the years following the discovery of LSD
was aimed at proving or disproving the "model psychosis"
hypothesis. Its power was such that for many years LSD sessions
conducted for any purpose were referred to as "experimental
psychoses," and LSD and similar substances were called hallucinogens,
psychotomimetics (psychosis-simulating compounds) or psychodysleptics
(drugs disrupting the psyche). This situation was not rectified
until 1957 when Humphrey Osmond, after mutually stimulating correspondence
with Aldous Huxley, coined a much more accurate term, "psychedelics"
(mind-manifesting or mind-opening drugs). (74) In these years
much effort was directed toward accurate phenomenological description
of the LSD experience and assessment of the similarities and differences
between the psychedelic states and schizophrenia. These descriptive
studies had their counterpart in the research exploring parallels
between these two conditions, as reflected in clinical measurements,
psychological tests, electro-physiological data, and biochemical
findings. The significance attributed to this avenue of research
found an expression in the number of studies contributing basic
data about the effects of LSD on various physiological and biochemical
functions as well as on the behavior of experimental animals,
on isolated organs and tissue cultures, and on enzymatic systems.
Of special interest from the point of view of the "model
psychosis" hypothesis were experiments studying the antagonism
between LSD and various other substances. The possibility of blocking
the LSD state, by premedication with another drug or by its administration
at the time of fully developed LSD effects, was seen as a promising
approach to the discovery of new directions in the pharmaco-therapy
of psychiatric disorders. Several biochemical hypotheses of schizophrenia
were formulated at this time, implicating specific substances
or whole metabolic cycles as the primary cause of this disease.
The serotonin hypothesis coined by Woolley and Shaw (104) received
by far the most attention. According to their model LSD causes
abnormal mental functioning by interfering with the neurotransmitter
substance serotonin (5-hydroxytryptamine). A similar mechanism
was postulated as the biochemical cause of schizophrenia.
This reductionistic and oversimplified approach to schizophrenia
was repeatedly criticized by psychoanalytically and phenomenologically
oriented clinicians and biochemical investigators, and finally
abandoned by most researchers. It became increasingly obvious
that the LSD-induced state had many specific characteristics clearly
distinguishing it from schizophrenia. In addition, none of the
biochemical mechanisms postulated for schizophrenia was unequivocally
supported by clinical and laboratory data. Although the "model
psychosis" approach did not resolve the problem of the etiology
of schizophrenia or provide a miraculous "test-tube"
cure for this mysterious disease, it served as a powerful inspiration
for many researchers and contributed in a decisive way to the
neurophysiological and psychopharmacological revolution of the
fifties and early sixties.
Another area in which the extraordinary effects of LSD proved
extremely helpful was self-experimentation by mental
health professionals. In the early years of LSD research didactic
LSD experiences were recommended as an unrivaled tool for the
training of psychiatrists, psychologists, medical students, and
psychiatric nurses. The LSD sessions were advertised as a short,
safe and reversible journey into the world of the schizophrenic.
It was repeatedly reported in various books and articles on LSD
that a single psychedelic experience could considerably increase
the subject's ability to understand psychotic patients, approach
them with sensitivity, and treat them effectively. Even though
the concept of the LSD experience as "model schizophrenia"
was later discarded by a majority of scientists, it remains an
unquestionable fact that experiencing the profound psychological
changes induced by LSD is a unique and valuable learning experience
for all clinicians and theoreticians studying abnormal mental
states.
The early experimentation with LSD also brought important new
insights into the nature of the creative process and contributed
to a deeper understanding of the psychology and psychopathology
of art. For many experimental subjects, professional
artists as well as laymen, the LSD session represented a profound
aesthetic experience that gave them a new understanding of modern
art movements and art in general. Painters, sculptors and musicians
became favorite LSD subjects because they tended to produce most
unusual, unconventional and interesting pieces of art under the
influence of the drug. Some of them were able to express and convey
in their creations the nature and flavor of the psychedelic experience,
which defies any adequate verbal description. The day of the LSD
experience often became a dramatic and easily discernible landmark
in the development of individual artists.
Equally deep was the influence of LSD research on the psychology
and psychopathology of religion. Even under the complex
and often difficult circumstances of early LSD experimentation,
some subjects had profound religious and mystical experiences
that bore a striking similarity to those described in various
sacred texts and in the writings of mystics, saints, religious
teachers and prophets of all ages. The possibility of inducing
such experiences by chemical means started an involved discussion
about the authenticity and value of this "instant mysticism."
Despite the fact that many leading scientists, theologians and
spiritual teachers have discussed this theme extensively, the
controversy about "chemical" versus "spontaneous"
mysticism remains unresolved until this day.
Any discussion of the various areas of LSD research and experimentation
would remain incomplete without mentioning certain systematic
explorations of its negative potential. For obvious reasons, the
results of this research, conducted by the secret police and armed
forces of many countries of the world, have not been systematically
reported and most of the information is considered classified.
Some of the areas that have been explored in this context are
eliciting of confessions, gaining of access to withheld secrets
and information, brainwashing, disabling of foreign diplomats,
and "nonviolent" warfare. In working with
individuals, the destructive techniques try to exploit the chemically
induced breakdown of resistances and defense mechanisms, increased
suggestibility and sensitivity to terroristic approaches, and
intensification of the transference process. In the mass approaches
of chemical warfare, the important variables are the disorganizing
effect of LSD on goal-oriented activity, and its uncanny potency.
The techniques of dispensation suggested for this warfare have
been various kinds of aerosols and contamination of water supplies.
For everybody who is even remotely familiar with the effects of
LSD, this kind of chemical warfare is much more diabolical than
any of the conventional approaches. Calling it non-violent or
humane is a gross misrepresentation.
THERAPEUTIC EXPERIMENTATION WITH LSD
From the point of view of our discussion, the most important area
of LSD research has been experimental therapy with this substance.
Observations of the dramatic and profound effects of minute quantities
of LSD on the mental processes of experimental subjects led quite
naturally to the conclusion that it might be fruitful to explore
the therapeutic potential of this unusual compound.
The possibility of therapeutic use of LSD was first suggested
by Condrau (21) in 1949, only two years after Stoll had published
the first scientific study of LSD in Switzerland. In the early
fifties several researchers independently recommended LSD as an
adjunct to psychotherapy, one which could deepen and intensify
the therapeutic process. The pioneers of this approach were Busch
and Johnson (17) and Abramson (1,2) in the United States; Sandison,
Spencer and Whitelaw (91) in England; and Frederking (28) in West
Germany.
These reports attracted considerable attention among psychiatrists,
and stimulated clinicians in various countries of the world to
start therapeutic experimentation with LSD in their own practice
and research. Many of the reports published in the following fifteen
years confirmed the initial claims that LSD could expedite the
psychotherapeutic process and shorten the time necessary for the
treatment of various emotional disorders, which made it a potentially
valuable tool in the psychiatric armamentarium. In addition, there
appeared an increasing number of studies indicating that LSD-assisted
psychotherapy could reach certain categories of psychiatric patients
usually considered poor candidates for psychoanalysis or any other
type of psychotherapy. Many individual researchers and therapeutic
teams reported various degrees of clinical success with alcoholics,
narcotic-drug addicts, sociopaths, criminal psychopaths, and subjects
with various character disorders and sexual deviations. In the
early sixties a new and exciting area was discovered for LSD psychotherapy:
the care of patients dying of cancer and other incurable diseases.
Studies with dying individuals indicated that LSD psychotherapy
could bring not only an alleviation of emotional suffering and
relief of the physical pain associated with chronic diseases,
it could also dramatically change the concept of death and attitude
toward dying.
Since the appearance of the early clinical reports on LSD much
time and energy has been invested in research of its therapeutic
potential, and hundreds of papers have been published on various
types of LSD therapy. Many psychopharmacological, psychiatric,
and psychotherapeutic meetings had special sections on LSD treatment.
In Europe, the initially isolated efforts of individual LSD researchers
resulted in an effort to create a homogeneous organizational structure.
