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Psychiatric Research with Hallucinogens:
What have we learned?
Charles S. Grob, M.D.
Yearbook for Ethnomedicine and the Study of Consciousness, Issue 3, 1994
©VWB - Verlag für Wissenschaft und Bildung, 1995
Abstract
After a twenty-five year period of virtual prohibition, formal
psychiatric research with hallucinogenic drugs has resumed. This
article reviews the process by which hallucinogens came to be
viewed as beyond the pale of respected and sanctioned clinical
investigation, and directs attention to the importance of fully
understanding the lessons of the past so as to avoid a similar
fate for recently approved research endeavors. The shamanistic
use of hallucinogenic plants as agents designed to facilitate
healing, acquire knowledge and enhance societal cohesion were
brutally repressed in both the Old and New Worlds by the progenitors
of our own contemporary Euro-American culture, often with complicity
of the medical professions. Knowledge of the properties and potentials
of these consciousness altering plants was forgotten or driven
deeply underground for centuries. It was not until the late 1800s
that German pharmaceutical researchers investigating the properties
of peyote re-discovered the profound and highly unusual effects
of these substances. A dispute anticipating the virulent controversies
of the 1960s ensued, however, pitting proponents of this new model
of consciousness exploration against those who questioned the
propriety of their colleagues enthusiasm for self experimentation
and penchant for sweeping proclamations. The history of hallucinogen
research in the 20th century has revolved around this regrettable
polarization, and as such has impeded the evolution of the field.
Developments in the second half of the 20th century were catalyzed
by the remarkable discoveries of the Swiss research chemist, ALBERT
HOFMANN. In the wake of his synthesis of the extraordinarily potent
psychoactive substance, Iysergic acid diethylamide, a period of
active investigation ensued. Notable gains were accomplished utilizing
the psychotomimetic model for understanding mental illness and
the low dose psycholytic approach for the treatment of a variety
of psychiatric conditions. However, it soon became apparent that
these models possessed inherent limitations when applied to the
orthodox psychiatric constructs then in vogue. The implementation
of the high dose psychedelic model, in spite of its apparent utility
in treating resistant conditions such as refractory alcoholism,
presented even greater difficulties in conforming to the boundaries
of conventional theory and practice. Acceptance of hallucinogens
as reputable tools for investigation and agents for treatment
were dealt a further and near fatal blow when they became embroiled
in the cultural wars of the 1960s. Together with revelations of
unethical activities of psychiatric researchers under contract
to military intelligence and the CIA, the highly publicized and
controversial behaviors of hallucinogen enthusiasts led to the
repression of efforts to formally investigate these substances.
For the next twenty-five years research with hallucinogens assumed
pariah status within academic psychiatry, virtually putting an
end to formal dialogue and debate.
We now have before us the opportunity to resurrect the long dormant
field of hallucinogen research. However, if we are to avoid replicating
the debacle of the past it is imperative that we learn from the
lessons of prior generations of researchers who saw their hopes
and accomplishments dissipate under the pressures of cultural
apprehension and the threat of professional ostracism. It is essential
that we avoid repeating the mistakes of the past. We are now beginning
to take definitive steps to end the protracted period of silence
and inactivity, but we must be ever mindful to do so tactfully
and with respect for the anxieties that will inevitably be provoked
in our colleagues. We must strive to facilitate dialogue and even
active collaboration with those who in the past may have been
loathe to even acknowledge that this might be a field worthy of
study. We must also adhere to current and accepted models of research
design, for to disregard the state of contemporary scientific
investigation would ultimately undermine our goals of fully exploring
the rich potentials of these substances. It will also be critical
to learn from the wisdom accrued over the ages by the aboriginal
practitioners of shamanic healing, for therein lies the benefits
of thousands of years of experience with hallucinogenic plants.
For more than two decades now the topic of hallucinogens as tools
of clinical investigation and models for healing within has been
relegated to the dustbin of history.
Psychiatric research with hallucinogens has resumed. After two
decades of virtual prohibition, formal authorization from federal
regulatory agencies to conduct investigative studies in the United
States with these unique mind altering substances has been successfully
obtained (STRASSMAN, 1991). The bitter and acrimonious debate
that raged through the 1960s and 1970s and into the 1980s has
subsided. Scientific and health policy makers have determined
that these drugs, although possessing an inherent abuse potential,
do have a safety profile of acceptable magnitude when compared
to drugs currently the subject of formal research investigation
as well as others actively dispensed in clinical practice. The
U.S. Food and Drug Administration has therefore determined that
formal and well controlled investigations designed to assess the
risk-benefit ratio of particular hallucinogenic substances may
now be pursued. However, for such studies to proceed successfully
and for the much heralded (and often vilified) potential of the
hallucinogens to be explored, it is imperative that we fully grasp
the lessons of the past. For, to paraphrase Santayana, if we fail
to understand our history, we will be condemned to repeat the
patterns and reactions which will inevitably lead to yet another
round of repudiation and rejection of this unique class of psychochemically
active substances, along with its inherent and inestimable potential
for learning and healing.
Shamanistic Roots:
Hallucinogens, throughout the breadth of time, have played a vital
albeit hidden and mysterious role. They have often, in aboriginal
and shamanic contexts, been at the absolute center of culture
and world view (DOBKIN DE RIOS, 1984). Opening up the doors to
the spiritual planes, and accessing vital information imperative
to tribal cohesion and survival, hallucinogenic plants became
what some scholars have considered to be the bedrock of human
civilization (WASSON, 1968; WASSON et al, 1978; HUXLEY, 1978).
Within the context of shamanic society, these awe inspiring botanicals
were utilized to facilitate healing, divine the future, protect
the community from danger and enhance learning (e.g. teaching hunters
the ways of animals) (CORDOVA-RIOS, 1971). However, with the advent
of stratified and hierarchical societies, such plant potentiators
came to be viewed as dangerous to the commonweal and controls
were placed on direct and revelatory access to the sacred (DOBKIN
DE RIOS and SMITH, 1976). In some societies (e.g. Aztec civilization)
use of psychotropic plants was restricted to the select castes
of the religious priesthood. In others, including the progenitors
of our own contemporary Euro-American culture, absolute proscriptions
on the use of plant drugs for divine purposes were decreed.
