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LSD — My Problem Child
Albert Hofmann
4. Use of LSD in Psychiatry
Soon after LSD was tried on animals, the first systematic investigation
of the substance was carried out on human beings, at the psychiatric
clinic of the University of Zurich. Werner A. Stoll, M.D. (a son
of Professor Arthur Stoll), who led this research, published his
results in 1947 in the Schweizer Archiv fur Neurologie und
Psychiatrie, under the title "Lysergsäure-diathylämid,
ein Phantastikum aus der Mutterkorngruppe" [Lysergic acid
diethylamide, a phantasticum from the ergot group].
The tests involved healthy research subjects as well as schizophrenic
patients. The dosages—substantially lower than in my first self-experiment
with 0.25 mg LSD tartrate—amounted to only 0.02 to 0.13 mg.
The emotional state during the LSD inebriation was here predominantly
euphoric, whereas in my experiment the mood was marked by grave
side effects resulting from overdosage and, of course, fear of
the uncertain outcome.
This fundamental publication, which gave a scientific description
of all the basic features of LSD inebriation, classified the new
active principle as a phantasticum. However, the question of therapeutic
application of LSD remained unanswered. On the other hand,
the report emphasized the extraordinarily high activity of LSD,
which corresponds to the activity of trace substances occurring
in the organism that are considered to be responsible for certain
mental disorders. Another subject discussed in this first publication
was the possible application of LSD as a research tool in psychiatry,
which follows from its tremendous psychic activity.
First Self-Experiment by a Psychiatrist
In his paper, W. A. Stoll also gave a detailed description of
his own personal experiment with LSD. Since this was the first
self-experiment published by a psychiatrist, and since it describes
many characteristic features of LSD inebriation, it is interesting
to quote extensively from the report. I warmly thank the author
for kind permission to republish this extract.
At 8 o'clock I took 60 mcg (0.06 milligrams) of LSD. Some 20
minutes later, the first symptoms appeared: heaviness in the limbs,
slight atactic (i.e., confused, uncoordinated) symptoms. A subjectively
very unpleasant phase of general malaise followed, in parallel
with the drop in blood pressure registered by the examiners.
A certain euphoria then set in, though it seemed weaker to me
than experiences in an earlier experiment. The ataxia increased,
and I went "sailing" around the room with large strides.
I felt somewhat better, but was glad to lie down.
Afterward the room was darkened (dark experiment); there followed
an unprecedented experience of unimaginable intensity that kept
increasing in strength. It w as characterized by an unbelievable
profusion of optical hallucinations that appeared and vanished
with great speed, to make way for countless new images. I saw
a profusion of circles, vortices, sparks, showers, crosses, and
spirals in constant, racing flux.
The images appeared to stream in on me predominantly from the
center of the visual field, or out of the lower left edge. When
a picture appeared in the middle, the remaining field of vision
was simultaneously filled up with a vast number of similar visions.
All were colored: bright, luminous red, yellow, and green predominated.
I never managed to linger on any picture. When the supervisor
of the experiment emphasized my great fantasies, the richness
of my statements, I could only react with a sympathetic smile.
I knew, in fact, that I could not retain, much less describe,
more than a fraction of the pictures. I had to force myself to
give a description. Terms such as "fireworks" or "kaleidoscopic"
were poor and inadequate. I felt that I had to immerse myself
more and more deeply into this strange and fascinating world,
in order to allow the exuberance, the unimaginable wealth, to
work on me.
At first, the hallucinations were elementary: rays, bundles of
rays, rain, rings, vortices, loops, sprays, clouds, etc. Then
more highly organized visions also appeared: arches, rows of arches,
a sea of roofs, desert landscapes, terraces, flickering fire,
starry skies of unbelievable splendor. The original, more simple
images continued in the midst of these more highly organized hallucinations.
I remember the following images in particular:
A succession of towering, Gothic vaults, an endless choir, of
which I could not see the lower portions.
A landscape of skyscrapers, reminiscent of pictures of the entrance
to New York harbor: house towers staggered behind and beside one
another with innumerable rows of windows. Again the foundation
was missing.
A system of masts and ropes, which reminded me of a reproduction
of a painting seen the previous day (the inside of a circus tent).
