From the Bulletin of the Multidisciplinary Association for Psychedelic Studies
MAPS - Volume 9 Number 2 Summer 1999 - pp. 11-14
Successful Outcome of a Single LSD Treatment in a Chronically Dysfunctional Man
Gary Fisher, Ph.D.
Editor's Note: As readers of the MAPS Bulletin know, we face a constant struggle to conduct research into the therapeutic applications of psychedelic drugs. Delays are the norm, and studies can take years to begin. We publish accounts like the one below because they are reminders of the sometimes surprising powerful effects that psychedelics can have. This account is by the same therapist who worked with psilocybin and LSD in the treatment of schizophrenic children in the early 60s (see MAPS Bulletin 7(3) 1997). Gary Fisher shares here the story of a man's single session with LSD. Fisher's account reminds us that the sitter, the preparation and the setting for a healing session with a psychedelic are integral parts of the drug's therapeutic effect.
In the 1960s I was conducting an LSD research project at a West Coast medical center on the use of LSD for intractable pain in terminally ill cancer patients. During this project the head of the Department of Psychiatry asked me if I thought it possible to "work in" an LSD treatment for the son of a CEO of a major corporation in the city. The message I got was to be cooperative. I met with the father and he told me that his son had had extensive and prolonged psychiatric treatment. He had been hospitalized at two of the country's most prestigious private psychiatric institutions but after eleven years of hospitalization and intensive psychoanalytic work no changes had occurred. For the following four years he saw a number of psychiatrists, tried every psychiatric drug available and even had a series of electro-shock treatments. The only procedure that he had not endured was psycho-surgery and the father was most reluctant to think about that alternative. The son was twenty-nine years old at the time, and had been in the psychiatric world for over fifteen years. He had never finished high school, never had a job and never had any friends. He had numerous diagnoses from a host of diagnosticians ranging from chronic schizophrenia to severe narcissistic character disorder. He never improved from any treatments, currently was not in treatment, and had run out of options. Although he had had numerous medications currently he was not being medicated because they made him feel worse. There was never any history of illegal drug usage. He spent his day in a darkened room constantly accompanied by a male psychiatric nurse. His activities were restricted to listening to the radio, watching TV, some reading, playing cards, and eating. The father requested that I see him at their home as the son refused to leave the house.
When I saw David he was almost friendly but a little aloof and formal. He had obviously read extensively in the psychiatric literature, and named off multiple symptoms from which he was suffering. His presenting symptoms included being phobic about most things in the world, being in a constant state of anxiety and fear, unable to sleep (having night terrors if he slept) and experiencing a constant range of distressing bodily sensations and recurring feelings of loss of reality. On interview, although he was loquacious, his affect was shallow and his self-descriptions were rehearsed - he was an old hand at being interviewed by psychotherapists. He was pleased at having attention again as after his two prolonged hospitalizations he had been secluded for two to three years in his room with his attendant, not even venturing to other parts of the house or yard. He did not evidence signs of acute psychosis. He elaborated in great detail about all the prestigious people and institutions where he had been treated, always ending with a sad and heavy resignation that they hadn't been able to help him. He had no memory deficit and could describe in detail the variety of professional people that he had encountered. After about two hours he queried me as to my credentials - my academic vita, experience, training and professional affiliations. He obviously didn't want to be treated by a nobody, only collecting trophies of victory worthy of him. Evidently I met his standards as he said he would cooperate with the LSD treatment. After my meeting with him I assessed him as "the most untreatable psychiatric patient in the world." His father was an enormously successful, famous and powerful person, but David was, too. He would go down in history as the man who defied the psychiatric world to treat him. This was his claim to fame. The contest read David vs. LSD and, I wondered, who would win this one?
My attempts at conducting our standard pre-session preparation were to no avail as he showed no interest in hearing about how this work was done. The session room was set up with the standard regime of music, flowers, artwork, artifacts from nature and tasty food morsels. Two other experienced sitters attended the session. The session was conducted in private quarters in a closed psychiatric ward of a large urban hospital. The format of the session was that developed by Hubbard  and the Saskatchewan group  with the key concepts of "set and setting," the focus of the endeavor being that the individual experience a transcendental state of consciousness. Sherwood, Stolaroff and Harmon precisely describe this process:
The concept underlying this approach is that an individual can have a single experience which is so profound and impressive that his life experiences in the months and years that follow become a continuing growth process...
There appears to emerge a universal central perception, apparently independent of subjects' previous philosophical or theological inclinations, which plays a dominant role in the healing process. This central perception, apparently of all who penetrate deeply in their explorations, is that behind the apparent multiplicity of things in the world of science and common sense there is a single reality, in speaking of which it seems appropriate to use such words as infinite and eternal. All beings are seen to be united in this Being...