Repression of Shamanistic Traditions:
To fully understand the enormous resistances to these drugs and
the unique experiences they induce, it would be revealing to examine
some elements of our historical legacy. A poorly appreciated period
from Fourteenth through Seventeenth Century European History has
been the persecution of indigenous healers, predominantly woman,
during the reign of the Inquisition, particularly in Northern
and Western Europe. During a span of three hundred years several
million women were accused of practicing witchcraft and condemned
to die. The Medieval scholar Jules Michelet has explored the complicity
between ecclesiastical and medical authorities in the subjugation
of non-sanctioned healing, commenting on the attitude of the Church
"that if a woman dare cure without having studied, she is
a witch and must die" (MICHELET, 1965). To have "studied"
in this context is to have faithfully adhered to the precepts
and moral authority of the Church, and to have forsworn receiving
knowledge from Nature.
A rich heritage of plant lore and applied healing had been passed
down from pagan and pre-Christian Europe, rivaling and often surpassing
the demonstrated efficacy of Church sanctioned medical practitioners.
Hallucinogenic plants with magical as well as healing properties
were essential elements of this indigenous pharmacopoeia. Members
of the Solanaceae family with their alkaloids atropine and scopolamine,
including a great number of species of the genus Datura, as well
as mandrake, henbane and belladonna, had wide application as agents
of healing and transcendence (HARNER, 1973). In taking action
against the indigenous use of psychotropic plants, the Church
sought to eliminate a perceived threat to its oligarchic powers
and reassert its monopoly on legitimate access to the supernatural
(O'NEIL, 1987). By casting the healer as a witch and the hallucinogenic
plants as tools of Satan, the Church succeeded not only in eliminating
competition to the elite physician class but also in virtually
eradicating knowledge of these vestiges of pagan and shamanic
consciousness.
A second historical period whose examination may be pertinent
to understanding our ingrained cultural resistances and aversion
to hallucinogens is the European conquest of the New World. Shortly
after arrival in Central and South America in the late Fifteenth
and early Sixteenth Centuries, the invading Spanish Conquistadors
observed an impressive array of psychoactive pharmacopoeia, including
morning glory seeds (containing the potent hallucinogen, Iysergic
acid), peyote and psilocybin mushrooms.
These extraordinary plants were utilized by the native inhabitants
to induce an ecstatic intoxication and were an integral component
of their aboriginal religion and ritual. As plant hallucinogens
were attributed to have supernatural powers, they were quickly
perceived by the European invaders as weapons of the Devil designed
to prevent the triumph of Christianity over traditional Indian
religion (FURST, 1976). An early Seventeenth Century Spanish observer
of native customs, Hernando Ruiz de Alarcon, wrote of the idolatries
he observed involving the consumption of the morning glory:
"Ololiuhqui is a kind of seed-like lentils produced by a type
of vine in this land, which when drunk deprive of the senses,
because it is very powerful, and by this means they communicate
with the devil, because he talks to them when they are deprived
of judgment with the said drink, and deceive them with different
hallucinations, and they attribute it to a god they say is inside
the seed" (GUERRA, 1971).
Identifying the threat not only to consolidating their power and
control over the conquered peoples, but also the danger of lower
caste immigrant Spaniards developing interest in native rituals
and healing practices, The Holy Inquisition of Mexico issued in
1616 a proclamation ordering the persecution and excommunication
of those who, under the influence of
"herbs and roots with which they lose and confound their
senses, and the illusions and fantastic representations they have,
judge and proclaim afterwards as revelation, or true notice of
things to come..." (GUERRA, 1967).
To continue to engage in native practices and utilize their traditional
plant hallucinogens as agents of knowledge and healing would risk
indictment of heresy and witchcraft, and inevitably the implementation
of the cruelest punishments of the Inquisition, from public flogging
to being burned alive at the stake. Unable to accept the indigenous
utilization of such psychoactive substances as anything other
than idolatry and a threat to their goals of domination and exploitation,
the European conquerors denied them legitimacy, endeavoring to
expunge their traditions and knowledge. Only by going deeply underground
and maintaining their world view and shamanic practices in secret
from the dominant Euro-American culture, has this knowledge survived.
Early Research with Hallucinogens:
Interest in plant hallucinogens lay dormant until the second half
of the Nineteenth Century when growing activities in the new fields
of experimental physiology and pharmacology sparked efforts at
laboratory analyses of medicinal plants. In the late 1880's German
toxicologist LOUIS LEWIN, often called the "father of modern
psychopharmacology", received a collection of peyote samples
from the Parke-Davis Pharmaceutical Company. Succeeding at isolating
several alkaloids from the peyote, LEWIN was unable to determine
the psychoactive component through animal testing. Hesitating
at experimenting on himself, LEWIN enlisted the aid of a more
intrepid colleague, ARTHUR HEFFTER, who ingested each of the alkaloids
until he identified the crucial one, which he named mescal (LEWIN,
1888).
Along with LEWIN'S published work, interest in plant hallucinogens
was encouraged by increasing dissemination of knowledge of the
Native American Indian use of peyote, a phenomena of increasing
prevalence as the century drew to a close. Obtaining a sample
of peyote from the South-Western plains, physician and founder
of the American Neurological Association WEIR MITCHELL, conducted
an experiment using himself as the subject. Although overwhelmed
with the aesthetic power of the experience, describing that the
peyote revealed "a certain sense of the things about me as
having a more positive existence than usual, MITCHELL expressed
alarm that such a profound experience might not be successfully
integrated within his contemporary context:
"I predict a perilous reign of the mescal habit... The temptation
to call again the enchanting magic of my experience will, I am
sure, be too much for some men to resist after they have once
set foot in this land of fairy colors where there seems so much
to charm and so little to excite horror or disgust" (MITCHELL,
1896).