LSD therapists from a number of European countries formed the
European Medical Society for Psycholytic Therapy, and members
held regular meetings dealing with the use of psychedelic drugs
in psychotherapy. This organization also formulated the specifications
and criteria for selection and training of future LSD therapists.
The counterpart of this organization in the United States and
Canada was the Association for Psychedelic Therapy. During the
decade of most intense interest in LSD research several international
conferences were organized for the exchange of experiences, observations
and theoretical concepts in this field (Princeton, 1959; Goettingen,
1960; London, 1961; Amityville, 1965; Amsterdam, 1967; and Bad
Nauheim, 1968).
The efforts to use LSD in the therapy of mental disorders now
span a period of almost three decades. It would be beyond the
scope of this presentation to describe all the specific contributions
to this unique chapter of the history of psychiatric treatment,
as well as give due attention to all the individual scientists
who participated in this avenue of research. The history of LSD
therapy has been a series of trials and errors. Many different
techniques of therapeutic use of LSD have been developed and explored
during the past thirty years. Approaches that did not have the
expected effect or were not supported by later research were abandoned;
those that seemed promising were assimilated by other therapists,
or developed further and modified. Instead of following this complicated
process through all its stages, I will try to outline certain
basic trends and the most important therapeutic ideas and concepts.
Three decades of LSD therapy is a sufficiently long period for
accumulating clinical observations and verifying research data.
We can, therefore, attempt a critical review of the clinical experience
in this area, summarize the current knowledge about the value
of LSD as a therapeutic tool in psychiatry, and describe the safest
and most effective techniques for its use.
Various suggestions concerning the therapeutic use of LSD were
based on the specific aspects of its action. The frequent occurrence
of euphoria in LSD sessions with normal volunteers seemed to suggest
the possibility that this drug could be useful in the treatment
of depressive disorders. The profound and often shattering effect
of LSD on psychological as well as physiological functions, amounting
to an emotional or vegetative shock, seemed to indicate that it
could have a therapeutic potential similar to electroshocks, insulin
treatment, or other forms of convulsive therapy. This concept
was supported by observations of striking and dramatic changes
in the clinical symptomatology and personality structure of some
subjects after administration of a single dose of LSD. Another
aspect of the LSD effect which seemed to be promising from the
therapeutic point of view was the unusual ability of this drug
to facilitate intensive emotional abreactions. The therapeutic
success of abreactive techniques such as hypnoanalysis and narcoanalysis
in the treatment of war neuroses and traumatic emotional neuroses
encouraged explorations of this property of LSD. One additional
interesting possibility of therapeutic use was based on the activating
or "provocational" effect of LSD. The drug can mobilize
and intensify fixated, chronic and stationary clinical conditions
that are characterized by just a few torpid and refractory symptoms,
and it was hypothesized that such chemically induced activation
might make these so-called oligosymptomatic states more amenable
to conventional methods of treatment. By far the most important
use of LSD was found in its combination with individual and group
psychotherapies of different orientations. Its effectiveness is
based on a very advantageous combination of various aspects of
its action. LSD psychotherapy seems to intensify all the mechanisms
operating in drug-free psychotherapies and involves, in addition,
some new and powerful mechanisms of psychological change as yet
unacknowledged and unexplained by mainstream psychiatry.
In the following sections, I will describe the most important
areas of therapeutic experimentation with LSD, give actual treatment
techniques and concepts, and discuss their empirical or theoretical
bases. Special attention will be paid to an evaluation of how
successfully individual approaches have withstood the test of
time.
STUDIES OF CHEMOTHERAPEUTIC PROPERTIES
OF LSD
The approaches that will be discussed in this section are based
on different clinical observations and different theoretical premises;
the common denominator is an exclusive emphasis on LSD as a chemotherapeutic
agent that has certain beneficial effects just by virtue of its
pharmacological action. The authors of these techniques were either
unaware of the significance of extrapharmacological factors or
did not specifically utilize them. If psychotherapy was used with
these approaches at all, it was only supportive and of the most
superficial kind, without any organic link to the LSD experience.
EXPLORATION OF EUPHORIANT AND ANTIDEPRESSIVE EFFECTS OF LSD
When Condrau (21) proposed the use of LSD for depression on the
basis of its euphoriant effect on some subjects, he followed the
model of opium treatment. He administered small and progressively
increasing daily doses of LSD to depressive patients and expected
alleviation of depression and positive changes in mood. According
to Condrau's statement, the results were not convincing and the
observed changes did not exceed the limits of the usual spontaneous
variations. He also noticed that LSD medication usually resulted
in deepening of the pre-existing mood rather than consistent euphorization.
Similar results were reported by other authors who used either
Condrau's model of daily medication with LSD in depressive patients
or isolated administrations of medium dosages of LSD with the
intention to dispel depression. Negative or inconclusive clinical
experiences have been reported by Becker, (8) Anderson and Rawnsley,
(3) Roubicek and Srnec, (89) and others.
By and large, the results of this approach to LSD therapy did
not justify continuation of research in this direction. Clinical
studies clearly indicated that LSD does not per se have
any consistent pharmacological effects on depression that could
be therapeutically exploited, and this approach has been abandoned.
SHOCK-INDUCING PROPERTIES OF LSD AND ITS EFFECT ON PERSONALITY
STRUCTURE
In the early period of LSD research, several authors suggested
that the profound and shattering experience induced by LSD could
have a positive effect on some patients comparable to the effect
of various methods of convulsive treatment such as electroshocks,
insulin coma therapy, or cardiazole and acetylcholine shocks.
Occasionally, unexpected and dramatic clinical improvements were
reported in psychiatric patients after a single LSD session. Observations
of this kind have been described in papers by Stoll, (97) Becker,
(8) Benedetti, (10) Belsanti, (9) and Giberti, Gregoretti and
Boeri. (30)
In addition, an increasing number of reports seemed to suggest
that sometimes a single administration of LSD could have a deep
influence on the personality structure of the subject, his or
her hierarchy of values, basic attitudes, and entire life style.
The changes were so dramatic that they were compared with psychological
conversions.[2] Many
LSD researchers made similar observations and became aware of
the potential therapeutic value of these transformative experiences.
The major obstacle to their systematic utilization for therapeutic
purposes was the fact that they tended to occur in an elemental
fashion, without a recognizable pattern, and frequently to the
surprise of both the patient and the therapist. Since the variables
determining such reactions were not understood, therapeutic transformations
of this kind were not readily replicable. However, it was this
category of observations and systematic efforts to induce similar
experiences in a more predictable and controlled way that finally
resulted in the development of an important treatment modality,
the so-called psychedelic therapy. The basic principles of this
therapeutic approach will be discussed later.
In summary, LSD can undoubtedly produce a profound emotional and
vegetative shock in a patient or an experimental subject. The
shock-effect tends, however, to be more disorganizing and disruptive
than therapeutic, unless it occurs within a special framework,
in a situation of complex psychological support, and after careful
preparation. The conversion mechanism is too unpredictable, elemental
and capricious to be relied upon as a therapeutic mechanism per
se.
THERAPEUTIC USE OF THE ABREACTIVE EFFECT OF LSD
Many observations from early LSD research clearly indicated that
the drug can facilitate reliving of various emotionally relevant
episodes from infancy, childhood, or later life. In the case of
traumatic memories, this process was preceded and accompanied
by powerful emotional abreaction and catharsis. It seemed, therefore,
only logical to explore the value of LSD as an agent for abreactive
therapy in a way similar to the earlier use of ether, short-acting
barbiturates, or amphetamines, in the same indication.
From the historical and theoretical point of view, this mechanism
can be traced back to the early concepts of Freud and Breuer.
(29) According to them, insufficient emotional and motor reaction
by a patient to an original traumatic event results in "jamming"
of the effect: the strangulated emotions ("abgeklemmter Affekt")
later provide energy for neurotic symptoms. Treatment then consists
in reliving the traumatizing memory under circumstances that make
possible a belated redirection of this emotional energy to the
periphery and its discharge through perceptual, emotional, and
motor channels. From the practical point of view, the abreactive
method was found especially valuable in the treatment of traumatic
emotional neuroses and became popular during the Second World
War as a quick and effective remedy for hysterical conversions
occurring in various battle situations.
