Ambrose Bierce, America's Civil War iconoclast, describes the mind as ": . . a mysterious form of matter secreted by the brain. Its chief activity consists in the endeavor to ascertain its own nature, the futility of the attempt being due to the fact that it has nothing but itself to know itself with." Bierce could not foresee scientific developments of the twentieth century: gradual elucidation of unconscious mental processes, knowledge of molecular protein metabolism in the brain, and neurophysiologic discoveries which make the phenomena of consciousness almost fathomable. Concurrent with these advances, psychedelic drugs emerged from the laboratory. Whether derived from plant life (marijuana, peyote, psilocybin, and morning-glory seeds) or created in the laboratory (LSD, dimethyltryptamine—DMT—and amphetamines), these drugs can markedly affect and possibly even alter the human brain, that supreme masterpiece of evolution.
Psychiatric problems associated with drug use are comparable with the kinds of problems which plague students who avoid drugs: (1) disturbances of intellectual functioning (thinking) ; anxiety, phobic, panic, or depressive episodes (feelings) ; and (3) behavioral disturbances (action). Most problems involve elements of all three, vary in degree from mild to severe, and tend to be acute (of short duration) or chronic (enduring and prolonged). They are also ubiquitous. Of the tens of millions of students in the United States (six million in colleges and universities), 10 per cent endure emotional problems which need professional attention and treatment. Most students with psychiatric problems do not receive appropriate treatment. Some seek help from peers and important adults in their environment. Many assume the role of doctor and "prescribe" drugs for themselves and friends. To relieve anxiety, a nervous high school student snitches a few pills from her mother's supply of tranquilizers. In response to academic pressures, a college freshman smokes marijuana to induce relaxation. A depressed sophomore takes LSD, hoping to rid himself of despair. In order to hide her gnawing disillusionment with college life, a dateless coed furtively sips vodka. These kinds of self-treatment frequently produce erratic results, distort an already complicated situation, and aggravate a glaring societal problem which is now dominated byinarijuana and LSD.
At the University of California at Los Angeles, until September of 1965, one patient, usually a student, was seen monthly because of complications following ingestion of LSD. During subsequent months, five to twenty individuals were seen each month at the Neuropsychiatric Institute (Unger'eider, Fisher, Fuller, and Caldwell, 1968).
College and community-health centers have observed similar increases. In a well-intentioned but futile effort to "control" the predicament, society has enacted hasty legislation. Instead of being controlled, drug use has merely been driven underground. In spite of prohibitive regulations at schools and punitive laws created by state and federal lawmakers, students are using illicit drugs to an extent far greater than most people are able, or willing, to admit. Some students claim that these drugs create the "real scene." The scene is now almost bizarre. A student rushes to a hospital because he has "freaked out" after eating peyote. Another student complains of taking 300p,g of LSD and getting no reaction. Still another, who has used no drugs for months, experiences a "flashback" of a previous psychedelic episode, but now it is a "bad trip."
Illogical? Of course. Bizarre? Probably. However, equally strange and inexplicable manifestations occur during psychology research. A fascinating experiment, conducted by Hebb (1961) at McGill University will illustrate:
Let us take a young, vigorous, healthy male, a college student, and deprive him simply of the perceptions that are part of ordinary life, which we take so for granted. Make him comfortable, feed him on request, but cut off that bombardment of sensory informations to which, normally, we are all exposed all the time except when asleep. We turn him in on himself, leave him to his thoughts. For some hours, this presents him with no great difficulty . . . but after a time a malaise appears, concerning the very center of the subject's being. The subject becomes restless and somewhat unhappy, but more significant is the report that he can no longer follow a connected train of thought. Some of our subjects entered the experiment thinking to review their studies or plan their research in the atmosphere of peace and meditation to be found inside the experimental cubicle. They were badly disappointed. Not only was serious thinking interfered with, but there was a repeated complaint that it was impossible to do any connected thinking of any kind. Tests of intelligence showed changes occurring by about the second day, and after the subjects had come out of isolation there were marked disturbances of ordinary motivation and work habits lasting 24 to 3§, hours . . . a good many had elaborate visual hallucinations, but these did not seem to involve the subject's own personal identity. More significant in the present context is the occurrence, in about 8% of the subjects, of sudden sharp emotional breaks, taking different forms, e.g., something like a temper tantrum, or an attack of claustrophobia, which put a sudden end to the experiment as far as these subjects were concerned; or in another group, alternatively, disturbances of the self-concept, in which the subject might feel that he had two bodies, that his head had parted company from his neck, or that he had become the immaterial mind wandering about space wholly detached from his body (p. 45).
