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
Early Laboratory and Clinical LSD Research
Therapeutic Experimentation With LSD
Studies of Chemotherapeutic Properties of LSD
The Need for a Comprehensive Theory of LSD Therapy
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, 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 areeliciting 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. 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.
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 whichmay 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. 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. 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.
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.
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.
* 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 HumanUnconscious: 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)