What is the nature of the LSD experience? There is
no simple answer to this question. Early in our work with LSD at
the Mental Research Institute it became clear that there are no
regular and predictable effects of LSD per se, but rather that
the effects are the result of a complex interaction4 of the drug, the
psychological and physical environment, the personality structure
of the subject and therapist, and the set or expectancy as to
what the drug would do. Judging from the literature on LSD, this
point about the relativity of LSD effects has not been
sufficiently emphasized (2).
Our conclusions regarding the psychological effects
of LSD have developed out of a series of exploratory studies that
were carried out at the Mental Research Institute over a two-year
period (1958-59). Ss have included 60 volunteers and 29
psychiatric patients. Most of the volunteers Ss were professional
people (psychiatrists, psychologists and social workers) who took
the drug, ostensibly, out of curiosity. The psychiatric patients
were, for the most part, already in regular psychotherapy and
were taking the drug as a part of their treatment. Many of our Ss
have had more than one LSD experience.
During some of the early work at the Institute
several ways of approaching the subject in the LSD state were
tried, including the administration of psychological tests and
the utilization of various interview techniques. Experiments in
this regard led to the conclusion that any attempt on the
experimenter's part to impose a structured test or interview on
the situation had the effect of radically altering the subjective
experience of S. The most significant effects of the drug seemed
to occur when S was allowed to follow his own spontaneous train
of thought.
The technique of administration used with most of
Ss, therefore, is based on an attempt to provide a relatively
permissive, comfortable and accepting atmosphere. Ss were
encouraged to give themselves up to the effects of the drug as
much as possible. All the drug sessions were conducted in a
small, sound-proofed room that was very comfortably furnished
with a couch, carpet, pictures on the wall, and a stereo record
player. Ss were usually provided with an opportunity to listen to
music or look at visual stimuli An attempt was made to reduce the
amount of stress to a minimum. Someone was with S during most of
the day. He therefore had the opportunity to talk with someone if
he wished, although it was made clear to each S that he need not
talk if he did not feel like it.
The dosages used have ranged from 50 to 200
micrograms, with the most frequent dosage being 100 micrograms.
Volunteer Ss and patients were treated in much the
same manner, except that the patients entered the sessions with a
very different set. The LSD sessions were presented to each
patient as an adjunct to his regular treatment, and his therapist
was usually present during a part of the time. The role
relationship between the experimenters and the patients was
naturally quite different from the role relationship between the
experimenters and the professional volunteer Ss. When a
professional volunteer takes LSD in the presence of a colleague
he is frequently thrown into considerable conflict as to what his
role should be. This often presents a rather difficult situation
for the person who is administering the drug as well.
In describing the effects that we have observed
under these conditions and with these Ss, it is important to
distinguish between two classes of effects. One class is the
immediate effects, i.e., those which occur within eight to twelve
hours after ingestion of the drug. The other class consists of
the more lasting effects, i.e., those which persist for an
indeterminate period after the immediate effects have dissipated.
In studying the immediate effects, the approach has
been to observe the subject's relatively spontaneous behavior
while he is under the influence of the drug and also to analyze
the tape recordings made of each drug session.
The immediate effects which have been observed
can roughly be classified into five categories:
1) Mood and affect;
2) Interpersonal behavior;
3) Sensory and perceptual effects;
4) Intellectual functioning and reality testing;
5) Intuitive-intellectual effects.
In terms of mood and affect, Ss have
demonstrated a wide range of reactions. Often an emotional
lability is seen which ranges from tearfulness to euphoria. There
is frequently an increased intensity to emotions in general.
Feelings of well-being or euphoria, which many subjects have
reported, tend to merge into feelings of omnipotence. Sometimes
there appears to be an increase in anxiety; while at other times
anxiety is decreased, and there is a feeling that previously
threatening things can be talked about. Ss tend to show an
increased concern with the feelings and events of the immediate
moment, and sometimes there is a marked lack of concern about the
past and future.
In terms of interpersonal behavior, Ss
typically have manifested an increased sensitivity to their
interactions with others. In many Ss this sensitivity has taken
the form of being easily hurt or feeling neglected. With the
majority of Ss there has been an enhancement of the relationship
with the person who is conducting the experience. Sometimes
patients have developed paranoid constructions about being
manipulated.
The following varieties of sensory and
perceptual effects have been relatively common with our Ss:
there is an increased sensitivity to sounds and visual stimuli in
general. Distortions of the body image (visual distortions which
are usually illusory but sometimes hallucinatory) also occur.