This, without drugs; no wonder that adverse reactions are common in psychedelic-drug use. Such reactions are conveniently classified as mild, moderate, or severe. Mild reactions predominate, usually appear abruptly, and consist of feelings of uneasiness and tension or of being physically uncomfortable and restless. Specific physical symptoms commonly occur: sweating, increased heart rate, and nausea (more frequent with peyote and LSD). However, in a mild reaction, the individual is able to tolerate and talk about what is happening. Although there may be some concern or fear that the anxiety and discomfort may increase, panic does not develop and behavior remains controlled. The "episode" may last but a few minutes, rarely an hour. Reassurance provided by a pleasant environment and supportive
friends is usually sufficient. A male undergraduate reports the following:
Last quarter a friend brought some marijuana to my apartment and I smoked too much of it—went into a half-hour "panic"— was really bad—after that it got good, ecstasy and all that, and I went to sleep eventually. The week-end before finals I got depressed about things and it happened again without any drugs—my girl friend brought me to the Health Center and a doctor gave me tranquilizers and I stayed in the infirmary overnight—was OK the next day. Two days later I got the "shakes" again, felt tense, anxious and afraid—reminded me of the first pot incident—like being sucked into a void and losing my identity. I was put on tranquilizers again and things got much better. Then last night the medicine didn't work and I got to trembling—wasn't afraid, though. I decided I should come in again.
During the interview he discussed at some length his guilt about recent sexual activities with his girl friend and the relevance of this to family problems which have bothered him for years. He said his girl friend has a relaxed attitude about sex and it bothers him that he doesn't. Since any medical treatment would have been at best perfunctory, he was referred for continuous outpatient psychotherapy. Drugs, for him,
ceased to be a problem.
Drug complications of a moderate degree tend to occur in (more or less) chronic users. Panic episodes, depersonalization, moderately severe depressions, and the "apathy syndrome" are examples of what is possible. Here are several cases.
During her ninth acid trip, a twenty-year-old coed "freaked out" while at a fraternity party. She dashed into the hills, got lost, and finally returned exhausted to be "confronted" by a dog which "terrified" her. She stumbled into the house and was "talked down" by the fellows, who also provided some Librium capsules. She told her therapist that prior to this trip she was depressed, yet aware that depression preceding drug intake makes a bad trip more possible. A nineteen-year-old male took 500p,g of LSD in divided doses, an hour apart. Prior to the second "installment," he played the guitar to "relax." Soon he
. . . began to get shaky and nervous—looked up at the ceiling and visual images distorted the color and design in the ceiling. My mind seemed to detach itself (depersonalization) from my body and it seemed that I was looking at myself. The room seemed to assume a soft, warm shape—it would be anything I wanted it to be—then I got worried that I might think about something negative and that it would expand and terrify me. I kept worrying about this. I wanted to go to sleep but I couldn't. It seemed that I was always being promised something, either a great insight or a great horror. I went to the bathroom, looked in the mirror and my face was distorted: big eyes, lips sinking. I tried to use the urinal but seemed to sink so I sat on the commode and urinated, then returned to the room. My friend had been asleep for several hours. It got to be dawn and I got worried about not sleeping. He got up and walked me to the campus—I still felt detached. We passed the church and I thought that if I prayed to God, He would help me—I got inside but looked up at the stained glass windows and they turned into a horrible psychedelic color and seemed to move. I ran outside and we went to the cafeteria. The doughnut I tried to eat looked weird; I got scared and asked my friend to take me to a doctor for help.