Much of the "psychotherapeutic" changes are seen to occur as a process of the following kind of experience:
The individual's conviction that he is, in essence, an imperishable self rather than a destructible ego, brings about the most profound reorientation at the deeper levels of personality. He perceives illimitable worth in this essential self, and it becomes easier to accept the previously known self as an imperfect reflection of this. The many conflicts which are rooted in lack of self-acceptance are cut off at the source, and the associated neurotic behavior patterns die away. (p. 77)
The session begins
Since he was so resistant to change, I felt he needed full dosage: 600 micrograms of LSD.5 I suggested he lie down, relax, close his eyes and go with the music. He declined this offer saying that he preferred to sit up but after a few moments, observing that the sitters were going to close their eyes and listen to the music and not engage him in small talk, out of boredom he picked up one of the art books and began casually leafing through it. I had told him the session would last many hours, at least eight and possibly up to twelve, so he knew he had a lot of time to kill.
After about thirty minutes he began to look stressed. He was obviously feeling the effects of the drug and I asked him what he was beginning to experience, explaining that it would be helpful to communicate the changes he was experiencing so that I could give him some hints about how to use these changes. He pulled himself together and quickly said "Nothing's happening." And that was that. So it went. He squirmed, trembled, sweated profusely, his eyes bugged out, he turned blotchy red, hyperventilated and looked like he was going to explode. To any of my gentle queries he responded with a firm "Nothing's happening." Finally he said, "Since nothing's happening I think I will just lie down for a while and listen to the music." The other two sitters and I simultaneously chorused, "Good idea." He lay on the couch; clenching his jaw and his fists, he would shake, perspire, groan, moan, make feeble guttural noises and then jolt back into the present time, look over at me and in a weak, feeble voice, say "Nothing's happening." This was turning out to be one of the most heart wrenching LSD sessions I had ever sat through. We knew there was nothing we could do but wait for him. We waited ten hours and his position never shifted. For the complete time, he never appeared to have any respite from this intense agony. He was totally exhausted and looked absolutely devastated. After ten hours, all he could muster was, "I guess this drug doesn't work with some people" and all I could manage was, "Well, we don't know a lot about this treatment yet. We all have a lot to learn." Both sitters and I agreed we had seldom experienced such an exhausting session. He stayed in the hospital overnight with his private attendant.
I met with him the next morning and he appeared overwhelmed with fatigue, still maintaining that he had no reaction whatsoever to the drug. During this follow- up meeting, I casually mentioned that because of all the different medications he had taken over the years, perhaps he had become drug tolerant and needed a second session with a much higher dosage. At this news he went stark white and was totally speechless. I then said that this one treatment was a special circumstance set up just for him and that we were not able to do further work with him in this hospital. That information got him breathing again and he looked as though he had just received reprieve from a death sentence. I mentioned that a colleague of mine had a private hospital in Holland where he used LSD and other psychedelic compounds in a series of treatments over a number of months. I suggested that he consider this if I was able to make such arrangements with this psychiatrist. Visibly shaken by this proposal he finally muttered that his father would probably not consider financially supporting such a costly undertaking, especially since he had absolutely no response to his first treatment. I left it at that, indicating I would contact my Dutch friend [Dr. G.W. Arendsen-Hein] to see if he could accommodate him if his father was amenable to the expense. My Dutch colleague agreed to treat this man at his residential hospital near Ederveen, Holland with the stipulation that I accompany him and participate in the first three sessions. I agreed and next contacted David's father who agreed to finance the venture.Note 1
I called David and told him that I had been successful in arranging this treatment program for him. He said he could not fly alone, that I would have to accompany him. I explained that had already been arranged and I would stay in Holland for his first three sessions. After a very long silence David agreed but said he could not go until he had attended to a number of personal matters. I asked him to let me know when he thought he would be ready to leave. That telephone conversation was the last contact I ever had with him.
In about three days I called his house and his mother answered. David was out and she was most anxious to talk to me. She said he had gone out by himself the day after my conversation with him - this was the first time he had gone out in several years. He had told her that when I called to tell me that he would call me when he was prepared to set a date to leave, as he was busy attending to personal matters. He did not inform her as to the nature of these personal matters but she was so ecstatic that he was going out of the house that she didn't want to "push it." I called in about a week, also not wanting to push it. She answered again and reported that he was gone a good part of every day but when he was home he told her that if I called to tell me that he was resting but that he would call me back. He was always either out or resting when I called.
David moves out
After a couple of months of this he moved out of his parents' home to his own apartment and started to do volunteer work in a library. His mother contacted me, updating me on his new life and his father called me on two occasions, saying that one LSD treatment had produced more results than the previous fifteen years of psychotherapy. To his parents, LSD was a miracle drug. After about a year I stopped contact with David's mother. At that time he had a part-time job, still did volunteer work at the library and she was sure that he had a girlfriend but he wasn't very communicative about his activities. He made contact with them on his terms and limited to the times he set. They didn't push him. My understanding of some of this was pretty simple. He couldn't tolerate another LSD session; whatever he went through he knew he couldn't do that again. He also couldn't lose face and he was fortunate in having parents who were so grateful for the changes that had occurred that they didn't require explanations from him about what had happened.