Inspired by reports of MITCHELL'S self-experimentation, the prominent
English physician HAVELOCK ELLIS decided to pursue a similar encounter
with the plant hallucinogen, which he later reported as an experience
of unparalleled magnitude, asserting that to
"once or twice be admitted to the rites of mescal is not
only an unforgettable delight but an educational influence of
no mean value" (ELLIS, 1897).
Such unqualified praise of a drug with as yet no proven medical
application, however, provoked harsh censure from the editors
of the British Medical Journal who expressed grave concern
of peyote's injurious potential and reprimanded ELLIS for irresponsibly
"putting the temptation before the section of the public
which is always in search of new sensation (BRITISH MEDICAL JOURNAL,
1898). Such a vituperative response to ELLIS' naive efforts at
publicizing and perhaps promoting auto-experimentation with magical
plants is an early harbinger of the conflict which mired and paralyzed
the field of hallucinogenic research some seventy years later.
Interest in the unusual psychogenic effects of peyote and, following
its synthesis in 1919, mescaline, continued through the 1920's.
Activities included further exploration of the unique visions
induced by the drug by a variety of literary figures and scholars
introduced to its exotic phenomena, although when WILLIAM JAMES
experienced a severe gastro-intestinal reaction upon attempting
to swallow a segment of peyote he is alleged to have stated: "Henceforth,
I'll take the visions on trust" (STEVENS, 1987). A comprehensive
survey of the effects of mescaline was published by KARL BERINGER,
a close associate of HERMANN HESSE and CARL JUNG, in his massive
tome "Der Meskalinrausch" (The Mescaline Inebriation)
in 1927, followed a year later by HEINRICH KLUVER's Mescal:
The "Divine" Plant and Its Psychological Effects, the
first attempt at formal classification and analysis of mescaline
visions (KLUVER, 1928).
And heralding the next phase of hallucinogen research, mescaline
was touted by psychiatric researchers as a putative biochemical
model for major mental disturbances, particularly schizophrenia
(GUTTMAN and MACLAY, 1936; STOCKINGS, 1940).
Dr HOFMANN'S Serendipitous Discovery:
The modern era of hallucinogen research began in the laboratory
of Dr. ALBERT HOFMANN, a senior research chemist for the Sandoz
Pharmaceutical Company in Basel, Switzerland. In mid April, 1943,
HOFMANN was engaged in work with the rye ergot fungus, Claviceps
purpurea, in an effort to identify a new analeptic for the
treatment of migraine headache. Acting on a premonition that
he had missed something, he returned to and prepared a fresh batch
of a compound he had previously synthesized in 1938 while searching
for a potential respiratory and circulatory stimulant, but which
had proved at that time to have what were considered to be uninteresting
results in animal testing. The chemical compound he had decided
to return to after this five year hiatus was the twenty-fifth
preparation of the Iysergic acid amide series, and had previously
received the designation of LSD-25.
While resynthesizing a modest quantity of this compound for further
study, HOFMANN complained of restlessness and feeling dizzy and
decided to return to his home to rest. He subsequently would write
that upon reaching home and lying down with his eyes closed he
experienced an "extreme activity of the imagination... there
surged upon me an uninterrupted stream of fantastic images of
extraordinary plasticity and vividness and accompanied by an intense
kaleidoscope like play of colors. After about two hours, the not
unpleasant inebriation, which had been experienced while I was
fully conscious, disappeared" (HOFMANN, 1983).
Realizing that he had accidentally absorbed during the re-crystallization
process a small quantity of the compound through his skin, HOFMANN
set out three days later, on April 19, 1943, to replicate the
phenomena by self administering what he considered to be an extremely
small and cautious dose, 250 micrograms. Intending to record his
subjective experiences of what he had assumed to be a very low
dose of the peculiar substance, less than an hour later HOFMANN
began to feel the onset of what was to be a powerful and indeed
frightening altered state of consciousness, and again felt compelled
to return to his home. HOFMANN would later report
"On the way home, my condition began to assume threatening
forms... Everything in my field of vision wavered and was distorted
as if seen in a curved mirror. I also had the sensation of being
unable to move from the spot. Nevertheless, my assistant later
told me that we had traveled very rapidly... My surroundings had
now transformed themselves in more terrifying ways. Everything
in the room spun around, and the familiar objects and pieces of
furniture assumed grotesque, threatening forms. They were in continuous
motion, animated, as if driven by an inner restlessness... Even
worse than these demonic transformations of the outer world, were
the alterations that I perceived in myself, in my inner being.
Every exertion of my will, every attempt to put an end to the
disintegrations of the outer world and the dissolution of my ego,
seemed to be wasted effort. A demon had invaded me, had taken
possession of my body, mind and soul."
Shortly thereafter, HOFMANN would describe,
"the climax of my despondent condition had passed... the
horror softened and gave way to a feeling of good fortune and
gratitude... now, little by little I could begin to enjoy the
unprecedented colors and plays of shapes that persisted behind
my closed eyes. Kaleidoscopic, fantastic images surged in on me,
alternating, variegated, opening and then closing themselves in
circles and spirals, exploding in colored fountains... Exhausted,
I then slept, to awake next morning refreshed, with a clear head,
though still somewhat tired physically. A sensation of well-being
and renewed life flowed through me." (HOFMANN, 1983).
Dr. HOFMANN'S shocking experience of madness and transcendence,
precipitated by an infinitesimally low dose of what would soon
be recognized as the most potent psychoactive substance known
to man, heralded the advent of a new era of psychiatric research
committed to uncovering the mysteries of the mind and revealing
the basis of mental illness.