There are synesthesias with all sorts of combinations of
sensations; e.g., music may produce visions of color, pictures
may produce sounds, and odors may produce visual and auditory
images or somatic sensations. There are transformations of the
time sense, such as time standing still, racing backwards or
forwards, or dragging interminably. The external world becomes
unstable, receding and approaching, flowing and vibrating.
In the area of intellectual functioning and
reality testing, LSD usually has resulted in a lability of
thought processes which frequently has manifested itself as a
flight of ideas. There often has been a marked disruption of the
organization of thoughts and concepts. In attempting to deal with
this disorganization, S has often come up with new, sometimes
insightful, ways of conceptualizing his experiences. Unless the
LSD therapist is equally at home with both old and new ideas he
may overlook creative aspects of the patient's thinking and label
it all as merely confused or psychotic. The therapist's confusion
may in turn confuse the patient.
There is still a fifth class of effects which could
be termed intuitive-intellectual effects. Included in this
category are experiences such as a feeling of oneness, a feeling
of "understanding" life and existence, religious
experiences, transcendental experiences, or a strong inclination
to think along philosophical lines. Such experiences have been
reported relatively frequently and appear to be a combination of
both emotional and intellectual functions. Patients who have had
vivid experiences of this type have tended to value them highly
and often have expressed the feeling that such experiences seem
to have some sort of lasting beneficial effect.
This list of immediate effects covers a wide range,
and frequently S in a single drug session will experience a large
number of them. It should be noted that many of the effects
mentioned are contradictory. In this connection it has been
observed that S will often shift from one experience or emotion
to its opposite in a very short time.
Individuals differed greatly in their responses
to LSD. At a given dosage some Ss reported that they experienced
little or nothing out of the ordinary, while others reported
extremely intense and unusual experiences. Of those who did
report significant effects, some experienced predominantly
unpleasant effects, while others felt the experience was
primarily pleasant; some were principally concerned with changes
in the body image, while others became preoccupied with esthetic
experiences on philosophical issues. It was also noted that the
same individual might show considerable variation in his response
to LSD from one session to the next.
In general we have felt that the more positive
kinds of experiences have something to do with S's willingness or
ability to give himself up to the effects of the drug. If S is
very concerned about maintaining control or fighting the effects
of the drug, the experiences can be frightening, sometimes
terrifying.5
By and large, however, we have observed very few reactions that
could be termed blatantly psychotic. It would probably be fairly
easy to induce more psychotic-like behavior if Ss were put into a
more stressful situation and made to feel more insecure.6
In studying the effectiveness of LSD as a
therapeutic adjunct, attention has been focused on what kinds of
possible lasting effects might occur as a result of one or
more LSD experiences. Often the more lasting effects seem
difficult for the patient to describe. A study of Ss' reports
along with observations of their behavior suggests that the
following kinds of changes occur as a result of a series of
therapeutically oriented LSD sessions: S becomes less anxious,
less rigid, more spontaneous, more tolerant of ambiguity, more
appreciative of esthetic and symbolic modes of expression, more
capable of enjoying intuitive, irrational experiences, and less
concerned over the past and future. Whether these changes are of
a universal order remains a question for further investigation.
It is conceivable that they are a function of the particular
sample of Ss, many of whom tended toward emotional constriction,
intellectualization and ruminative thinking.
In addition to these general kinds of changes,
there are specific changes that have to do with the individual's
dynamics. Often S may gain a new perspective on himself or gain
an important insight into his defenses which results in a change
in behavior. Sometimes, however, what the patient calls
"insight" turns out to be an irrational, ineffable and
peculiar experience that seemed to have a very important personal
meaning to S. As an example of this, a man felt during his
initial LSD experience that his joints were somehow grinding
together. He felt that all of the rough edges in his joints were
ground smooth, and this gave him a "well oiled" feeling
which seemed to persist for weeks afterwards.
One of the most intriguing aspects of the use of
LSD as in psychotherapy is that when positive changes have
occurred they often seem to have occurred in terms of the person's
value system rather than in terms of recovered memories,
interpersonal insights and the like, as is usually the case with
more traditional forms of psychotherapy. Such changes are
apparently in the direction of a higher valuation of esthetic,
creative, philosophic and perhaps even religious interests.
It should be pointed out that although the use of
LSD in therapy often results in changes that one would not get
otherwise, this does not obviate the need for regular
psychotherapeutic procedures. Although the patient may make
significant gains as a result of an LSD experience, we have
concluded that the experience needs to be followed up with
regular therapeutic sessions in order to work through the
insights that have been gained and the behavioral changes that
have been initiated.