There is hardly a single LSD therapist who would have doubts about
the unique abreactive properties of LSD. It would be, however,
a great oversimplification to approach and understand LSD treatment
only as abreaction therapy. This was clearly demonstrated in a
controlled study by Robinson. (86) Present opinion is that abreaction
is an important component of LSD psychotherapy, but it represents
just one of many therapeutic mechanisms resulting from the complex
action of this drug.
USE OF THE ACTIVATING EFFECT OF LSD ON CHRONIC AND FIXATED
SYMPTOMS
This approach was inspired by the clinical experience that LSD
has an intensifying and mobilizing effect on manifest and latent
psychopathological symptoms. The principle of activation or "provocation"
therapy with LSD was theoretically developed and employed in practice
by the Austrian researcher Jost. (41) This concept was based on
clinical observations of an interesting relationship between the
nature and course of the psychotic process and prognosis of the
disease. It has been a well-known clinical fact that acute schizophrenic
episodes with dramatic, rich and colorful symptoms have a very
good prognosis. They frequently result in spontaneous remission,
and therapy of these conditions is usually very successful. Conversely,
schizophrenic states with an inapparent and insidious onset, a
few stagnating and torpid symptoms, and a stationary course have
the poorest prognosis and are very unresponsive to conventional
treatments.
After analyzing a great number of trajectories of psychotic episodes,
Jost came to the conclusion that it is possible to find a certain
culmination point in the natural course of psychosis beyond which
the disease shows a trend towards spontaneous remission. In schizophrenia,
these culmination points are usually characterized by hallucinatory
experiences of death or destruction, disintegration of the body,
regression and transmutation. These negative sequences are then
followed by fantasies or experiences of rebirth.
The assumption of such a culmination point in the spontaneous
course of the illness could explain, according to Jost, some puzzling
observations made during electroshock therapy. As ECT seems to
accelerate the spontaneous development of the disease along the
intrinsic trajectory, it makes a great deal of difference at which
point it is applied. If the electroshock is administered before
the psychosis reaches the culmination point, it produces dramatic
manifestations and intensifies the clinical picture. If it is
given after the culmination point has been reached; this results
in a rapid sedation of the patient and remission of the symptoms.
In their practical approach, Jost and Vicari (42) intended to
accelerate the spontaneous development of the disease by a combination
of chemical and electrophysiological means to mobilize the autonomous
healing forces and processes within the organism. They administered
LSD and when the clinical condition was activated by its effect,
they applied electroconvulsive therapy. The authors described
substantial shortening of the schizophrenic episode, reduction
in the number of electroshocks required to reach clinical improvement,
and often a deeper remission.
Sandison and Whitelaw, (92) two British researchers and pioneers
in LSD research, used a similar principle of applying a conventional
treatment technique in patients whose clinical condition was activated
by LSD. However, instead of administering ECT, they used the tranquilizing
effect of chlorpromazine (Thorazine). In their study, psychotic
patients from various diagnostic groups were given LSD and two
hours later intramuscular injection of the tranquilliser. Although
the results seemed promising, the authors themselves later discarded
the idea that the administration of chlorpromazine played a positive
role in this procedure.
In general, the idea of provocational therapy with LSD has not
found a broader acceptance in clinical practice and has remained
limited to the attempts described above. However, Jost's theoretical
speculations contain several interesting ideas that can prove
very fruitful if used in a more dynamic and creative way. The
basic principle of activating fixated symptoms by LSD can be used
in the context of intensive psychotherapy; a single LSD session
can often help overcome stagnation in a long-term psychotherapeutic
process. Also, Jost's concepts of an intrinsic trajectory of the
psychotic process and the value of its acceleration are in basic
agreement with certain modern approaches to schizophrenia discussed
in the writings of R. D. Laing, (52) John Perry, (80) Julian Silverman,
(94,95) and Maurice Rappaport. (84) Similarly, the observations
regarding Jost's concept of the culmination moment of the schizophrenic
process and the specific experiences associated with the breaking
point make new sense if they are viewed in the context of dynamic
matrices in the unconscious rather than from the point of view
of Jost's mechanical model. We will discuss this issue in detail
in connection with the perinatal matrices and the therapeutic
significance of the ego death and rebirth experience.
LSD-ASSISTED PSYCHOTHERAPY
As indicated in the above survey of therapeutic experimentation
with LSD, the efforts to exploit purely pharmacological properties
of this drug have failed to bring positive results. The concept
of LSD as simply a chemotherapeutic agent has been abandoned by
all serious researchers in the field. The use of LSD as an activating
substance, in Jost and Vicari's sense, has not found its way into
clinical practice, at least not in its original mechanical form.
The abreactive action of LSD is valued highly, but it is usually
considered to be only one of many effective mechanisms operating
in LSD therapy. The shock-effect of LSD cannot in itself be considered
therapeutic; unless it occurs in a specifically structured situation,
it can have detrimental rather than beneficial consequences. The
influence of LSD on the personality structure in the sense of
a conversion is a well-established clinical fact; however, the
occurrence of this phenomenon during unstructured administrations
of LSD is rare, unpredictable and capricious. Special preparation,
a trusting therapeutic relationship, psychological support, and
a specifically structured set and setting are necessary to make
therapeutic use of this aspect of the LSD effect.
There seems to be general agreement at present among LSD therapists
that the therapeutic outcome of LSD sessions depends critically
on factors of a nonpharmacological nature (extrapharmacological
variables). The drug itself is seen as a catalyst that activates
the unconscious processes in a rather unspecific way. Whether
the emergence of the unconscious material will be therapeutic
or destructive is not determined simply by the biochemical and
physiological action of LSD. It is a function of a number of non-drug
variables, such as the personality structure of the subject, the
relationship he or she has with the guide, sitter or persons present
in the session, the nature and degree of specific psychological
help, and the set and setting of the psychedelic experience. For
this reason all the approaches that try to utilize LSD simply
as another chemotherapeutic agent are, by and large, bound to
fail. This does not mean that it is not possible to benefit from
an LSD experience if the drug is taken in an unstructured situation.
However, extrapharmacological factors have such a profound influence
on the LSD session and its final outcome that one cannot expect
a reasonable degree and consistency of therapeutic success unless
the non-drug variables are sufficiently understood and controlled.
Thus the optimal use of LSD for therapeutic purposes should always
involve administration of the drug within the framework of a complex
psychotherapeutic program; this approach offers the most therapeutic
possibilities. In this respect, the potential of LSD seems to
be quite extraordinary and unique. The ability of LSD to deepen,
intensify and accelerate the psychotherapeutic process is incomparably
greater than that of any other drug used as an adjunct to psychotherapy,
with the exception perhaps of some other members of the psychedelic
group, such as psilocybin, mescaline, ibogaine, MDA, (methylenedioxy-amphetamine),
or DPT (dipropyltryptamine).
In the professional literature, the combination of LSD with various
forms of psychotherapy has been referred to by many different
names: psycholysis (Sandison), psychedelic therapy (Osmond), symbolysis
(van Rhijn), hebesynthesis (Abramson), lyserganalysis (Giberti
and Gregoretti), oneiroanalysis (Delay), LSD analysis (Martin
and McCririck), transintegrative therapy (MacLean), hypnodelic
treatment (Levine and Ludwig), and psychosynthesis (Roquet). Individual
therapists using LSD psychotherapy have differed considerably
in regard to the dosage used, frequency and total number of psychedelic
sessions, the intensity and type of the psychotherapeutic work,
and certain specificities of set and setting.
In view of all these differences and variations, any comprehensive
discussion of the history of LSD psychotherapy would involve giving
separate descriptions of all the individual therapists and therapeutic
teams. Yet, it is possible with a degree of over-simplification,
to distinguish certain basic ways of using LSD in psychotherapy.
These modalities fall into two major categories, which differ
in the degree of significance attributed to the role of the drug.