The Psychotomimetic Model:
ALBERT HOFMANN'S discovery of LSD soon led to a period of intense
interest and activity designed to explore its utility as a model
of understanding and treating psychotic illness. Such a direction
was consistent with earlier investigations equating the mescaline
catalyzed altered state of consciousness with the subjective experience
of schizophrenic patients (GUTTMAN and MACLAY, 1936; STOCKINGS,
1940). TAYLEUR STOCKINGS had described the similarities between
the two states:
"Mescaline intoxication is indeed a true "schizophrenia"
if we use the word in its literal sense of "split mind",
for the characteristic effect of mescaline is a molecular fragmentation
of the entire personality, exactly similar to that found in schizophrenic
patients... Thus the subject of the mescaline psychosis may believe
that he has become transformed into some great personage, such
as a god or a legendary character, or a being from another world.
This is a well-known symptom found in states such as paraphrenia
and paranoia" (STOCKINGS, 1940).
Noting the enormity of perceptual disturbances induced by LSD,
coupled with the sensation in some subjects of losing their mind,
as had transiently been the case with Dr. HOFMANN, Sandoz in 1947
began actively marketing LSD to psychiatric researchers and practitioners
as a tool for understanding psychoses. Not only was LSD experimentation
in normal subjects proposed as a viable model for studying the
pathogenesis of psychotic illness, but psychiatrists were encouraged
to self-administer the drug so as to gain insight into the subjective
world of the patient with serious mental illness (STEVENS, 1987).
For a young field struggling to gain credibility as a medical
science, this model of chemically controlled psychosis emerged
as a propitious sign for the future.
Preoccupation with the hallucinogen induced psychotimimetic model
continued through the 1950's. The psychotomimetic position was
summarized by one its leading proponents, Harvard psychiatrist
MAX RINKEL:
"The psychotic phenomena produced were predominantly schizophrenia-like
symptoms, manifested in disturbances of thought and speech, changes
in affect and mood, changes in perception, production of hallucinations
and delusions, depersonalizations and changes in behavior. Rorschach
tests and concrete-abstract thinking tests showed responses quite
similar to those obtained with schizophrenics" (RINKEL and
DENBER, 1958). However, it became increasingly apparent that although
an impressive array of psychiatric researchers and theoreticians
had elucidated and elaborated upon the startling degree of resemblance
between schizophrenia and the hallucinogenic experience, a growing
consensus was emerging that the dissimilarities between the two
states essentially obviated the value of the chemical psychosis
model (GRINSPOON and BAKALAR,1979). Speaking at the First International
Congress of Neuropsychopharmacology in 1959, the legendary MANFRED
BLEULER enunciated the central argument in opposition to the psychotomimetic
model. He stated that it was the gradual and inexorable progression
of a symptom complex which included disturbed thought processes,
depersonalization and auditory hallucinations, evolving into a
generalized functional incapacitation which was characteristic
of schizophrenia. He concluded with the demonstrative declaration
that although the psychotomimetic drugs may have strengthened
our conceptual understanding of organic psychoses, they have contributed
nothing to the understanding of the pathogenesis of schizophrenia"
(BLEULER, 1959).
Hallucinogen Research and the Role of the CIA:
Following the end of World War II, as relations with our former
ally the Soviet Union began to deteriorate and Cold War tensions
heightened, a program was initiated by the U.S. Central Intelligence
Agency to develop a speech inducing drug for use in interrogations
of suspected enemy agents. Such a search was in part stimulated
by knowledge of prior, albeit unsuccessful, efforts by Nazi medical
researchers at the Dachau Concentration Camp to utilize mescaline
as an agent of mind control (MARKS, 1979). By the early 1950's
the CIA had acquired from Sandoz Pharmaceutical a large quantity
of the highly touted psychotomimetic, LSD, and had begun their
own extensive testing program. Early experiments often involved
the furtive "dosing" of unwitting subjects, including
employees of the CIA and other intelligence organizations, soldiers
and customers solicited by prostitutes in the service of the CIA.
Given the ill-prepared mental set of the victim, the often adverse
setting in which the "experiment" occurred and the lack
of therapeutic aftercare, it is no surprise that highly deleterious
outcomes, including suicide, did occur. Although knowledge of
this irresponsible and ethically suspect association between the
CIA and hallucinogenic substances remained suppressed for the
next twenty years, knowledge of such activities was ultimately
obtained through the Freedom of Information Act (MARKS, 1979;
LEE and SCHLAIN, 1985).
Through the 1950's, as Cold War fears escalated, the CIA began
to develop an affinity for the psychotomimetic model then in vogue.
In order to further their own goals of investigating the mind
control potentials of hallucinogenic drugs, the CIA began to recruit
and fund a number of distinguished psychiatric researchers. Included
among these was Ewen Cameron, elected President of the American
Psychiatric Association in 1953 and first President of the World
Psychiatric Association. Capitalizing on the CIA's preoccupation
with LSD's purported ability to break down familiar behavior patterns,
Cameron received funding to develop a bizarre and unorthodox method
for treating severe mental illness. The treatment protocol began
with "sleep therapy", where patients were sedated with
barbiturates for a several month period, and was followed by a
"depatterning" phase of massive electroshock and frequent
doses of LSD designed to obliterate past behavior patterns. Patient's
were then once again heavily sedated, and subsequently subjected
to a prolonged "psychic driving" reconditioning phase
where they received constant auditory bombardment from speakers
under their pillows repeating tape recorded messages, with some
patient's hearing the same message repeated a quarter of a million
times. Given the gross excesses in all modalities of this "treatment",
inevitably severe neuro-psychiatric deterioration was incurred
by many of Cameron's unconsented subjects (MARKS, 1979; LEE and
SCHLAIN, 1985). Ultimately, the efforts of the CIA and their contract
psychiatrists came to naught as their ill-advised collaboration
with hallucinogens yielded little of value to support either the
CIA's mind control theories or the psychotomimetic investigations
of psychiatric researchers.