A phenothiazine spansule helped give him a fourteen-hour sleep; he hadn't slept more than five hours any night during the past week. In the Morning he appeared rested, felt transformed. He told of family members who suffer from insomnia. He also mentioned that he didn't like to be "high" on anything, even beer, because he needed to be in control of himself. He said he took the LSD because he was dissatisfied with school, wanted to change, and that he had an "irresistible impulse." An interview five days later showed full recovery.
Another male, also nineteen, reported that he obtained a mediocre average during the first quarter of his freshman year. He enlivened the second quarter by taking LSD every second or third day, for a total of thirty trips. He lost interest in studying, dropped a course, and ended the quarter on academic probation. After registration for the third quarter, he abandoned LSD, but drank beer excessively. A disastrous third quarter terminated, quite appropriately, in a medical leave. He related that before he ever took LSD he once smoked four "joints" within fifteen minutes and it "zonked me completely—I was reduced to a nonfunctional stage of vegetable mass—mind clicking like a computer machine. I ended up in bed in the fetal position still going strong. It was over in an hour but I felt mentally 'hung-over.' " During summer vacation, in spite of a promise to himself, he couldn't resist trying acid again:
I took 500g about five o'clock in the afternoon while in a depressed mood, and got a little frightened about taking so much. I went for a walk after eating and things were starting to get out of hand. I was sitting in the park and it went out of control—the visual effect. I looked at the geraniums and it seemed to me that I couldn't get out. I ripped myself away and started to walk home. It seemed an eternity. Each block seemed miles but I fixed my eyes on the sidewalk and finally got home. It was about eleven and I went to bed. The map on the wall seemed to be playing with me like the water scene in Disney's Sorcerer's Apprentice—I began to be preoccupied with killing myself. I advanced my mind to the point that suicide was necessary to decrease the paranoid horror—to stop the map and walls from overwhelming me—I reached the state where it had complete control of me. About two-thirty I went to sleep, but didn't go to work the next day. I went to our minister and did get some help from him. I kind of returned to a placid acceptance of things and decided that I'd never go near acid again.
After returning to the university, he did B— work, which he believes will be improved in subsequent quarters. When asked how he now felt about the bad trip, he said,
Unfortunately, I've read too much of the odd-ball literature stuff —cellular consciousness and all that—I wonder about the possible validity of metaphysical concepts, extrasensory perception and the supernatural. I won't go around and say that because I've taken some pills I now see the light.
He subsequently involved himself in psychotherapy and is doing well academically.
Janowitz (1967), director of Mental Health Services at the University of Massachusetts, tells of a series of students coming in because they were not able to come down off a "high" induced by marijuana. Feelings of estrangement, poor reality testing, and strange body concepts have continued even weeks and months after the last marijuana episodes. He reports that all but one of these students responded well to medication.
Barbato (1967), director of University Health Services at the University of Denver, writes of a student who was picked up by the police in town at about two A.M. The student was wandering aimlessly and obviously under the influence of some drug, but created no disturbance and was brought to the Health Service by the officer, who did not book him. By late morning he was able to leave on his own. He admitted having smoked marijuana and said it was prompted by curiosity.
Prolonged use of potent psychedelic drugs can exert a gradual and insidious effect on some individuals who fervently maintain that they have developed insight into themselves and that they can be objective toward their involvements with the drugs. Ungerleider et al. (1968), at UCLA, describe chronic side effects as a
. . . dramatic shift in one's value system. Many persons after using LSD are no longer interested in working or playing what they call "ego games of society." LSD users often leave their families and become quite withdrawn, devoting most of their time to thinking, writing and talking about LSD, and what they would term "perceptual distortion." This refers to a subjective feeling of improvement concomitant with an objective loss of functioning.
It is to be expected that the incidence of such side effects will increase. Ungerleider et al. report that at the UCLA Neuropsychiatric Institute prior to September 1965, one problem case associated with LSD ingestion was seen approximately every two months. Beginning at that time, the incidence increased gradually from five to twenty cases a month. In addition, phone calls from people in trouble were coming in at the rate of twenty-five to a hundred per month.