The first category involves approaches in which the emphasis is
on systematic psychotherapeutic work; LSD is used to enhance the
therapeutic process or to overcome resistances, blocks and periods
of stagnation. The approaches in the second category are characterized
by a much greater emphasis on the specific aspects of the drug
experience and the psychotherapy is used to prepare the subjects
for the drug sessions, give them support during the experiences,
and to help them integrate the material.
FACILITATION OF THE PSYCHOTHERAPEUTIC PROCESS BY LSD ADMINISTRATION
During the years of therapeutic experimentation, there have been
several systematic attempts to use small doses of LSD to enhance
the dynamics of individual or group psychotherapy. In general,
the disadvantages of this approach seem to outweigh its potential
benefits. The use of small dosages does not save much time, since
it does not shorten the duration of the drug action so much as
decrease its depth and intensity. Similarly, the risks involved
in the use of low doses in psychiatric patients are not necessarily
lower than those related to high-dose sessions. It is of greater
advantage to interpolate occasional LSD sessions using medium
or high dosages in the course of systematic long-term psychotherapy
at times when there is little therapeutic progress. In the following
text we will briefly describe each of the above approaches.
Use of Small Doses of LSD in Intensive Psychotherapy
In this treatment modality the patients participate in a systematic
course of long-term psychotherapy, and in all the sessions they
are under the influence of small doses of LSD in the range of
25 to 50 micrograms. The emphasis is clearly on psychotherapy
and LSD is used to intensify and deepen the usual psychodynamic
processes involved. Under these circumstances, the defense mechanisms
are weakened, the psychological resistances tend to decrease,
and the recall of repressed memories is greatly enhanced. LSD
also typically intensifies the transference relationship in all
its aspects and makes it easy for the therapist as well as the
patient to understand clearly the nature of the processes involved.
Under the influence of the drug, patients are usually more ready
to face repressed material and accept the existence of deep instinctual
tendencies and conflicts within themselves. All the situations
in these LSD sessions are approached with appropriate modifications
of techniques of dynamic psychotherapy. The content of the drug
experience itself is interpreted and used in much the same way
as the manifest content of dreams in regular non-drug psychotherapy.
In the past this approach has been mostly used in combination
with psychoanalytically oriented psychotherapy, although it is
theoretically and practically compatible with many other techniques,
such as Jungian analysis, bioenergetics and other neo-Reichian
therapies, and Gestalt practice.
Use of Small Doses of LSD in Group Psychotherapy
In this treatment modality all the participants in a session of
group psychotherapy, with the exception of the leaders, are under
the influence of small doses of LSD. The basic idea is that the
activation of individual dynamic processes will result in a deeper
and more effective group dynamic. The results of this approach
have not been very encouraging. Coordinated and integrated group
work is usually possible only with small dosages of LSD which
do not have a very profound psychological impact on the group
members. If the dosages are increased, the group dynamic tends
to disintegrate and it becomes increasingly difficult to get the
group to do organized and coordinated work. Each participant experiences
the session in his or her unique way, and most of them find it
difficult to sacrifice their individual process to the demands
of group cohesion.
An alternative approach to the psychedelic group experiences which
may be very productive is its ritual use, as practiced
by certain aboriginal groups: the peyote sessions of the Native
American Church or Huichol Indians, yagé ceremonies of
the Amahuaca or Jivaro Indians in South America, ingestion of
sacred mushrooms (Psilocybe mexicana) by the Mazatecs
for healing and sacramental purposes, or the ibogaine rites of
some tribes in Gabon and adjacent parts of the Congo. Here verbal
interaction and the cognitive level are typically transcended
and group cohesion is achieved by non-verbal means, such as collective
rattling, drumming, chanting, or dancing.
After a few initial attempts to conduct traditional group psychotherapy
with all the members intoxicated by LSD, this technique was abandoned.
However, exposure to a group or contact with co-patients during
the termination period of an individual LSD session can be a very
useful and productive experience. The assistance of an organized
group of drug-free peers can be particularly helpful in working
through some residual problems from the drug session. A combination
of the new experiential techniques developed for use in encounter
groups can also be of great value in this context. Another useful
technique is the combination of individually experienced LSD sessions
with subsequent analysis and discussion of the material in drug-free
group sessions involving all the subjects participating in the
LSD program.
Occasional Use of LSD Sessions in Intensive Psychotherapy
This approach involves regular, systematic, long-term psychotherapy,
with occasional interpolation of an LSD session. The dosages administered
in this context are in the medium or high range, usually between
100 and 300 micrograms. The aim of these psychedelic sessions
is to overcome dead points in psychotherapy, intensify and accelerate
the therapeutic process, reduce the resistances, and obtain new
material for later analysis. A single LSD session interpolated
at a critical time can contribute considerably to a deeper understanding
of the client's symptoms, the dynamics of his or her personality,
and the nature of the transference problems. The revealing confrontation
with one's unconscious mind, recall and reliving of repressed
biographical events, manifestation of important symbolic material,
and intensification of the therapeutic relationship that results
from a single LSD session can frequently provide powerful incentives
for further psychotherapy.
TECHNIQUES OF LSD THERAPY
Although psychotherapy is a very important component of the approaches
in this category, the primary emphasis is on the specificities
of the drug experience. The psychotherapeutic techniques involved
are modified and adjusted to the nature of the LSD state to form
an integral and organic unit with the psychedelic process.
Psycholytic Therapy With LSD
The term psycholytic was coined by the British researcher and
pioneer in LSD therapy, Ronald A. Sandison. Its root, lytic
(from the Greek lysis=dissolution) refers to the process
of releasing tensions, dissolving conflicts in the mind. It should
not be confused with the term psychoanalytic (analyzing
the psyche). This treatment method represents in theory as well
as in clinical practice an extension and modification of psychoanalytically
oriented psychotherapy. It involves administration of LSD at one-
to two-week intervals, usually in the dosage range of from 75
to 300 micrograms. The number of drug sessions in a psycholytic
series varies depending on the nature of the clinical problem
and the therapeutic goals; it oscillates between fifteen and one
hundred, the average probably being somewhere around forty. Although
there are regular drug-free interviews in the intervals between
the sessions, there is a definite emphasis on the events in the
LSD sessions.
The drug sessions take place in a darkened, quiet and tastefully
furnished room that suggests a homelike atmosphere. The therapist
is usually present for several hours at the time when the session
culminates, giving support and specific interpretations when necessary.
During the remaining hours the patients are alone, but they may
ring for the therapist or nurse if they feel the need. Some LSD
programs use one or more co-patients as sitters for the termination
periods of the sessions, or allow the patient to socialize with
the staff and other clients.
All the phenomena that occur in LSD sessions or in connection
with LSD therapy are approached and interpreted using the basic
principles and techniques of dynamic psychotherapy. Certain specific
characteristics of the LSD reaction however, require some modifications
of the usual techniques. These involve a greater activity on the
part of the therapist, elements of assistance and attendance (for
example, in case of vomiting, hypersalivation, hypersecretion
of phlegm, coughing, or urination), a more direct approach, occasional
physical contact and support, psychodramatic involvement in the
patients experience, and higher tolerance for acting-out behavior.
This makes psycholytic procedure similar to the modified psychoanalytic
techniques used for psychotherapy with schizophrenic patients.
It is necessary to abandon the orthodox analytic situation where
the patient reclines on the couch and is expected to share his
or her free associations while the detached analyst sits in an
armchair and occasionally offers interpretations. In psycholytic
therapy, patients are also asked to stay in the reclining position
with their eyes closed. However, LSD subjects may on occasion
remain silent for long periods of time or, conversely, scream
and produce inarticulate sounds; they might toss and turn, sit
up, kneel, put their head in one's lap, pace. around the room,
or even roll on the floor. Much more personal and intimate involvement
is necessary, and the treatment frequently requires genuine human
support.
In psycholytic therapy, all the usual therapeutic mechanisms are
intensified to a much greater degree than in single LSD sessions.