The Psycholytic Treatment Model:
Early experimentation in Switzerland following ALBERT HOFMANN'S
discovery in the 1940's had discerned a phenomena quite different
than that of the much heralded yet bizarre psychotomimetic mental
experience. In subjects given a relatively low dose of LSD, there
appeared to occur a release of repressed psychic material, particularly
in anxiety states and obsessional neuroses. By allowing this otherwise
repressed and threatening material to flow effortlessly into consciousness,
investigators surmised that low dose LSD treatment could facilitate
the psychotherapy process (STOLL,1947). Application of the low
dose model in Europe as well as the United States ascertained
that psycholytic treatment had particular value with patients
with rigid defenses mechanisms and excessively strict superego
structures. By facilitating ego regression, uncovering early childhood
memories and inducing an affective release, psychiatrists claimed
to have achieved a breakthrough in reducing the duration and improving
the outcome of psychotherapeutic treatment (CHANDLER and HARTMANN,
1960). Problems arose with the psycholytic paradigm, however,
as critics noted that the content of regressed material released
from the unconscious was extremely sensitive to the psychiatrist's
own analytic orientation, in most cases Freudian or Jungian. Questions
arose over whether the phenomena observed in the psychotherapeutic
sessions, including the often positive treatment outcome, were
not simply attributable to the presence of heightened powers of
suggestibility. Moreover, with psycholytic treatments, care had
to be taken to utilize sufficiently low dosages of the hallucinogen
that the patient's ego would not be overwhelmed to the point where
verbal analysis would be inhibited. When in the course of psycholytic
psychotherapy higher dosages were utilized, the resultant experience
could no longer be contained within the intended theoretical framework,
thus necessitating delineation of an entirely new paradigm.
The Psychedelic Treatment Model:
Psychiatrists utilizing the higher dose model, on their patients
as well as self-experimenting on themselves, quickly realized that
they had accessed an entirely new and novel dimension of consciousness.
As Dr. HOFMANN had experienced during his own exploration, this
unexpected level of awareness could alternately be rapturous or
terrifying. The first psychiatrist to explore this paradigm was
the Canadian researcher HUMPHREY OSMOND. Utilizing first mescaline,
and later LSD, OSMOND devoted his studies to the treatment of
alcoholism, a notoriously difficult and refractory condition.
Noting that some alcoholics were only able to cease their pathological
drinking behaviors after they had experienced a terrifying, hallucinatory
episode of delirium tremens during alcohol withdrawal, OSMOND
set out to replicate this state through utilization of a high
dose hallucinogen model. Observing that what distinguished his
treatment successes from his treatment failures was whether a
transcendent and mystical state of consciousness was attained,
OSMOND recognized the strong resemblance to states of religious
conversion, bringing to mind WILLIAM JAMES' old axiom that "the
best cure for dipsomania is religiomania". Dissatisfied with
the prevailing jargon, and arguing that his model demonstrated
that hallucinogens did much more than "mimic psychosis",
OSMOND introduced at the 1957 meeting of the New York Academy
of Sciences the term psychedelic, explaining that the "mind
manifesting" state did not necessarily produce a predictable
and pathological sequence of events, but rather could catalyze
an enriching and life changing vision. And in presaging the cacophonous
debate that would shortly fall upon the infant field of hallucinogen
research, OSMOND concluded that the psychedelic model not only
allowed us to escape "Freud's gloomier moods that persuaded
him that a happy man is a self-deceiver", but would soon
come to the aid of humanity's imperiled existence and "have
a part to play in our survival as a species" (OSMOND, 1957).
The Prohibition of Hallucinogen Research:
With the evolution to the psychedelic model, hallucinogens moved
beyond the bounds of control of the medical elite (NEILL, 1987).
No longer could they be confined to investigations of a model
psychosis, nor could they be contained within the framework of
conventional psychiatric therapies with implicit prescribed roles
for doctor and patient. By blurring the boundaries between religion
and science, between sickness and health, and between healer and
sufferer, the psychedelic model entered the realm of applied mysticism.
As word of the astounding phenomenon induced by the psychedelic
model spread into the culture at large, the inevitable backlash
occurred. Horrified that this extraordinary investigative probe
had been appropriated from their control, the leaders of the psychiatric
profession directed harsh criticism at their irrepressible and
increasingly evangelistic colleagues. ROY GRINKER, the first editor
of the prestigious Archives of General Psychiatry, in a 1963 editorial
castigated those psychiatric researchers who had become preoccupied
with administering "the drug to themselves, and some, who
became enamored with the mystical hallucinatory state, eventually
in their 'mystique' became unqualified as competent investigators"
(GRINKER, 1963). And a year later, in the Journal of the American
Medical Association, GRINKER charged researchers with "using
uncontrolled, unscientific methods. In fact, these professionals
are widely known to participate in drug ingestion, rendering their
conclusions biased by their own ecstasy... The psychotomimetics
are being "bootlegged", and as drugs now under scientific
investigation they are being misused" (GRINKER,1964). In
moving beyond the boundaries of conventional scientific inquiry,
the hallucinogens had "become invested with an aura of magic"
(COLE and KATZ, 1964), and thus could no longer be provided the
status and protection of their elite profession. The covenant
had been broken. The hallucinogens, along with the proponents
of their continued exploration, were cast out, becoming pariahs
in a land and a time that increasingly viewed them as threats
to public safety and social order.
By the mid-1960's, the secret was out. Growing interest in hallucinogens
had catalyzed, and was catalyzed by, profound cultural shifts.
Along with the social upheaval surrounding opposition to an increasingly
unpopular war in South-East Asia, hallucinogens assumed a central
role in a movement that began to question many of the basic values
and precepts of mainstream Euro-American culture. The populace,
fueled by sensational media accounts, grew to identify hallucinogens
as a prime suspect in inciting the accelerating state of cultural
havoc. And along with the drugs themselves, adherents of the experimental
and treatment models became increasingly identified as part of
the problem. Such circumstances were in no way improved by the
rash pronouncements from the radical wing of what had rapidly
become identified as an hallucinogen-inspired political movement.
The leaders of one notorious research group in particular drew
public ire and aroused anxiety and panic by such proclamations
as:
"Make no mistake: the effect of consciousness-expanding drugs
will be to transform our concepts of human nature, of human potentialities,
of existence. The game is about to be changed, ladies and gentleman...