One male graduate student at Stanford felt that LSD gave him powers of observation and reasoning which excelled those of the faculty—His professors disagreed. Until he "revised" his style of thinking, he was in danger of being asked to pursue his originality elsewhere. Without drugs, such grandiosity in thinking would suggest a paranoid disorder. The probable effect of LSD in the student suggests aggravation of latent paranoid tendencies.
It is perfectly understandable that troubled and emotionally unstable individuals are frequently those most attracted to psychedelic drugs. Essential to part of this motivation is a wish that these problems will magically diminish or disappear. Professionally trained researchers and much of the "lay" literature report dramatic improvement or even "cure" ( an awkward word to use in psychiatry) for individuals "treated" with LSD. These reports are poorly substantiated and constitute fervency rather than science. The same is true of hysterical scare articles, in many newspapers, which violently condemn psychedelic drugs, even marijuana.
Not only troubled individuals seek these drugs. As described by Lipinski and Lipinski (1967), various motivations prompt drug use in students, who seek change and improvement in personality style and function. The opposite may occur. Walters (1967) asserts that "the hallucinogenic drugs are dangerous . . . their result is narcissism and their penalty is emptiness and decreased self-esteem." Farnsworth (1966), director of Health Services at Harvard University, warns of the abuse of psychedelic drugs in young adults. He feels that these
drugs inhibit academic function, creativity, and interpersonal relationships.
In severe adverse reactions, panic, psychotic episodes, or suicide may occur. Panic reactions are symptoms of a complex (usually intense) emotional build-up, often accompanied by paranoid thoughts of a persecutory nature, seeking expression in erratic, impulsive action.
If appropriate emergency treatment is readily available, hospitalization is not necessary. At the Haight-Ashbury Free Medical Clinic in San Francisco, "bummers" are "talked down" by volunteer workers, who are most frequently nonprofessional individuals personally experienced with drugs. David Smith, director of the clinic, feels that nonprofessionals do a better job of handling a panic reaction than a psychiatrist, who may complicate matters by focusing on negative symptoms instead of providing reassurance and support. So-called "antidote" drugs (phenothiazines and sedatives)' are rarely used or needed at the Free Clinic. Drug synergy in the form of the atropine effect of DMT added to the atropine effect of a phenothiazine is thereby avoided, since many drug users do not always know which
drug or drugs they have ingested. Such a synergistic effect can produce death, as can happen when an individual who is drunk takes a non-lethal but excessive amount of barbiturates.
Psychotic episodes are short-lived or prolonged, involve thoughtm distortions (called delusions ), fear, illusions, and unusual if not bizarre behavior. Frequently, due to the abrupt onset, the episode startles. A twenty-year-old male had this experience:
About six weeks ago I went to Vietnam on a ten-week civilian volunteer program, but was sent home because I was using drugs: the Eastern type of marijuana and a small amount of LSD. I didn't accomplish what I wanted to do. For six weeks I used drugs, immersing myself in them and in teaching. I was caught by a government official and three days later was on a plane returning home. My parents and friends were surprised and a little amazed at my personality change-1 understand it as a type of schizophrenia—I'm very ambitious—want to talk to the New York Times about covering the situation in Vietnam—want to bring my Vietnamese girl friend back here and marry her—she could go to college—she's bright.
He was confused, moderately dissociated, and depressed. He asked whether I thought he should take any more drugs. I strongly advised that he let his doctor prescribe any drugs he might need, and helped with a referral for treatment. That evening, at home, he took 50014 of LSD, became floridly psychotic, and on an emergency basis was hospitalized.
Another case involves a twenty-one-year-old male and some marijuana.