A new and specific element is the successive, complex and systematic
reliving of traumatic experiences from childhood, which is associated
with emotional abreaction, rational integration, and valuable
insights.[3] The therapeutic
relationship is usually greatly intensified, and analysis of the
transference phenomena becomes an essential part of the treatment
process.
The toll that psycholytic therapy has had to pay for its theoretical
rooting in Freudian psychoanalysis has been confusion and conflict
about the spiritual and mystical dimensions of LSD therapy. Those
psycholytic therapists who firmly adhere to the Freudian conceptual
framework tend to discourage their patients from entering the
realms of transcendental experiences, either by interpreting them
as an escape from relevant psychodynamic material or by referring
to them as schizophrenic. Others have identified the psychoanalytic
framework as incomplete and restricting and become more open to
an extended model of the human mind. The conflict concerning the
interpretation of transpersonal experiences in LSD therapy and
the attitude toward them is not only a matter of academic interest.
Major therapeutic changes can occur in connection with transcendental
states, and so facilitation or obstruction of these experiences
can have very concrete practical consequences.
Typical representatives of the psycholytic approach have been
Sandison, Spencer and Whitelaw, Buckman, Ling, and Blair in England;
Arendsen-Hein and van Rhijn in Holland; Johnsen in Norway; and
Hausner, Tauterman, Dytrych and Sobotkiewiczova in Czechoslovakia.
This approach was developed in Europe and is more characteristic
of European LSD therapists. The only therapist using psycholytic
therapy in the United States at this time is Kenneth Godfrey of
the Veterans Administration Hospital in Topeka, Kansas. In the
past it was practiced by Eisner and Cohen, Chandler and Hartman,
Dahlberg and others.
Psychedelic Therapy with LSD
This therapeutic approach differs from the preceding one in many
important aspects. It was developed on the basis of dramatic clinical
improvements and profound personality changes observed in LSD
subjects whose sessions had a very definite religious or mystical
emphasis. Historically, it is related to the development of a
unique LSD treatment program for alcoholics, conducted in the
early fifties by Hoffer and Osmond in Saskatchewan, Canada. These
authors were inspired by the alleged similarity between the LSD
state and delirium tremens, reported by Ditman and Whittlesey
(23) in the United States. Hoffer and Osmond combined this observation
with the clinical experience that many chronic alcoholics give
up drinking after the shattering experience of delirium tremens.
In their program, they initially gave LSD to alcoholic patients
with the intention of deterring them from further drinking by
the horrors of a simulated delirium tremens. Paradoxically, however,
it seemed to be the profound positive experiences in LSD sessions
that were correlated with good therapeutic results. On the basis
of this unexpected observation Hoffer and Osmond, in cooperation
with Hubbard, laid the foundations of the psychedelic treatment
technique.
The main objective of psychedelic therapy is to create optimal
conditions for the subject to experience the ego death and the
subsequent transcendence into the so-called psychedelic peak experience.
It is an ecstatic state, characterized by the loss of boundaries
between the subject and the objective world, with ensuing feelings
of unity with other people, nature, the entire Universe, and God.[4]
In most instances this experience is contentless and is accompanied
by visions of brilliant white or golden light, rainbow spectra
or elaborate designs resembling peacock feathers. It can, however,
be associated with archetypal figurative visions of deities or
divine personages from various cultural frameworks. LSD subjects
give various descriptions of this condition, based on their educational
background and intellectual orientation. They speak about cosmic
unity, unio mystica, mysterium tremendum, cosmic
consciousness, union with God, Atman-Brahman union, Samadhi, satori,
moksha, or the harmony of the spheres.
Various modifications of psychedelic therapy use different combinations
of elements to increase the probability of psychedelic peak experiences
occurring in LSD sessions. Before the actual session there is
typically a period of drug-free preparation conducted with the
aim of facilitating the peak experience. During this time, the
therapist explores the patients' life history, helps them to understand
their symptoms, and specifically focuses on personality factors
that could represent serious obstacles to achieving the psychedelic
peak experience. An important part of the preparation is the therapist's
explicit and implicit emphasis of the growth potential of the
patients, and an encouragement to reach the positive resources
of their personalities. Unlike conventional psychotherapy, which
usually goes into detailed exploration of psychopathology, psychedelic
therapy tries to discourage the patient's preoccupation with pathological
phenomena, be they clinical symptoms or maladjustive interpersonal
patterns. In general, there is much more concern about transcending
psychopathology than interest in its analysis.
Occasionally, patients even receive direct advice and guidance
as to how they could function more effectively. This approach
is very different from the undisciplined and random advising in
life situations against which psychoanalytically oriented therapists
so emphatically warn. It does not involve specific suggestions
for solving important problems of everyday life, such as marriage
or divorce, extramarital affairs, induced abortions, having or
not having children, and taking or leaving a job. Psychedelic
counseling operates on the very general level of a basic strategy
of existence, life philosophy, and hierarchy of values. Some of
the issues that might be discussed in this context are, for example,
the relative significance of the past, present, and future; the
wisdom of drawing one's satisfaction from ordinary things that
are always available in life; or the absurdity of exaggerated
ambitions and needs to prove something to oneself or to others.
From the practical point of view, the general directions in psychedelic
counseling are based on observations of specific changes in individuals
who have been successfully treated with LSD psychotherapy. They
involve an orientation and approach toward life that seem to be
associated with the absence of clinical symptoms and with a general
feeling of well-being, joy and affirmation of the life process.
Although the psychedelic philosophy and life strategy were developed
quite independently from the work of Abraham Maslow, (64) some
of the principles of this approach are closely related to his
description of a self-realizing person and his concept of metavalues
and metamotivations. Another important aspect of the discussions
in the preparatory period is exploration of the subject's philosophical
orientation and religious beliefs. This is particularly relevant
in view of the fact that psychedelic sessions frequently revolve
around philosophical and spiritual issues.
The last interview before the drug experience usually focuses
on technical questions specifically related to the psychedelic
session. The therapist describes the nature of the drug effect
and the spectrum of experience that it might trigger; special
attention is paid to the importance of total yielding to the effect
of the drug and psychological surrender to the experience.
In psychedelic therapy there is great emphasis on aesthetically
rich settings and a beautiful environment. LSD sessions are conducted
in tastefully furnished rooms, decorated with flowers, paintings,
sculptures and selected art objects. Wherever possible, natural
elements are emphasized. The treatment facility should ideally
be located near the ocean, mountain ranges, lakes or wooded areas
as exposure of LSD subjects to natural beauty during the termination
period of the sessions is an important part of the psychedelic
procedure. If this is not possible, examples of natures creativity
are brought into the treatment room: beautiful potted plants and
fresh-cut flowers, collections of colorful minerals of interesting
shapes, a variety of exotic sea-shells, and photographs of enticing
scenery. Fresh and dried fruit, assorted nuts, raw vegetables
and other natural foods are characteristic items in the armamentarium
of psychedelic therapists, as are fragrant spices and incense;
these offer an opportunity to engage both smell and taste in the
rediscovery of nature. Music plays a very important role in this
treatment modality; a high fidelity stereophonic record player,
a tape recorder, several sets of headphones and a good collection
of records and tapes are standard equipment in psychedelic treatment
suites. The selection of music is of critical importance, in general
and in relation to different stages of the sessions or specific
experiential sequences.
The dosages used in this approach are very high, ranging from
300 to 1500 micrograms of LSD. In contrast to the use of serial
LSD sessions in the psycholytic treatment, psychedelic therapy
typically involves only one high-dose session or, at the most,
two or three. This procedure has been aptly referred to as a "single
overwhelming dose." During the drug experience, patients
are encouraged to stay in a reclining position, use eyeshades,
and listen to stereophonic music through headphones for the entire
period of maximum drug effect. Verbal contact is generally discouraged
and various forms of non-verbal communication are preferred whenever
it seems necessary to provide support.