An evening sky of an unimaginable pale blue over the dark roofs
of a Spanish city. I had a peculiar feeling of anticipation, was
full of joy and decidedly ready for adventure. All at once the
stars flared up, amassed, and turned to a dense rain of stars
and sparks that streamed toward me. City and sky had disappeared.
I was in a garden, saw brilliant red, yellow, and green lights
falling through a dark trelliswork, an indescribably joyous experience.
It was significant that all the images consisted of countless
repetitions of the same elements: many sparks, many circles, many
arches, many windows, many fires, etc. I never saw isolated images,
but always duplications of the same image, endlessly repeated.
I felt myself one with all romanticists and dreamers, thought
of E. T. A. Hoffmann, saw the maelstrom of Poe (even though, at
the time I had read Poe, his description seemed exaggerated).
Often I seemed to stand at the pinnacle of artistic experience;
I luxuriated in the colors of the altar of Isenheim, and knew
the euphoria and exultation of an artistic vision. I must also
have spoken again and again of modern art; I thought of abstract
pictures, which all at once I seemed to understand. Then again,
there were impressions of an extreme trashiness, both in their
shapes and their color combinations. The most garish, cheap modern
lamp ornaments and sofa pillows came into my mind. The train of
thought was quickened. But I had the feeling the supervisor of
the experiment could still keep up with me. Of course I knew,
intellectually, that I was rushing him. At first I had descriptions
rapidly at hand. With the increasingly frenzied pace, it became
impossible to think a thought through to the end. I must have
only started many sentences.
When I tried to restrict myself to specific subjects, the experiment
proved most unsuccessful. My mind would even focus, in a certain
sense, on contrary images: skyscrapers instead of a church, a
broad desert instead of a mountain.
I assumed that I had accurately estimated the elapsed time, but
did not take the matter very seriously. Such questions did not
interest me in the slightest.
My state of mind was consciously euphoric. I enjoyed the condition,
was serene, and took a most active interest in the experience.
From time to time I opened my eyes. The weak red light seemed
mysterious, much more than before. The busily writing research
supervisor appeared to me to be very far away. Often I had peculiar
bodily sensations: I believed my hands to be attached to some
distant body, but was not certain whether it was my own.
After termination of the first dark experiment, I strolled about
in the room a bit, was unsure on my legs, and again felt less
well. I became cold and was thankful that the research supervisor
covered me with a blanket. I felt unkempt, unshaven, and unwashed.
The room seemed strange and broad. Later I squatted on a high
stool, thinking all the while that I sat there like a bird on
the roost.
The supervisor emphasized my own wretched appearance. He seemed
remarkably graceful. I myself had small, finely formed hands.
As I washed them, it was happening a long way from me, somewhere
down below on the right. It was questionable, but utterly unimportant,
whether they were my own hands.
In the landscape outside, well known to me, many things appeared
to have changed. Besides the hallucinations, I could now see the
real as well. Later this was no longer possible, although I remained
aware that reality was otherwise.
A barracks, and the garage standing before it to the left, suddenly
changed to a landscape of ruins, shattered to pieces. I saw wall
wreckage and projecting beams, inspired undoubtedly by the memory
of the war events in this region.
In a uniform, extensive field, I kept seeing figures, which I
tried to draw, but could get no farther than the crudest beginnings.
I saw an extremely opulent sculptural ornamentation in constant
metamorphosis, in continuous flux. I was reminded of every possible
foreign culture, saw Mexican, Indian motifs. Between a grating
of small beams and tendrils appeared little caricatures, idols,
masks, strangely mixed all of a sudden with childish drawings
of people. The tempo was slackened compared to the dark experiment.
The euphoria had now vanished. I became depressed, especially
during the second dark experiment, which followed. Whereas during
the first dark experiment, the hallucinations had alternated with
great rapidity in bright and luminous colors, now blue, violet,
and dark green prevailed. The movement of larger images was slower
milder, quieter, although even these were composed of finely raining
"elemental dots," which streamed and whirled about quickly.