These possibilities naturally threaten every branch of the Establishment.
The dangers of external change appear to frighten us less than
the peril of internal change. LSD is more frightening than the
Bomb!" (LEARY and ALPERT, 1962).
In response to escalating fears that hallucinogens had become
an out of control menace to public safety and cultural stability,
the government moved to restrict access to these potent agents
of change. Psychiatric leaders, gravely concerned by the threat
to public mental health, and perhaps to their professional image
as well, vehemently urged government regulating agencies to tighten
their controls. ROY GRINKER, illustrious psychiatrist and President
of the American Medical Association, issued an urgent warning to
his colleagues that greater damage lay ahead unless usage of these
hazardous chemical agents were contained. Going beyond merely
calling for the psychiatry profession to take action against this
growing peril, which would include denouncing the renegades within
its own ranks, GRINKER castigated the government for having been
woefully lacking in vigilance and having neglected its duty:
"The Food and Drug Administration has failed in its policing
functions. The drugs are indeed dangerous even when used under
the best of precautions and conditions (GRINKER, 1964).
Driven into action by increasingly lurid media and law enforcement
accounts of widespread hallucinogen use among the young, amidst
dire warnings that this insidious threat would erode the values
and work ethic of future generations, government regulators had
no choice but to act. In 1965 the Congress passed the Drug Abuse
Control Amendment, which placed tight restrictions on hallucinogen
research, forcing all research applications to be routed through
the FDA for approval. In April, 1966, succumbing to mounting adverse
publicity, Sandoz Pharmaceutical ceased the marketing of what
their esteemed research chemist ALBERT HOFMANN would come to call
"my problem child ' (HOFFMAN,1983). Also during the spring
of 1966, Senator Robert Kennedy called for Congressional Hearings
on the problem. Kennedy, whose wife Ethel had reportedly received
psychiatric treatments with LSD, expressing concern that potentially
vital research was being obstructed, questioning:
"Why if they were worthwhile six months ago, why aren't they
worthwhile now?... I think we have given too much emphasis
and so much attention to the fact that it can be dangerous and
that it can hurt an individual who uses it... that perhaps to
some extent we have lost sight of the fact that it can be very,
very helpful in our society if used properly" (LEE and SCHLAIN,
1985).
Kennedy's pleas went unheeded, as over the next few years more
and more stringent restrictions were imposed on hallucinogen research,
culminating in the Bureau of Narcotics and Dangerous Drugs (the
predecessor to the Drug Enforcement Agency) decision to place
the hallucinogens in the Schedule I class, reserved for dangerous
drugs of abuse with no medical value. Research ground to a virtual
halt. Government, civic and medical leaders had all responded to
their call to duty, permanently expunging, they hoped, what President
LYNDON JOHNSON had declared in his State of the Union address
in January, 1968, "these powders and pills which threaten
our nation's health, vitality and self-respect" (STEVENS,
1987).
Discounting Hallucinogen Research:
Hallucinogens, in the guise of an experimental probe into the
mysterious world of mental illness, had burst on the scene during
the infancy of psychiatric research. It had not only unleashed
a firestorm of controversy as a highly touted therapeutic intervention,
but had greatly contributed to the development of the exciting
new specialty of laboratory neurochemistry research. Access to
these unique agents for animal research has been permitted to
continue unimpeded, and they have contributed greatly to our understanding
of neurotransmitter systems, brain imaging techniques and behavioral
pharmacology (JACOBS, 1984; FREEDMAN, 1986). And yet, human research
with hallucinogens has, until now, vanished from the scene. Discounted
for ever having held value or potential, it is as if they had
never been with us. A source of embarrassment and shame, hallucinogen
research became a non-issue, virtually disappearing from the professional
literature and educational curriculums. By the early 1970's, psychiatric
researchers and academicians had perceived that to continue to
advocate for human research with hallucinogens, or even to be
identified with past interest in their therapeutic potential,
might seriously jeopardize their future careers. Difficult decisions
had to be made. From the mid 1960's onward, a split began to appear
in the ranks of psychiatric hallucinogen researchers. For those
who would maintain their enthusiasm for the potentials of these
singular substances, a path of professional marginalization would
follow. For those who would take a stand against their perfidious
threat, accolades and professional advancement would be forthcoming.
For most, however, it was to be a process of quietly disengaging,
often from what had been a passionate interest, and re-directing
their careers towards tamer and less disputable areas. With very
few exceptions (GRINSPOON and BAKALAR, 1979; GRINSPOON and BAKALAR,
1986; STRASSMAN, 1984), a veil of silence had descended over the
putative role of hallucinogen research in psychiatry.
The Future of Hallucinogen Research in Psychiatry:
Where are we to go with this most unusual class of psychoactive
substances? Some would say it is best to let sleeping dogs lie,
that the hallucinogens only brought discord and controversy to
the ranks of psychiatry and their re-examination can only lead
to further turmoil and acrimony. Psychiatry has moved far beyond
the time where hallucinogens were viewed as being on the cutting
edge of research investigation. Many psychiatrists graduating
from training programs in the last decade are not even aware of
the role hallucinogens once did play in the arena of legitimate
research. The conventional point of view is that these drugs are
potential substances of abuse, nothing more. Within mainstream,
academic psychiatry forums for discussion of the relative merits
of resuming inquiries into this area have been restricted. What
was once a roar of often vituperative debate has receded to barely
a whisper.
Perhaps this twenty-five year period of quiescence and retreat
into relative obscurity has been necessary to finally give the
question of hallucinogens a fair hearing. We have seen in a prior
epoch of investigation a playing field painfully polarized between
ardent advocates and fervent foes of the hallucinogens' putative
role as agents of discovery and healing. The truth has always
rested somewhere in between the dichotomous poles of panacea and
toxin. The protagonists of the past, whose careers and integrity
so often appeared to be interwoven with the content and outcome
of their fierce debate, are exiting the arena. Rumblings of renewed
interest are being heard within the halls of academic psychiatry.