The content of psychedelic sessions frequently has a definite
archetypal emphasis and draws on the specific symbolism of certain
ancient and pre-industrial cultures. Some psychedelic therapists
therefore tend to include elements of Oriental and primitive art
in the interior decoration of their treatment rooms. The art objects
used in this context range from Hindu and Buddhist sculptures,
paintings and mandalas, Pre-Columbian ceramics and Egyptian statuettes
to African tribal art and Polynesian idols. In extreme instances
of this approach, some LSD therapists burn fragrant incense, use
ritual objects from specific spiritual traditions and read passages
from ancient sacred texts such as the I Ching or the Tibetan Book
of the Dead. (54) Systematic use of universal symbols has also
been described as part of the setting for psychedelic sessions.
(60)
In the psychedelic approach, not much attention is paid to psychodynamic
issues unless they specifically emerge and present a problem in
treatment. The development of transference phenomena is generally
explicitly or implicitly discouraged; the limitation of visual
contact by the use of eyeshades for most of the session helps
to considerably decrease the occurrence of severe problems of
this nature. The therapeutic mechanism considered of utmost importance
is the psychedelic peak experience, which usually takes the form
of a death-rebirth sequence with ensuing feelings of cosmic unity.
None of the theoreticians of psychedelic therapy has as yet formulated
a comprehensive theory of psychedelic treatment that accounts
for all the phenomena involved and is supported by clinical and
laboratory data. The existing explanations use the framework and
terminology of religious and mystical systems or make general
references to the mechanisms of religious conversion. Some authors
who have tried to offer physiochemical or neurophysiological interpretations
have not been able to move in their speculations beyond the most
general abstract concepts. These include explanations suggesting
that LSD facilitates the process of unlearning and relearning
by activation of stress mechanisms in the organism, or that the
therapeutic effect of LSD is based on chemical stimulation of
the pleasure centers in certain archaic parts of the brain. This
lack of a comprehensive theoretical system constitutes an important
difference between the psychedelic approach and psycholytic therapy,
which leans in theory and practice on the systems of various schools
of dynamic psychotherapy.
Psychedelic therapy has never become popular in Europe and with
a few exceptions has not even been recognized or accepted by European
therapists. Its use has remained by and large limited to the North
American continent where it originated. Its most noted representatives
in Canada have been Hoffer, Osmond and Hubbard, Smith, Chwelos,
Blewett, McLean, and McDonald. In the United States, the beginnings
of psychedelic therapy were associated with the names of Sherwood,
Harman and Stolaroff; Fadiman, Mogar and Allen; Leary, Alpert,
and Metzner; and Ditman, Hayman and Whittlesey. During the last
fourteen years, a group of psychiatrists and psychologists working
in Catonsville, Maryland, has been systematically exploring the
potential of psychedelic therapy in the treatment of various psychiatric
problems, in the training of mental health professionals, and
in the care of dying cancer patients. This research program, conducted
initially at the Research Unit of the Spring Grove State Hospital
and, since 1969, at the Maryland Psychiatric Research Center in
Catonsville, Maryland, has been headed by Albert A. Kurland, M.D.
The basic principles of the kind of psychedelic therapy employed
by this group and the methodological approach to its clinical
evaluation had been formulated by Sanford Unger. Other professionals
who functioned as LSD therapists and researchers in this team
were Cimonetti, Bonny, Leihy, DiLeo, Lobell, McCabe, Pahnke, Richards,
Rush, Savage, Schiffman, Soskin, Wolf, Yensen, and Grof.
In general, psychedelic therapy seems to be most effective in
the treatment of alcoholics, narcotic-drug addicts, depressed
patients, and individuals dying of cancer In patients with psychoneuroses,
psychosomatic disorders and character neuroses, major therapeutic
changes usually cannot be achieved without systematically working
through various levels of problems in serial LSD sessions.
Anaclitic Therapy With LSD (LSD Analysis)
The term anaclitic (from the Greek anaklinein—to
lean upon) refers to various early infantile needs and tendencies
directed toward a pregenital love object. This method was developed
by two London psychoanalysts, Joyce Martin (62) and Pauline McCririck.
(68) It is based on clinical observations of deep age regression
occurring in LSD sessions of psychiatric patients. During these
periods many of them relive episodes of early infantile frustration
and emotional deprivation. This is typically associated with agonizing
cravings for love, physical contact, and other instinctual needs
experienced on a very primitive level.
The technique of LSD therapy practiced by Martin and McCririck
was based on psychoanalytic understanding and interpretation of
all the situations and experiences occurring in drug sessions
and in this sense is very close to psycholytic approaches. The
critical difference distinguishing this therapy from any other
was the element of direct satisfaction of anaclitic needs of the
patients. In contrast to the traditional detached attitude characteristic
of psychoanalysis and psycholytic treatment, Martin and McCririck
assumed an active mothering role and entered into close physical
contact with their patients to help them to satisfy primitive
infantile needs reactivated by the drug.
More superficial aspects of this approach involve holding the
patients and feeding them warm milk from a bottle, caressing and
offering reassuring touches, holding their heads in one's lap,
or hugging and rocking. The extreme of psychodramatic involvement
of the therapist is the so-called "fusion technique,"
which consists of full body contact with the client. The patient
lies on the couch covered with a blanket and the therapist lies
beside his or her body, in close embrace, usually simulating the
gentle comforting movements of a mother caressing her baby.
The subjective reports of patients about these periods of "fusion"
with the therapist are quite remarkable. They describe authentic
feelings of symbiotic union with the nourishing mother image,
experienced simultaneously on the level of the "good breast"
and "good womb." In this state, patients can experience
themselves as infants receiving love and nourishment at the breast
of the nursing mother and at the same time feel totally identified
with a fetus in the oceanic paradise of the womb. This state can
simultaneously involve archetypal dimensions and elements of mystical
rapture, and the above situations be experienced as contact with
the Great Mother or Mother Nature. It is not uncommon that the
deepest form of this experience involves feelings of oneness with
the entire cosmos and the ultimate creative principle, or God.
The fusion technique seems to provide an important channel between
the psychodynamic, biographical level of the LSD experience and
the transcendental states of consciousness. Patients in anaclitic
therapy relate that during their nourishing exchange with the
mother image, the milk seemed to be "coming directly from
the Milky Way." In the imaginary re-enactment of the placentary
circulation the life-giving blood can be experienced as sacramental
communion, not only with the material organism, but with the divine
source. Repeatedly, the situations of "fusion" have
been described in all their psychological and spiritual ramifications
as fulfillment of the deepest needs of human nature, and as extremely
healing experiences. Some patients described this technique as
offering the possibility of a retroactive intervention in their
deprived childhood. When the original traumatic situations from
childhood become reenacted in all their relevance and complexity
with the help of the "psychedelic time-machine," the
therapist's affection and loving care can fill the vacuum caused
by deprivation and frustration.
The dosages used in this treatment technique ranged between 100
and 200 micrograms of LSD, sometimes with the addition of Ritalin
in later hours of the sessions. Martin and McCririck described
good and relatively rapidly achieved results in patients with
deep neuroses or borderline psychotic disorders who had experienced
severe emotional deprivation in childhood. Their papers, presentations
at scientific meetings, and a film documenting the anaclitic technique
stirred up an enormous amount of interest among LSD therapists
and generated a great deal of fierce controversy. The reactions
of colleagues to this treatment modality ranged from admiration
and enthusiasm to total condemnation. Since most of the criticism
from the psychoanalytically oriented therapists revolved around
the violation of the psychoanalytic taboo against touching and
the possible detrimental consequences of the fusion technique
for transference-countertransference problems, it is interesting
to describe the authors' response to this serious objection.
Both Martin and McCririck seemed to concur that they had experienced
much more difficulty with transference relationships before they
started using the fusion technique. According to them, it is the
lack of fulfillment in the conventional therapeutic relationship
that foments and perpetuates transference. The original traumatic
situations are continuously reenacted in the therapeutic relationship
and the patient essentially experiences repetitions of the old
painful rejections. When the anaclitic needs are satisfied in
the state of deep regression induced by the drug, the patients
are capable of detaching themselves emotionally from the therapist
and look for more appropriate objects in their real life.