During the first dark experiment, the commotion had frequently
intruded upon me; now it often led distinctly away from me into
the center of the picture, where a sucking mouth appeared. I saw
grottoes with fantastic erosions and stalactites, reminding me
of the child's book Im Wunderreiche des Bergkonigs [In
the wondrous realm of the mountain king]. Serene systems of arches
rose up. On the right-hand side, a row of shed roofs suddenly
appeared; I thought of an evening ride homeward during military
service. Significantly it involved a homeward ride: there was
no longer anything like departure or love of adventure. I felt
protected, enveloped by motherliness, was in peace. The hallucinations
were no longer exciting, but instead mild and attenuated. Somewhat
later I had the feeling of possessing the same motherly strength.
I perceived an inclination, a desire to help, and behaved then
in an exaggeratedly sentimental and trashy manner, where medical
ethics are concerned. I realized this and was able to stop.
But the depressed state of mind remained. I tried again and again
to see bright and joyful images. But to no avail; only dark blue
and green patterns emerged. I longed to imagine bright fire as
in the first dark experiment. And I did see fires; however, they
were sacrificial fires on the gloomy battlement of a citadel on
a remote, autumnal heath. Once I managed to behold a bright ascending
multitude of sparks, but at half-altitude it transformed itself
into a group of silently moving spots from a peacock's tail. During
the experiment I was very impressed that my state of mind and
the type of hallucinations harmonized so consistently and uninterruptedly.
During the second dark experiment I observed that random noises,
and also noises intentionally produced by the supervisor of the
experiment, provoked simultaneous changes in the optical impressions
(synesthesia). In the same manner, pressure on the eyeball produced
alterations of visual perceptions.
Toward the end of the second dark experiment, I began to watch
for sexual fantasies, which were, however, totally absent. In
no way could I experience sexual desire. I wanted to imagine a
picture of a woman; only a crude modern-primitive sculpture appeared.
It seemed completely unerotic, and its forms were immediately
replaced by agitated circles and loops.
After the second dark experiment I felt benumbed and physically
unwell. I perspired, was exhausted. I was thankful not to have
to go to the cafeteria for lunch. The laboratory assistant who
brought us the food appeared to me small and distant, of the same
remarkable daintiness as the supervisor of the experiment.
Sometime around 3:00 P.M. I felt better, so that the supervisor
could pursue his work. With some effort I managed to take notes
myself. I sat at the table, wanted to read, but could not concentrate.
Once I seemed to myself like a shape from a surrealistic picture,
whose limbs were not connected with the body, but were rather
painted somewhere close by....
I was depressed and thought with interest of the possibility of
suicide. With some terror I apprehended that such thoughts were
remarkably familiar to me. It seemed singularly self-evident that
a depressed person commits suicide....
On the way home and in the evening I was again euphoric, brimming
with the experiences of the morning. I had experienced unexpected,
impressive things. It seemed to me that a great epoch of my life
had been crowded into a few hours. I was tempted to repeat the
experiment.
The next day I was careless in my thinking and conduct, had great
trouble concentrating, was apathetic. . . . The casual, slightly
dream-like condition persisted into the afternoon. I had great
trouble reporting in any organized way on a simple problem. I
felt a growing general weariness, an increasing awareness that
I had now returned to everyday reality.
The second day after the experiment brought an irresolute state....
Mild, but distinct depression was experienced during the following
week, a feeling which of course could be related only indirectly
to LSD.
The Psychic Effects of LSD
The picture of the activity of LSD obtained from these first investigations
was not new to science. It largely matched the commonly held view
of mescaline, an alkaloid that had been investigated as early
as the turn of the century. Mescaline is the psychoactive constituent
of a Mexican cactus Lophophora williamsii (syn. Anhalonium
lewinii). This cactus has been eaten by American Indians ever
since pre-Columbian times, and is still used today as a sacred
drug in religious ceremonies. In his monograph Phantastica
(Verlag Georg Stilke, Berlin, 1924), L. Lewin has amply described
the history of this drug, called peyotl by the Aztecs. The alkaloid
mescaline was isolated from the cactus by A. Heffter in 1896,
and in 1919 its chemical structure was elucidated and it was produced
synthetically by E. Spath. It was the first hallucinogen or phantasticum
(as this type of active compound was described by Lewin) to become
available as a pure substance, permitting the study of chemically
induced changes of sensory perceptions, mental illusions (hallucinations),
and alterations of consciousness. In the 1920s extended experiments
with mescaline were carried out on animal and human subjects and
described comprehensively by K. Beringer in his book Der Meskalinrausch
(Verlag Julius Springer, Berlin, 1927). Because these investigations
failed to indicate any applications of mescaline in medicine,
interest in this active substance waned.