I had some kind of emotional crisis or breakdown which was precipitated by a break-up with my girl. Then I took some marijuana and went off the deep end. Suddenly I left school and went to see my mother, who wanted me to stay at home. I didn't, and started driving back to school. I began hallucinating, thought I was chasing around trying to find my girl friend and a fraternity brother. I was driving like a mad man, once on the wrong side of the freeway. Then I stopped the car and climbed down the embankment. I dug into the soil trying to find my girl friend and fraternity brother. My fingers started bleeding. I took off all my clothes and ran through a field to a house where a woman lived alone. After opening the door, she panicked and ran screaming out of the house to a neighbor's. The three of them tried to calm me. About five minutes later the police arrived and took me into custody, where a doctor gave me first aid. In jail I tried to commit suicide—had lots of religious thoughts. They booked me on a vagrancy charge. I pled guilty. Then they took me to a mental hospital.
Extensive in-patient psychiatric treatment resulted in improvement. Marijuana, at best, played an incidental role. Psychotic reactions lasting months or years occur in those individuals who possess a predilection for such a reaction, either by being a "borderline individual" (prepsychotic) or because of "malvaria." According to Hoffer (1965), a malvarian is an individual who excretes in his urine a mauve factor, identifiable qualitatively by a laboratory litmus-paper test. It is believed that some of these individuals possess a (greater than average) latency for schizophrenia, possibly due to familial biogenetic predisposition. Hoffer contends that malvarians are more likely to endure prolonged adverse reactions to psychoactive agents, especially LSD. Further research is necessary to investigate the possibility of this suspected clinical entity.
Suicide is an uncomfortable reality in America. In college students, the suicide rate of about 1/10,000 per year is higher than the suicide rate of the nonstudent population of the same age. In the total population, one third of all suicides occur in individuals who use drugs obtained from, or prescribed by, a physician (Brophy, 1967). This would include those who beg or steal drugs from relatives and friends. Conventional suicide ( drug ingestion such as that of barbiturates, leaping from heights, and some car "accidents") cannot match the sensationalism evoked when LSD is incriminated.
In Southern California, a twenty-three-year-old student took LSD three times within four months. He developed the delusion that he had all the answers to the work in his academic program and went to discuss this with his professor, who referred him to the outpatient psychiatric clinic. He was evaluated as schizoid and severely depressed and was hospitalized. A month later he left the hospital against medical advice, saying he was going to return to his work. Police were notified, but he couldn't be located. Two days later he committed suicide by inhaling carbon monoxide.
Another male student, age twenty, took LSD eight or nine times, came to the outpatient psychiatric clinic because of being "out of contact with reality" intermittently. While waiting for the psychiatrist on emergency call to interview him, he impetuously fled from the building, ran into the parking lot, and rammed himself against a parked car, breaking his neck. As a quadriplegic in the hospital, he displayed no emotion but told of "feeling that I was fused with the car —that we were one." Death occurred in two weeks.
The last case brings up a vital point: an individual who remains aware that the bizarre effects of LSD intoxication are due to the influence of the drug which he has taken will tend not to act in a bizarre manner. He who "forgets" what is happening sacrifices reality orientation, permitting terror to be followed by impulsive, life-endangering behavior. Apathy can also be life endangering, though not in the physical sense. It endangers mental and emotional stability. The "apathy syndrome" is a risk invited by the chronic LSD user.
A twenty-year-old male undergraduate voluntarily came to the student health center. He spoke slowly, deliberately, and his voice contained no discernible emotion. He hadn't shaved or changed clothes for a week. During the past year, he had taken LSD more than forty times, gradually withdrew from his friends, and lived alone. He said,
"I want to go away somewhere and be alone. I'm tired of school. Someone said that I could get a medical leave and not get F's in all my courses. I haven't been to classes in six weeks." He appeared dejected and disillusioned. Hospitalization was refused; he declined any medication. A medical leave was arranged and he left the office. Three years have passed; he remains on medical leave. Of course, one sees analogous cases in students who eschew drugs.
A specter waits. It is called amphetamine, a chemically uncomplicated mime capable of several beguiling roles. Usually, for students, it is prescribed for those individuals who desire to lose weight or for procrastinators needing to grind out term papers or indulge in exam-cramming. Its most vicious role is manifest when amphetamines are injected intravenously. Thus, a person "shoots speed" to "blow his mind." Users proclaim that this sledgehammer effect has no equal. Doubtless. The undesired medical and psychiatric complications are also not to be doubted. They include: abscesses, septicemia, and hepatitis, due to needle contamination. An in-house drug administered with out-house sanitation.