A new dialogue is slowly starting to emerge. Hopefully, the lessons
of the past will be appreciated, and utilized to forge a partnership
and collaboration where divergent perspectives will be given a
fair and open hearing, and the true potential of the hallucinogens
may finally be illuminated.
As the sleeping giant of hallucinogen research emerges from its
twenty-five year slumber, it will perceive that the world of psychiatry
has vastly changed from when it was put to rest. The once reigning
rulers of psychoanalysis have receded to positions of relative
obscurity as the field has become progressively dominated by the
adherents of biological reductionism. The insights gleaned from
the individual case study, once the standard of psychoanalytic
investigation, have been devalued and supplanted by the rigorous
methodological research design of modern psychiatry. In the future,
the putative value of hallucinogens in psychiatry can no longer
rest on claims deriving from anecdotal case studies, as inspiring
as they may be, but rather must evolve out of the findings of
well-structured, controlled, scientific investigation. To achieve
relevance and be accepted as a reputable field of study, hallucinogen
research must satisfy the standards of contemporary psychiatric
research. To maintain an iconoclastic insistence that the very
nature of these substances transcends standard research design
would be to prolong their marginalization and deny the opportunity
to finally explore their potential utility.
The knowledge base of biological psychiatry and the neurosciences
has exploded over the last two decades, facilitated in part by
probes and techniques developed with hallucinogen research in
animals (JACOBS, 1984; FREEDMAN, 1986). The potential for further
advances in our understanding of the mechanisms of brain function
has been recognized and enunciated at a technical meeting of the
National Institute of Drug Abuse (NIDA) in July, 1992, which concluded
that it is now time to move beyond pure animal research into the
realm of human investigation. We are now on the threshold of initiating
studies utilizing state of the art research techniques, including
sophisticated brain imaging scans, neuroendocrine challenge tests
and receptor binding studies, in human subjects. The strategy
of pursuing such biological investigations will likely not only
yield valuable new information in the neurosciences, but facilitate
the re-legitimization of human research with hallucinogens and
ultimately become prelude to the re-exploration of their effects
on perception, cognition and emotion.
One of the most controversial arenas of hallucinogen research
during the 1950s and 1960s, and persisting as an alluring hope,
has been its putative role in alleviating mental suffering. During
a mere fifteen year period over a thousand clinical papers were
published in the professional literature discussing the experiences
of 40,000 patients treated with hallucinogens (GRINSPOON and BAKALAR,
1979). While many of these reports were presented in the form
of descriptive case studies, and are attributed little value by
contemporary research standards, they can help point the way for
future investigations. A wide variety of psychopathological phenomena
were subjected to intervention with hallucinogens, often leading
to encouraging reports of positive clinical outcome. Unfortunately,
examining these stimulating accounts in retrospect reveals notable
flaws in their design, including primitive and by today's standards
deficient measures designed to evaluate therapeutic change, lack
of outcome follow-up and unwillingness to utilize appropriate
control subjects. As the debate over hallucinogens intensified,
it also became apparent that from both warring camps investigators'
biases (whether conscious or unconscious) were confounding their
results. From our current vantage point it is often difficult
to ascertain the true significance of this past research other
than to appreciate that sufficient clinical change appears to
have been catalyzed that further investigation is merited. And
as we prepare to delve into the question of the hallucinogens
application to treatment models, it will be essential that we
control for the flaws that made a previous generation of research
suspect. State of the art research methodology must be utilized,
including proper attention to set and setting, control populations
and measures of short and long term treatment outcome. An atmosphere
of active collaboration among investigators with contrasting perspectives
needs to be established, avoiding at all costs the schism
which led to the collapse of earlier efforts.
The Relevance of the Past:
We are on the threshold of initiating explorations which may have
considerable ramifications for our future. There is much at stake
and much to learn. But in order to take full advantage of this
opportunity we must fully understand our past, including that
which we know of from cultures distant to our own place and time.
Plant derived hallucinogens once played a vital albeit poorly
appreciated role in our prehistorical lineage (FURST 1976; DOBKIN
DE RIOS, 1984). While psychiatry has traditionally held a disparaging
and pathologizing view towards shamanic belief systems and practices
(DEVEREUX, 1958), evidence supplied by transcultural anthropological
investigators (JILEK, 1971; NOLL, 1983) demonstrate that shamanic
practices may actually be conducive to high levels of psychological
health and functioning. To move beyond the commonly held psychiatric
viewpoint that shamanism is nothing more than primitivism and
the prehistorical wellspring of mental illness, would allow for
receptivity to learning from a paradigm which has incorporated
for thousands of years the utilization of hallucinogens as a vital
facet of belief systems and healing practices (BRAVO and GROB,
1989). If we are to optimally assess the true clinical efficacy
and safety of the hallucinogens, it is imperative that we be conscious
of the critical extrapharmacological variables which we know to
be integral to the shamanic model. Ample attention and sensitivity
must be given to the preparation for the hallucinogen experience,
the powerful expectation effects directed toward predetermined
therapeutic goals, the formalized structure of the session and
the integration of the altered state experience in the days, weeks
and months following the experience. The failure to adhere to
any of these aspects of the shamanic paradigm would be to deny
hallucinogen research the full opportunity to test its true value.
What removes the shamanic world view so far from our own, and
consequently presents the greatest challenges when attempting
to incorporate its insights into contemporary research methodology,
is the belief that the plant hallucinogens are sacraments of divine
origin. However, it is this reverential and spiritual utilization
of psychoactive substances which so pointedly distinguish the
practices of tribal and shamanic peoples from our own contemporary
profaned and pathologized context of drug abuse. Hallucinogens
in the shamanic world have traditionally played a critical role
in rites of initiation, providing personal regeneration and radical
change, and are perceived as essential to the process of growth
and maturity and the acquisition of meaning (GROB and DOBKIN DE
RIOS, 1992; ZOJA, 1989). They are not misused or abused, and
are not agents of societal chaos and destruction. Their use is
fully sanctioned and integrated into the mainstream of society,
and commonly utilized in ritually prescribed and elder facilitated
ceremonies. The hypersuggestible properties of the hallucinogens,
utilized within an highly controlled set and setting, achieves
a powerful effect reinforcing cultural cohesion and commitment.