With the discovery of LSD, hallucinogen research received a new
impetus. The novelty of LSD as opposed to mescaline was its high
activity, lying in a different order of magnitude. The active
dose of mescaline, 0.2 to 0.5 g, is comparable to 0.00002 to 0.0001
g of LSD; in other words, LSD is some 5,000 to 10,000 times more
active than mescaline.
LSD's unique position among the psychopharmaceuticals is not only
due to its high activity, in a quantitative sense. The substance
also has qualitative significance: it manifests a high specificity,
that is, an activity aimed specifically at the human psyche. It
can be assumed, therefore, that LSD affects the highest control
centers of the psychic and intellectual functions.
The psychic effects of LSD, which are produced by such minimal
quantities of material, are too meaningful and too multiform to
be explained by toxic alterations of brain function. If LSD acted
only through a toxic effect on the brain, then LSD experiences
would be entirely psychopathological in meaning, without any psychological
or psychiatric interest. On the contrary, it is likely that alterations
of nerve conductivity and influence on the activity of nerve connections
(synapses), which have been experimentally demonstrated, play
an important role. This could mean that an influence is being
exerted on the extremely complex system of cross-connections and
synapses between the many billions of brain cells, the system
on which the higher psychic and intellectual functions depend.
This would be a promising area to explore in the search for an
explanation of LSD's radical efficacy.
The nature of LSD's activity could lead to numerous possibilities
of medicinal-psychiatric uses, as W. A. Stoll's ground-breaking
studies had already shown. Sandoz therefore made the new active
substance available to research institutes and physicians as an
experimental drug, giving it the trade name Delysid (D-Lysergsäure-diäthylamid)
which I had proposed. The printed prospectus below describes possible
applications of this kind and voices the necessary precautions.
Delysid (LSD 25)
D-lysergic acid diethylamide tartrate
Sugar-coated tablets containing 0.025 mg. (25 µg)
Ampoules of 1 ml. containing 0.1 mg. (100 µg) for
oral administration
The solution may also be injected s.c. or i.v. The
effect is identical with that of oral administration
but sets in more rapidly.
PROPERTIES
The administration of very small doses of Delysid (1/2-2 µg/kg
body weight) results in transitory disturbances of affect, hallucinations,
depersonalization, reliving of repressed memories, and mild neurovegetative
symptoms. The effect sets in after 30 to 90 minutes and generally
lasts 5 to 12 hours. However, intermittent disturbances of affect
may occasionally persist for several days.
METHOD OF ADMINISTRATION
For oral administration the contents of 1 ampoule of Delysid
are diluted with distilled water, a 1% solution of tartaric acid
or halogen-free tap water.
The absorption of the solution is somewhat more rapid and
more constant than that of the tablets.
Ampoules which have not been opened, which have been protected
against light and stored in a cool place are stable for an unlimited
period. Ampoules which have been opened or diluted solutions retain
their effectiveness for 1 to 2 days, if stored in a refrigerator.
INDICATIONS AND DOSAGE
a) Analytical psychotherapy, to elicit release of repressed
material and provide mental relaxation, particularly in anxiety
states and obsessional neuroses.
The initial dose is 25 µg (1/4 of an ampoule or 1 tablet).
This dose is increased at each treatment by 25 µg until the
optimum dose (usually between 50 and 200 µg) is found. The
individual treatments are best given at intervals of one week.
b) Experimental studies on the nature of psychoses: By taking
Delysid himself, the psychiatrist is able to gain an insight into
the world of ideas and sensations of mental patients. Delysid
can also be used to induce model psychoses of short duration in
normal subjects, thus facilitating studies on the pathogenesis
of mental disease.