The psychic effects? Wow! One gets cerebral "flashes," intense stimulation and wakefulness, hallucinations, loss of appetite, insomnia, mental exhaustion, and possibly convulsions preceding death. Tolerance to the drug is rapidly developed; therefore, increasingly larger amounts of the drug are necessary to obtain and maintain the "desired" effects. The average dose of an amphetamine prescribed by a physician is five milligrams; a devotee shooting "crystal" (methedrine) requires five, ten, or even twenty times that amount.
Serious complications following methedrine use are a common occurrence in the Haight-Ashbury district, and surely are also seen in all major cities. Physicians and staff at college health services are uneasy about the insidious but recognized increase in the use of amphetamines. One university in the South reported six amphetamine-induced psychoses in the past year. Recently, three students using amphetamine intravenously have come to our attention, two because hepatitis required their hospitalization. They recovered. The third student admitted to using heroin occasionally. The "hard stuff" is rare on college campuses.
Accurate statistics on trends of drug use among students are not obtained easily. The consensus of college mental-health personnel is, in 1968, that LSD usage is decreasing, while marijuana usage is increasing. Good news for botanists; bad news for amateur chemists. Unfortunately, marijuana is not totally innocuous. Keeler (1967) reports eleven cases of adverse reactions in a student population, including symptoms of panic, gross confusion, depersonalization, depression, and paranoia. He further comments that "all but two of the eleven individuals considered the benefits to far outweigh the unfortunate aspects and planned to continue use of the drug."
Reports of chromosomal damage and congenital birth defects, though not as yet scientifically documented, probably play a relative role in LSD's becoming less popular. More likely, the fact that the drug doesn't do much for students has an infinitely greater negative effect. In general, college students are better informed about drugs than older generations. But some can be incredibly naive. They are also gullible, particularly in regard to peer and "in-group" influences. These enticements and pressures are exerted on both emotionally disturbed and well-functioning students.
McGlothlin, Cohen, and McGlothlin (1967), studying the effects of LSD on normal human beings, find that ". . . persons who place strong emphasis on structure and control generally have n6 taste for the experience and tend to respond minimally if exposed. Those who respond intensely tend to prefer a more unstructured, spontaneous, inward-turning (though not socially introverted) life, and score somewhat higher on tests of aesthetic sensitivity and imaginativeness. They also tend to be less aggressive, less competitive, and less conforming."
Great literature provides marvelous characters who were aesthetically sensitive and by experimentation were "transformed." Dante invaded Hell by means of fantasy. Faust beckoned Mephistopheles to transform his body and soul. Dr. Jekyll ingested a foaming chemical to create Mr. Hyde; but what would have happened if Dante had chewed peyote, Faust had smoked pot, and Dr. Jekyll had become an acid head? Would the stories of Dante, Goethe, and Stevenson have been different? Imagine Kaffka on a "trip," Anton Bruckner "blowing his mind," El Greco "stoned."
The promise of transfiguration is inherent in psychedelic-drug use. But there isn't an erg of work, a microgram of love, a measure of creativity, or a degree of motivation in all the psychoactive agents that exist. These qualities exist in people, not in drugs. It is true that some individuals are stimulated or affected by drugs to perform work, love, and to be motivated toward function and productivity. Others may be negatively "stimulated."
In summary it can be said that psychedelic drugs make evident what already exists within the human mind, whether it be suicide or creation, hate or love, apathy or productivity. It is imperative that these drugs (use and abuse, as well as research, which must be continued) be controlled and utilized, if appropriate, by professionally trained and competent individuals. The crude laboratory, indiscriminate "prescribing," and persecution by misguided laws and authorities can play no effective role in a society which professes to be rational.
As in the Faustian dilemma, life must contain viable opposites and degrees of mystery. Albert Einstein, perhaps the most aesthetically sensitive scientist of our century, said, "The most beautiful experience we can have is the mysterious. It is the fundamental emotion which stands at the cradle of true art and true science."