This situation has a parallel in the early developmental history
of the individual. Those children whose infantile emotional needs
were adequately met and satisfied by their parents find it relatively
easy to give up the affective ties to their family and develop
independent existence. By comparison, those individuals who experienced
emotional deprivation and frustration in childhood tend to get
trapped during their adult life in symbiotic patterns of interaction,
destructive and self-destructive clinging behavior, and life-long
problems with dependence-independence. According to Martin and
McCririck, the critical issue in anaclitic therapy is to use the
fusion technique only during periods of deep regression, and keep
the experience strictly on the pregenital level. It should not
be used in the termination periods of the sessions when the anaclitic
elements could get easily confused with adult sexual patterns.
The anaclitic technique never achieved wide acceptance; its use
seemed to be closely related to unique personality characteristics
in its authors. Most other therapists, particularly males, found
it emotionally difficult and uncomfortable to enter into the intimate
situation of fusion with their clients. However, the importance
of physical contact in LSD psychotherapy is unquestionable and
many therapists have routinely used various less-intense forms
of body contact.
Hypnodelic Therapy
The name of this treatment technique is a composite derived from
the words "hypnosis" and "psychedelic." The
concept of hypnodelic therapy was developed by Levine and Ludwig
(58) in an effort to combine the uncovering effect of LSD into
an organic whole with the power of hypnotic suggestion. In their
approach the hypnotic technique was used to guide the subject
through the drug experiences and modulate the content and course
of the LSD session.
The relationship between hypnosis and the LSD reaction is very
interesting and deserves a brief mention here. Fogel and Hoffer
(27) reported that they were able to counteract the effects of
LSD by hypnotic suggestion and, conversely, at a later date evoke
typical LSD phenomena in a subject who had not ingested the drug
that day. Tart (100) conducted a fascinating experiment of "mutual
hypnosis," in which two persons trained both as hypnotists
and hypnotic subjects continued to hypnotize each other into an
increasingly deep trance. From a certain point on they became
unresponsive to Tart's suggestions and shared a complicated inner
journey that bore many similarities to psychedelic states.
In Levine and Ludwig's hypnodelic treatment, the first interview
focused on the exploration of the patient's clinical symptoms,
present life situation, and past history. Subsequently, the patient
was trained as a hypnotic subject; high fixation of the eyes was
used as the principle method of trance induction. Ten days later
the psychiatrist conducted a psychedelic session using 125 to
200 micrograms of LSD. During the latency period, which usually
lasts thirty to forty minutes when the drug is administered orally,
the patient was exposed to hypnotic induction so that at the time
of onset of the LSD effect, he or she was typically in a state
of trance. Because of a basic similarity between LSD experiences
and the phenomena of hypnosis the transition from hypnotic trance
to the LSD state tends to be relatively smooth. During the culmination
period of the LSD session, the psychiatrists tried to use the
effect of the drug for therapeutic work while also utilizing their
hypnotic rapport with the patients. They helped them to work through
important areas of problems, encouraged them to overcome resistances
and psychological defenses, guided them to relevant childhood
memories, and facilitated catharsis and abreaction. Toward the
end of the session, the patients were given posthypnotic suggestions
to remember all the details of the session and to continue thinking
about the problems that emerged during the session. A special
isolated room was provided for them for the rest of the session
day.
Levine and Ludwig explored the efficacy of the hypnodelic technique
in narcotic-drug addicts and alcoholics. According to their original
report, the combination of LSD administration and hypnosis proved
to be more effective than either of the components used separately.
Aggregate LSD Psychotherapy
In this form of LSD therapy en masse, patients experience
their LSD sessions usually with medium or high dosages, in the
company of several co-patients participating in the same psychedelic
treatment program. The basic difference between this therapeutic
approach and the LSD-assisted group psychotherapy described earlier
is the absence of any effort at coordinated work with the group
as a whole during the time of the drug action. The most important
reason for giving the drug simultaneously to a large number of
individuals is to save time for the therapeutic team. Despite
the fact that they share the same room, patients essentially experience
their sessions individually with only occasional, unstructured
encounters and interactions of an elemental nature. A standard
program of stereophonic music is usually offered to the entire
group, or several alternative channels might be made available
on different headphone circuits. Sometimes the projection of slides
of emotionally relevant and provocative material or aesthetically
stimulating pictures and mandalas can form an integral part of
the program for the session day. The therapist and his helpers
provide collective supervision; individual attention is given
only if absolutely necessary. On the day following the drug session
or. later on, the individual experiences of the participants are
usually shared with other group members.
This approach has its advantages and disadvantages. The possibility
of treating a number of patients simultaneously is an important
factor from the economic point of view, and could in the future
represent the answer to the unfavorable ratio between mental health
professionals and psychiatric patients. On the other hand, the
lack of sensitive individualized support might make this treatment
less effective and less conducive to working through some especially
difficult and demanding areas of personal problems. There is also,
in such a collective situation, a danger of psychological contagion;
panic reactions, aggressive behavior and loud abreactions of individual
patients can negatively influence the experiences of their peers.
If the group approach is sensitively combined with individual
work when necessary, however, its advantages can outweigh its
drawbacks.
The best-known treatment program of this kind was a multidimensional
approach to psychedelic psychotherapy developed by Salvador Roquet,
(87) a Mexican psychiatrist and founder of the Albert Schweitzer
Association in Mexico City. Although his therapeutic program utilized
other psychedelic drugs and substances of plant origin in addition
to LSD, it deserves more detailed discussion in this context.
Roquet combined his training as a psychoanalyst with his knowledge
of the indigenous healing practices and ceremonies of various
Mexican Indian groups and created a new approach to therapy with
psychedelic drugs that he called psychosynthesis. This should
not be confused with the theory and practice of the original psychotherapeutic
system also called psychosynthesis developed in Italy by Roberto
Assagioli. The latter approach is strictly a non-drug procedure,
although it shares with psychedelic therapy a strong transpersonal
emphasis. In Roquet's approach, therapy was conducted with groups
of ten to twenty-eight patients of differing ages and sexes. The
members of each group were carefully selected to make the group
as heterogeneous as possible with respect to age, sex, clinical
problems, the psychedelic drug received, and length of time already
spent in treatment. Each group included novices just beginning
therapeutic work, individuals who were in the main course of treatment,
and patients about to terminate therapy. An important goal of
the selection process was to offer a broad spectrum of suitable
figures for projections and imaginary roles. Various members of
such a heterogeneous group could then represent authority figures,
maternal and paternal images, sibling substitutes, or objects
of sexual interest.
Following the example of Indian rituals, the drug sessions took
place at night All the participants met in a large room for a
leaderless group discussion that lasted about two hours. These
meetings allowed the patients to meet new members and discuss
their fears, hopes and expectations; they also gave the participants
ample opportunity for projections and transferences that had an
important catalyzing influence on their drug sessions and frequently
provided valuable learning experiences. The treatment room was
large and decorated with paintings and posters with evocative
themes. A wide spectrum of psychedelic substances were administered
in these meetings, including LSD, peyote, a variety of psilocybin-containing
mushrooms, morning glory seeds, Datura ceratocaulum and
ketamine.
The patients spent most of the time in a reclining position on
mattresses arranged along the walls, though they were allowed
to move around freely if they wanted. Two stereo systems were
used and a wide variety of music and sounds was available to influence
the depth and intensity of the group's reactions. An important
part of the psychedelic sessions was a sensory overload show using
slides, movies, stereo effects, and intermittent flashes of colored
floodlights. Several themes considered to be of crucial relevance
were interwoven in the otherwise erratic and confused barrage
of unrelated images and sounds, these included birth, death, violence,
sexuality, religion, and childhood. The sensory overload portion
of the drug sessions lasted about six hours and was followed by
a reflective phase that lasted until sunrise. Following this,
the therapists and all participants rested for an hour.