Since David chose not to divulge his experiences, one can only hypothesize what occurred. Clearly he had been in great turmoil and severe anguish throughout his session. Observationally he had what is popularly referred to as "a bad trip." A bad trip is when an individual uses all his energies into combating the pending loss of ego control. The ego, in fighting to stay identified with what is "known," creates a living hell - everything turns to negations, everything is experienced as threatening and dangerous. All of the rejecte! d aspects of the self are projected onto the external world and one experiences "reality" as demonic - such is the stuff of psychosis.Note 2 David undoubtedly had endless duels with his devils. The central and challenging question remains: "Why did David decide to change his life, to give up his "uniqueness" in the world and join the human condition with the rest of us?" His circumstances allowed him to remain at home living his life as he had lived it - being uniquely "untreatable" and that LSD therapy would be just another unsuccessful attempt to change him.
I posit that he saw what a horrific price he was paying to maintain this ego position; he saw his "victory" as empty; that his special place in the world was a meaningless one. That he took on the task of going out into the world he had left as an early teenager is quite astounding; that he did it on his own, even more astounding. It was a testament to the strength of his ego. Part of his unwillingness to share with me the results of his treatment session could have been that he identified me as a father. I was a powerful person who had powerful "medicine" and powerful connections. He wasn't quite ready to embrace as an ally this kind of potency - he was more willing to take on the world at his pace and on his own terms. I suspect that he knew that I knew something about this world of altered consciousness, that I was dedicated to help him explore it, and this was a mystery to him but he was not ready to take on this task. He decided he would rather become an "ordinary" person.
From the first day I met David I never treated him as a "patient," I never engaged him at the level that he had always functioned - therapist and patient. I treated him as though he were a perfectly rational and sane person. I never talked "therapy talk" with him, never interpreted any of his behavior, never psychoanalyzed him. I was always respectful of him, never played the role of the doctor, and although I listened to whatever he said I never responded or engaged in any conversation related to his psychopathology. I was very quiet with him and any comments I did make were extremely benign.
Although almost nothing is known of this man's experiences with the non-ordinary realities induced by the drug, what we do know is that profound changes occurred in his behavior following these experiences; be became a functional human being after fifteen years of extreme dysfunctional behavior - this was a remarkable phenomenon.
The purpose in reporting this case study has been to give testimony to the fact that psychedelics are powerful tools for an individual to use in accessing those forces in his psyche which determine the course of his life. In the revelations that occur in these states of expanded consciousness, one has the opportunity to explore and understand what is needed to be known in order to acknowledge the essential worth of the self and to discover the humanistic-spiritual existential "laws."
These processes are the same for everyone, regardless of one's status in life's many hierarchies. One's station or condition in life is not at issue - only at issue is the proper use of these materials administered in a safe and protected environment by sitters who have travelled the path of self-discovery themselves and know that each person can, with the help of enlightened guidance, achieve profound depth of understanding.
Note 1 An interesting aside that baffled both David and his father was that I never charged for any of my services. I felt that this fact was an additional phenomenon that helped penetrate David's view of the psychiatric world wherein therapists' only interest in him was for his monetary value. He never raised the issue, nor did I.
Note 2 Common experience among seasoned psychedelic voyagers in that the nitty-gritty psychodynamic work is accomplished during so-called "bad trips": that is, where the condition of one's humanity is illuminated. Having pleasant aesthetic and sensory experiences is important for people who never experience such phenomena, but for the usual person, a pleasant ego time doesn't touch the hidden internal conflicts which cause the difficulties in life.
1 Fisher, G. Psychotherapy for the dying: principles and illustrations with special reference to the utilization of LSD. Omega, 1970, 1, 3-16
2 MacLean, J.R., MacDonald, P.C., Byrne, V.P. and Hubbard, A.M. The use of LSD-25 in the Treatment of Alcoholism and other Psychiatric Problems. Quart. J. of Studies of Alcoholism, 1961, 22, 34-45.
3 Blewett, D.B. and Chwelos, N. Handbook for the Therapeutic Use of LSD-25: Individual and Group Procedures. Unpublished Manuscript; Regina, Saskatchewan, 1959.
4 Sherwood, J.N., Stolaroff, M.J. and Harmon, W.W. The Psychedelic Experience - A New Concept in Psychotherapy. Journal of Neuropsychiatry, 1962, 4, 69-80.
5 Fisher, G. Some comments concerning dosage levels of psychedelic compounds for psychotherapeutic experiences. The Psychedelic Review, 1963, 1, 208-218.