How effective is LSD as a psychotherapeutic agent?
Ratings of improvement based on therapists' judgments and in some
cases pre- and post-LSD psychological tests indicate that 15 of
the 29 patients who received one or more LSD sessions benefited
therefrom. This evidence is far from conclusive, however, since
these patients were receiving regular therapy at the same time
and since no control group was utilized. Plans had been made at
the Mental Research Institute to undertake a more complete and
well controlled study of the therapeutic effectiveness of LSD,
but unfortunately we have not yet been able to obtain sufficient
financial support to carry these out. Although much has been
written on LSD as a therapeutic adjunct, there is still a dearth
of well controlled studies with adequate measures of change.
Comparable data are not available on our
professional volunteers. We were primarily interested in learning
from these Ss their theoretical interpretation of their
experiences and their judgment as to how LSD might best be
utilized. We found it difficult to obtain post-LSD reports from
these Ss, and their reports when obtained were oriented more
toward the personal experience rather than to theoretical
interpretation. Even though these sessions were not
therapeutically oriented (though conducted in a therapeutic
setting) many professional Ss reported increased feelings of
well-being and confidence. For example, one volunteer had the
annoying habit of being late and consuming even more time with
apologies. Since the LSD experience she has been observed to be
less often tardy---and if late she is less guilt ridden and
apologetic.
Our work with LSD so far has perhaps raised more
questions than it has answered. One of the most important of
these is the question of the relationship between personality
factors and response to LSD. Our attempts to predict the kind of
LSD response a person would have, based on pre-LSD test and
interview data, have been discouraging. For example, three
patients had Holzman, TAT, and historical evidence from which the
only possible prediction was a psychotic break under LSD. On the
contrary, they seemed to have richly rewarding experiences.7 It seems clear
that LSD can provide very therapeutic experiences for some,
although more research is needed to determine what kind of person
is most likely to benefit.
Another unanswered question is the relationship
between the nature of the experience and its aftereffects. Many
workers have assumed that positive experiences are most helpful
and that transcendental experiences have the greatest therapeutic
potential. And yet there are instances where frightening or
terrifying experiences have had beneficial aftereffects. Several
of our professional Ss have remarked that they believed that much
of the beneficial effect of LSD was due to a person's having
faced a stressful and ambiguous situation and worked it through
satisfactorily.
Exploratory LSD studies carried out at the Mental Research Institute over a two-year period have suggested that LSD may prove to be a very powerful tool in speeding up movement and overcoming resistances in psychotherapy. LSD did not, on the other hand, show promise as a diagnostic tool. When therapeutic changes did occur they often were of a qualitatively different order than those which occur in traditional psychotherapy. Under the influence of LSD, the individual goes through highly intense and unusual experiences which may well change the way in which he views his life.
3. Mental Research Institute,
Medical Research Foundation, Palo Alto, California. This work was
made possible by USPHS Grant MY2621. (back)
4. I prefer the word
"transaction" introduced by Cantril (6). Implicit in
this concept is the necessity to structure the environment
according to what one wishes to get out of it (22). The
patterning of the milieu described hereafter derives from the
Hollywood Hospital group, though the symposium antedates their
publication (17). Ed. (back)
5. Beringer (4) noted the same
thing for mescaline in 1927. (back)
6. Dr. Terrill's conjecture was
soon thereafter confirmed. An associate put himself in an extreme
stress situation by privately consuming 200 micrograms of LSD
which he had stolen. It took him two years for a full recovery. (back)
7. A three-year follow-up on
this trio is instructive. Dr. P.S. made a dramatic improvement
following LSD, but two years of family therapy were required to
sustain it. His pre-LSD Holzman shows many torn, syphilitic,
bleeding genitals and ani. The post-LSD Holzman is more typified
by nymphs dancing with satyrs.
Mrs. B.L.S. could not tolerate sexual relations
with her husband. He had had a vasectomy and she thought him
abnormal. Following LSD their sex life became satisfactory until
he suggested anal intercourse; this suggestion restored her
frigidity which has since remained inviolate.
Mr. I.M. suffered from a three-year spell of
impotence, but after LSD was able to have normal sexual relations
twice in an evening. His wife cooperated fully. The next morning
she upbraided him bitterly for having raped her while drunk.
Three years of therapy were required to restore his potency. (back)