The integrative session involved group discussions and sharing
of experiences. The main objective of this phase was to facilitate
integration of the material uncovered in the drug session and
to apply the insights to the problems of everyday living. Depending
on the nature of the interactions this process took from four
to twelve hours. The course of therapy consisted of ten to twenty
drug sessions depending on the nature and seriousness of the clinical
problems involved. The patient population consisted mostly of
neurotic out-patients, although Roquet also described various
degrees of success with some antisocial personalities and selected
schizophrenics.
THE NEED FOR A COMPREHENSIVE THEORY OF
LSD THERAPY
Therapeutic experimentation with LSD, and psychedelic research
in general, has been very negatively influenced by the existence
of the black market, unsupervised self-experimentation, sensational
journalism, and irrational legislative measures. Despite the fact
that LSD now has been known for almost three decades, the literature
describing its effects and therapeutic potential is controversial
and inconclusive. Further developments in this field would require
that independent teams in different countries interact and cooperate
in collecting experimental data and exchanging information. However,
the number of places studying LSD has been cut down considerably
and continues to decrease. Although the present prospects for
extensive psychedelic research are rather grim, there are indications
that systematic exploration will be resumed after the general
confusion has been clarified and rationality reintroduced into
the study of the problems involved.
Whatever becomes of LSD research in the future, there are good
reasons to analyze the observations and results of past psychedelic
experimentation and present the most important insights and findings
in a simple and comprehensive form. Such an effort seems justified
whether this study becomes an epitaph to the LSD era or a manifesto
for future psychedelic researchers. If we are witnessing the "swan
song' of psychedelic research, it would be interesting in retrospect
to be able to throw more light on the controversies and lack of
theoretical understanding concerning the nature of the LSD effect.
If LSD research continues into the future, clarification of the
present confusion and disagreements would be of great practical
importance. Additional controlled studies on a large scale are
needed to assess the efficacy of LSD as an adjunct to psychotherapy
with a satisfactory degree of scientific accuracy. However, unless
the critical reasons for past controversies can be clearly identified
and taken into consideration in future research, the new studies
will probably perpetuate old errors and yield correspondingly
inconclusive results.
As indicated above, individual authors and research teams used
LSD starting from very different premises. They followed different
therapeutic objectives, adhered to different theoretical systems,
employed differing technical approaches, and administered the
drug in the most disparate frameworks and settings. It is my belief
that the main reason for the controversies about LSD therapy is
a lack of understanding regarding the nature of the LSD effect,
and the absence of a plausible and generally acceptable conceptual
framework that would reduce the vast amounts of observed data
to certain common denominators. Such a theoretical system would
have to provide understanding of the content and course of separate
sessions as well as of repeated exposures to LSD in a therapeutic
series. And it should be able to explain the paramount importance
of extrapharmacological factors—the personalities of the subject
and the guide, their mutual relationship, and the elements of
the set and setting—in the development of LSD sessions.
Other important problems that should be accounted for within a
comprehensive theoretical framework are the occasional prolonged
reactions and even psychotic breakdowns that occur after some
of the sessions, or the later recurrences of the LSD-like states
("flashbacks"). The general understanding of these phenomena
is at present very incomplete and unsatisfactory, a situation
that has serious practical consequences. One result of it is that
the approach of mental health professionals to complications of
the non-medical use of psychedelics is generally ineffective and
often harmful.
A comprehensive theory of LSD psychotherapy should also be able
to bridge the gap at present existing between psycholytic and
psychedelic therapy, the two most relevant and vital approaches
to LSD treatment, and some other therapeutic modifications such
as anaclitic and hypnodelic therapy. It should be possible to
find important common denominators and explanatory principles
for these various approaches and understand their indications
and contraindications, as well as successes and failures. A conceptual
framework correctly reflecting the most important aspects of the
LSD effect should be able to provide practical directives concerning
the optimal conditions for the use of this substance in psychotherapy.
This would involve general treatment strategy, as well as details
concerning dosages, effective approaches to various special situations,
use of auxiliary techniques, and the specific elements of set
and setting. Finally, a useful, comprehensive theory should provide
a number of partial working hypotheses of a practical and theoretical
nature that could be tested with the use of scientific methodology.
In view of the complex and multileveled nature of the problems
involved, it is extremely difficult to formulate at present a
conceptual framework that would fully satisfy all the above criteria.
For the time being, even a tentative and approximate theoretical
structure, organizing most of the important data and providing
guidelines for therapeutic practice, would represent distinct
progress. In the following chapters an attempt will be made to
present a tentative framework for the theory and practice of LSD
psychotherapy. It is my belief that a conceptual system that could
account for at least the major observations of LSD therapy requires
not just a new understanding of the effects of LSD, but a new
and expanded model of the human mind and the nature of human beings.
The researches on which my speculations are based were a series
of exploratory clinical studies, each of which represented an
exciting venture into new territories of the mind as yet uncharted
by Western science. It would be unrealistic to expect that they
would be more than first sketchy maps for future explorers. I
am well aware of the fact that, following the example of old geographers,
many areas of my cartography would deserve to be designated by
the famous inscription: Hic sunt leones.[5]
The proposed theoretical and practical framework should be considered
as an attempt to organize and categorize innumerable new and puzzling
observations from several thousand LSD sessions and present them
in a logical and comprehensive way. Even in its present rough
form, this conceptual framework has proved useful in understanding
the events in psychedelic sessions run in a clinical setting,
as well as LSD states experienced in the context of non-medical
experimentation; following its basic principles has made it possible
to conduct LSD therapy with maximum benefit and minimum risk.
I believe that it also offers important guidelines for more effective
crisis intervention related to psychedelic drug use and more successful
treatment of various complications following unsupervised self-experimentation.
NOTES
* Numbers in parentheses refer to the Bibliography
in the printed edition.—ed.(back)
1. One microgram or gamma is one millionth
of a gram, about thirty-five billionths of an ounce.(back)
2. Conversions are sudden, very dramatic
personality changes occurring unexpectedly in psychologically
predisposed individuals in certain specific situations. The direction
of these profound transformations is usually contrary to the subject's
previous beliefs, emotional reactions, life values, attitudes
and behavior patterns. According to the area which they primarily
influence, we can distinguish religious, political, moral, sexual,
and other conversions. Religious conversions of atheists to true
believers or even religious fanatics have been observed in gatherings
of ecstatic sects and during sermons of famous charismatic preachers,
such as John Wesley. Maya Deren gave in her Divine Horsemen
(22) a unique description of her conversion to Haitian voodoo,
which occurred during her study of aboriginal dances. Victor Hugo's
example of the moral conversion of Jean Valjean in Les Miserables
(39) found its way into psychiatric handbooks and gave its name
to a special kind of corrective emotional experience. The most
spectacular illustration of political conversion and later reconversion
was described by Arthur Koestler in his Arrow in the Blue
(47) and The God That Failed. (46) Biblical examples of
moral and sexual conversions of a religious nature are the stories
of Barabas and Mary Magdalene.(back)
3. The significance of traumatic memories
from childhood for the dynamics of psycholytic therapy has been
systematically studied and described by Hanscarl Leuner. (57)
See also the discussion of psychodynamic experiences in the first
volume of this series, Stanislav Grof, Realms of the Human
Unconscious: Observations from LSD Research. (32)
Subsequent references to this book will be indicated by a shortened
title, thus: Realms of the Human Unconscious.(back)
4. Walter Pahnke (76) summarized the basic
characteristics of spontaneous and psychedelic peak experiences
in his nine mystical categories. According to him, the essential
features of these states are: (1) feelings of unity, (2) transcendence
of time and space, (3) strong positive affect, (4) sense of reality
and objectivity of the experience, (5) sacredness, (6) ineffability,
(7) Paradoxicality, (8) transiency, and (9) subsequent positive
changes in attitudes and behavior. The Psychedelic Experience
Questionnaire (PEQ) developed by Pahnke and Richards makes it
possible to assess whether or not the psychedelic peak experience
occurred in an LSD session, and allows for its gross quantification.
(back)
5. Hic sunt leones literally
means "Here are lions"; this expression was used by
early geographers in the old charts to denote insufficiently explored
territories, possibly abounding in savages, wild animals, and
other dangers. (back)