These apparent beneficial effects of shamanic hallucinogen use
contrast markedly with the destructive outcomes often observed
in our own contemporary contexts (DOBKIN DE RIOS and GROB, 1993).
An Illustrative Model:
One of the most exciting areas of investigation from the past
era of hallucinogen research was the treatment of severe, refractory
alcoholism. In the 1950s psychiatric researchers had identified
the similarities between the spectrum of the LSD experience and
the phenomenology of delirium tremens (OSMOND, 1957; DITMAN and
WHITTLESEY,1959). As alcoholism was notorious for its lack of
responsiveness to conventional treatment approaches, great interest
and energies were directed towards this area of study. Highly
impressive short term results of treatment with hallucinogens
(CHWELOS et al, 1959; MACLEAN et al, 1961; VAN DUSEN et al, 1967)
gave impetus to a surge of enthusiasm that a dramatic and effective
intervention had finally been found. Additional support was forthcoming
from BILL WILSON, the founder of Alcoholics Anonymous, who revealed
that his own carefully supervised experiences with LSD had not
only been an highly valuable personal experience, but also fully
compatible with the tenets of the movement he had started (GROF,
1987). However, as the level of discord within the psychiatric
profession and the degree of alarm in the public heightened, resistance
to accepting the hallucinogen model for alcoholism intensified.
As mainstream psychiatry could no longer stand idly in the face
of threatened radical upheaval, so the Board of Trustees of Alcoholics
Anonymous felt compelled to reject their creator BILL WILSON'S
proposed endorsement.
It soon became apparent that the methodological shortcomings of
the research alleging to demonstrate unequivocally positive results
in the treatment of alcoholism would undermine progress in the
field. Poorly controlled research design, with questionable measures
of change and inadequate follow-up, led to charges that hallucinogen
advocates had been blinded by their own enthusiasm and had misinterpreted
and misrepresented their findings. Opponents of the hallucinogen
treatment model would subsequently conduct their own clinical
trials, designed to refute what they perceived as dangerous and
exaggerated claims of therapeutic success (SMART et al, 1966;
HOLLISTER et al, 1969; LUDWIG, LEVINE and STARK, 1970). These
studies, which purported to demonstrate an entire lack of treatment
efficacy of models utilizing hallucinogens, were received by the
psychiatric establishment with great relief. In fact, the LUDWIG,
LEVINE and STARK study provided such reassurance to a profession
so shaken by its own iconoclasts, as well as satisfying contemporary
formal medical research standards with such aplomb, that it was
awarded the prestigious Lester N. Hofheimer Prize for Research
from the American Psychiatric Association. Nevertheless, the investigations
designed to provide the last word on the "failed" hallucinogen
treatment model have themselves come under scathing attack. Not
only have the investigators lack of appreciation of set and setting,
failure to adequately prepare their patients for the experience
and refusal to allow for follow-up integration been identified
(GRINSPOON and BAKALAR, 1979), but the capricious nature of medical
research has itself been implicated, "At a time when LSD
was popular, LEVINE and LUDWIG (1967) had reported positive results.
.. When LSD fell out of favor and the positive results became
politically unwise, they obtained negative results. Unconsciously
or consciously they built into their study a number of antitherapeutic
elements that guaranteed a therapeutic failure (GROF, 1980).
The discussion of the potential role of hallucinogens in the treatment
of alcoholism, and by inference its application to other psychiatric
disorders as well, would not be complete without an examination
of the role of the plant hallucinogen, peyote, in the treatment
of Native American Indians. Evidence exists that peyote was in
widespread use in Central America and revered as a medicine and
religious sacrament as early as 200 B.C. (FURST, 1976). After
the American Civil War, the use of peyote moved north of the Rio
Grande River and quickly spread to dozens of native tribes throughout
the United States and Canada. During the 1870s and 1880s a peyote
vision religion developed in reaction to the inexorable encroachment
of non-native peoples onto the Indian lands and the associated,
deliberate destruction of native culture. With the defeat and
subjugation of the Native American people, alcoholism became epidemic.
Although until recently faced with unrelenting political repression
by the U.S. government, the Native American Church, a syncretistic
church combining elements of traditional Indian religion and Christianity
and utilizing peyote as its ritual sacrament, has been recognized
by anthropologists and psychiatrists as being the only effective
treatment for endemic alcoholism (SCHULTES, 1938, LA BARRE, 1947,
BERGMAN, 1971, ALBAUGH and ANDERSON, 1974). KARL MENNINGER, a
revered figure in the development of American Psychiatry in the
20th Century, has stated:
"Peyote is not harmful to these people; it is beneficial,
comforting, inspiring, and appears to be spiritually nourishing.
It is a better antidote to alcohol than anything the missionaries,
the white man, the American Medical Association, and the public
health services have come up with." (BERGMAN, 1971).
Integral to the positive treatment outcome with peyote has been
its sacramental utilization within the ritual context of mystical-religious
experience. The Native American Church is a clear contemporary
example of the successful application of the shamanic model to
the treatment of severe, refractory illness. Although the Native
American Church applies to a circumscribed and relatively homogenous
population, it provides a valuable lesson on the importance of
the shamanic model and the need for attentiveness to set and setting,
intention, preparation and integration, as well as group identification.
If we are to develop optimal research design for evaluating the
therapeutic utility of hallucinogens, it will not be sufficient
to adhere to strict standards of scientific methodology alone.
We must also pay heed to the examples provided us by such successful
applications of the shamanic paradigm. It will only be then, when
we have wedded our state of the art research designs to the wisdom
accrued from the past, that we will adequately appreciate what
role hallucinogens may have in our future.
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