In normal subjects, doses of 25 to 75 µg re generally
sufficient to produce a hallucinatory psychosis (on an average
1 µg/kg body weight). In certain forms of psychosis and in
chronic alcoholism, higher doses are necessary (2 to 4 µg/kg
body weight).
PRECAUTIONS
Pathological mental conditions may be intensified by Delysid.
Particular caution is necessary in subjects with a suicidal tendency
and in those cases where a psychotic development appears imminent.
The psycho-affective liability and the tendency to commit impulsive
acts may occasionally last for some days.
Delysid should only be administered under strict medical supervision.
The supervision should not be discontinued until the effects of
the drug have completely orn off.
ANTIDOTE
The mental effects of Delysid can be rapidly reversed by the
i.m. administration of 50 mg chlorpromazine.
Literature available on request.
SANDOZ LTD., BASLE, SWITZERLAND
The use of LSD in analytical psychotherapy is based mainly on
the following psychic effects.
In LSD inebriation the accustomed world view undergoes a deep-seated
transformation and disintegration. Connected with this is a loosening
or even suspension of the I-you barrier. Patients who are bogged
down in an egocentric problem cycle can thereby be helped to release
themselves from their fixation and isolation. The result can be
an improved rapport with the doctor and a greater susceptibility
to psychotherapeutic influence. The enhanced suggestibility under
the influence of LSD works toward the same goal.
Another significant, psychotherapeutically valuable characteristic
of LSD inebriation is the tendency of long forgotten or suppressed
contents of experience to appear again in consciousness. Traumatic
events, which are sought in psychoanalysis, may then become accessible
to psychotherapeutic treatment. Numerous case histories tell of
experiences from even the earliest childhood that were vividly
recalled during psychoanalysis under the influence of LSD. This
does not involve an ordinary recollection, but rather a true reliving;
not a réminiscence, but rather a réviviscence,
as the French psychiatrist Jean Delay has formulated it.
LSD does not act as a true medicament; rather it plays the role
of a drug aid in the context of psychoanalytic and psychotherapeutic
treatment and serves to channel the treatment more effectively
and to shorten its duration. It can fulfill this function in two
particular ways.
In one procedure, which was developed in European clinics and
given the name psychotytic therapy, moderately strong doses
of LSD are administered in several successive sessions at regular
intervals. Subsequently the LSD experiences are worked out in
group discussions, and in expression therapy by drawing and painting.
The term psycholytic therapy was coined by Ronald A. Sandison,
an English therapist of Jungian orientation and a pioneerof clinical
LSD research. The root -lysis or -lytic signifies
the dissolution of tension or conflicts in the human psyche.
In a second procedure, which is the favored treatment in the United
States, a single, very high LSD dose (0.3 to 0.6 mg) is administered
after correspondingly intensive psychological preparation of the
patients. This method, described as psychedelic therapy,
attempts to induce a mystical-religious experience through the
shock effects of LSD. This experience can then serve as a starting
point for a restructuring and curing of the patient's personality
in the accompanying psychotherapeutic treatment. The term psychedelic,
which can be translated as "mind-manifesting" or "mind-expanding,"
was introduced by Humphry Osmond, a pioneer of LSD research in
the United States.
LSD's apparent benefits as a drug auxiliary in psychoanalysis
and psychotherapy are derived from properties diametrically opposed
to the effects of tranquilizer-type psychopharmaceuticals. Whereas
tranquilizers tend to cover up the patient's problems and conflicts,
reducing their apparent gravity and importance: LSD, on the contrary,
makes them more exposed and more intensely experienced. This clearer
recognition of problems and conflicts makes them, in turn, more
susceptible to psychotherapeutic treatment.
The suitability and success of LSD in psychoanalysis and psychotherapy
are still a subject of controversy in professional circles. The
same could be said, however, of other procedures employed in psychiatry
such as electroshock, insulin therapy, or psychosurgery, procedures
that entail, moreover, a far greater risk than the use of LSD,
which under suitable conditions can be considered practically
safe.
Because forgotten or repressed experiences, under the influence
of LSD, may become conscious with considerable speed, the treatment
can be correspondingly shortened. To some psychiatrists, however,
this reduction of the therapy's duration is a disadvantage. They
are of the opinion that this precipitation leaves the patient
insufficient time for psychotherapeutic working-through. The therapeutic
effect they believe, persists for a shorter time than when there
is a gradual treatment, including a slow process of becoming conscious
of the traumatic experiences.
Psycholytic and especially psychedelic therapy require thorough
preparation of the patient for the LSD experience, to avoid his
or her being frightened by the unusual and the unfamiliar. Only
then is a positive interpretation of the experience possible.
The selection of patients is also important, since not all types
of psychic disturbance respond equally well to these methods of
treatment. Successful use of LSD-assisted psychoanalysis and psychotherapy
presupposes specific knowledge and experience.
In this respect self-examination by psychiatrists, as W. A. Stoll
has pointed out, can be most useful. They provide the doctors
with direct insight, based on firsthand experience into the strange
world of LSD inebriation, and make it possible for them truly
to understand these phenomena in their patients, to interpret
them properly, and to take full advantage of them.
The following pioneers in use of LSD as a drug aid in psychoanalysis
and psychotherapy deserve to be named in the front rank: A. K.
Busch and W. C. Johnson, S. Cohen and B. Eisner, H. A. Abramson,
H. Osmond, and A. Hoffer in the United States; R. A. Sandison
in England; W. Frederking and H. Leuner in Germany; and G. Roubicek
and S. Grof in Czechoslovakia.
The second indication for LSD cited in the Sandoz prospectus on
Delysid concerns its use in experimental investigations on the
nature of psychoses. This arises from the fact that extraordinary
psychic states experimentally produced by LSD in healthy research
subjects are similar to many manifestations of certain mental
disturbances. In the early days of LSD research, it was often
claimed that LSD inebriation has something to do with a type of
"model psychosis." This idea was dismissed, however,
because extended comparative investigations showed that there
were essential differences between the manifestations of psychosis
and the LSD experience. With the LSD model, nevertheless, it is
possible to study deviations from the normal psychic and mental
condition, and to observe the biochemical and electrophysiological
alterations associated with them. Perhaps we shall thereby gain
new insights into the nature of psychoses. According to certain
theories, various mental disturbances could be produced by psychotoxic
metabolic products that have the power, even in minimal quantities,
to alter the functions of brain cells. LSD represents a substance
that certainly does not occur in the human organism, but whose
existence and activity let it seem possible that abnormal metabolic
products could exist, that even in trace quantities could produce
mental disturbances. As a result, the conception of a biochemical
origin of certain mental disturbances has received broader support,
and research in this direction has been stimulated.
One medicinal use of LSD that touches on fundamental ethical questions
is its administration to the dying. This practice arose from observations
in American clinics that especially severe painful conditions
of cancer patients, which no longer respond to conventional pain-relieving
medication, could be alleviated or completely abolished by LSD.
Of course, this does not involve an analgesic effect in the true
sense. The diminution of pain sensitivity may rather occur because
patients under the influence of LSD are psychologically so dissociated
from their bodies that physical pain no longer penetrates their
consciousness. In order for LSD to be effective in such cases,
it is especially crucial that patients be prepared and instructed
about the kind of experiences and transformations that await them.
In many cases it has proved beneficial for either a member of
the clergy or a psychotherapist to guide the patient's thoughts
in a religious direction. Numerous case histories tell of patients
who gained meaningful insights about life and death on their deathbeds
as, freed from pain in LSD ecstasy and reconciled to their fate,
they faced their earthly demise fearlessly and in peace.
The hitherto existing knowledge about the administration of LSD
to the terminally ill has been summarized and published by S.
Grof and J. Halifax in their book The Human Encounter with Death
(E. P. Dutton, New York, 1977). The authors, together with E.
Kast, S. Cohen, and W. A. Pahnke, are among the pioneers of this
application of LSD.
The most recent comprehensive publication on the use of LSD in
psychiatry, Realms of the Human Unconscious: Observations from
LSD Research (The Viking Press, New York, 1975), likewise comes
from S. Grof, the Czech psychiatrist who has emigrated to the
United States. This book offers a critical evaluation of the LSD
experience from the viewpoint of Freud and Jung, as well as of
existential analysis.
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