|
|
A New Behavior Change Program Using Psilocybin
TIMOTHY LEARY, RALPH METZNER, MADISON PRESNELL,
GUNTHER WEIL, RALPH SCHWITZGEBEL, AND SARAH KINNE [1]
Psychotherapy Vol. 2, No. 2, July,
1965, pp. 61-72
This paper describes the procedure and results of a new kind of
behavior change or rehabilitation program The methods used here
may have applications to a wide range of settings in the field
of rehabilitation or behavior change.
The program aims to produce such changes in prisoners' ways of
thinking and living as will enable them to stay out of prison
once they are: released. It is well known that our contemporary
prison systems do not perform this function (usually called "reforming"
the criminal). Fifty to seventy percent of offenders paroled or
released return within a 5-year period, with a nationwide average
of 67% (Mattick, 1960) .
Many attempts have been made to develop treatment programs which
would better serve the purpose of "reform" or "rehabilitation."
Our program may be summarized as follows:
(1) It is a collaborative group program; we avoid as much as possible
the traditional doctor-patient, researcher-subject, or professional-client
roles.
(2) The program is relatively short and emphasizes the crucial
importance of certain far-reaching "insight" experiences
(produced by consciousness-altering drugs).
(3) The program has a built in evaluation procedure. Records of
changes serve as feedback for the group members and to communicate
the activities of the group to other research workers.
The program does not require expensive professional personnel.
It does require persons (usually non-professionals possessing
a certain egalitarian wisdom) who are experienced in the procedures
we have developed.
Although the particular combination of methods used in this program
is new, some of the methods have been used successfully by others
within institutional settings. Stürup (1957) has developed
a group "total treatment" program for criminals, involving
insight experience, self-help in changing patterns of interaction
and the concept of the "chain-reaction" by which groups
are encouraged to further their own learning and progress. The
Highfields project, which uses "guided group interaction"
to provide insight and assumes that increased responsibility makes
for change, is also similar in many respects (McCorkle et al.,
1958). Feedback and self-evaluation) by the group has been discussed
by Jenkins (1948). Most writers on group treatment have agreed
that the learning and change takes place through observation and
understanding of "here-and-now" experience and behavior.
The group behavior which serves as the focus around which the
learning takes place may be role-playing (Levit and Jennings,
1960) or psychodrama (Moreno, 1959); or it may be some set of
stimuli brought in from the outside, such as a problem or a case-history
(Slater, 1961). In our case, the group experience around which
the therapeutic process is constructed is the shared insight experienced
by psilocybin.[2]
Although psilocybin per se has only rarely been used in therapy
(e.g. Duché and Laut, 1961) other drugs from the same group
such as LSD-25 have of course been widely used as adjuncts to
therapy (e.g. Abrahamson, 1955; Cutner, 1959; Sandison,
1954). More recently Tenenbaum (1961) also reports the use of
LSD with criminal offenders in a prison setting.
The halfway house for parolees is also an integral part of our
program. There have been many attempts to establish such transitional
institutions, based on the principle of support coming from others
who have shared similar experiences. The St. Dismas Home in St.
Louis for ex-convicts, the Synanon, Inc. group in California for
ex-addicts, and especially Alcoholics Anonymous are some of the
better known examples.
PROCEDURES
This program was carried out in the Massachusetts Correctional
Institution, Concord, a maximum security prison for younger offenders,
between February, 1961, and January, 1963. Concord's daily average
population in 1959 was 395, the average are is around 21 or 22.
During 1959, 67% of the 247 men committed were recidivists, i.e.,
had served former commitments, mostly in county jails or juvenile
institutions.
The program as now developed through pilot studies, and continual
revision and improvement over the period of a year may be divided
into five stages: selection, testing, change program, pre-parole
period and parole. In describing the stages we will distinguish
between what we actually did and what we would now do, having
learned from our mistakes.
Stage 1: Selection. Candidates for the program were
selected by the prison parole officer according to the following
criteria: (1) they were eligible for parole in three to five months'
time; (2) they had not had more than one previous parole violation.
We now add a third criterion: we don't accept inmates who will
be paroled out of state because of the difficulty of keeping adequate
follow-up records. The group thus selected is interviewed by a
clinical psychologist and. a psychiatrist jointly, the program
is explained and volunteers are accepted. Of the 40 men interviewed
2 refused and 6 did not complete the program for technical reasons.
Thus only 32 men are involved in the final evaluation.
During our pilot studies we also accepted inmates from sources
other than the parole officer. Three were referred by the prison
psychiatrist. One was accepted because of his interest in the
project. These were older men with longer records and longer sentences.
We now feel that it is wiser to adhere strictly to the criteria
developed because otherwise the project becomes involved with
power struggles in the institution which may cause tension in
the groups. Also, older inmates serving long sentences pursue
somewhat different objectives in the group than men who are about
to be paroled. These different goals need not conflict but they
are distinct: a young offender at Concord is most likely to concern
himself with post-release adjustment to life outside. An older
offender serving a 15-20 year sentence is more likely to be trying
to find ways of adjusting to prison life.
It should be noted that the participants are not necessarily men
who have sought help for "psychological" problems. Simultaneous
individual therapy for participants in the group program may be
a valuable complement. However, the group program, with its emphasis
on collaborative ways of self-help, provides a behavior change
setting for many men who would refuse to seek help within the
traditional psychiatric framework.
We have experimented with different sizes of groups, five to ten
inmates with three psychologists. Large groups are too unwieldy.
For the major experiment the groups consisted of three new inmates,
one psychologist and one additional inmate who had already participated
in the program once.
Stage 2: Testing and feedback. After an initial
discussion meeting the inmates take a battery of personality tests
consisting of the MMPI (Minnesota Multiphasic Personality Inventory),
the CPI (California Psychological Inventory), the Maher Sentence
Completion Test (Watt & Maher, 1958), designed especially
to measure cynicism in prisoners, and a TAT (Thematic Apperception
Test) constructed especially to measure a variety of motives.
Then follow three to four discussion meetings (twice a week).
Test results are "fedback" and personal situations are
reviewed. The group is told about the possible experiences with
psilocybin and encouraged, on the basis of their test results
and the information on psilocybin, to plan and initiate their
own individual personality change programs. This may take the
form of statements such as "I want to understand what drinking
means to me" or "I want to try and reduce my paranoid
suspicions." We have found, however, that the first
time a person takes psilocybin most can be learned by not imposing
any plans or pre-conceived interpretation on the experience. Thus,
goal-setting becomes more important for second or third experiences.
Group leaders carefully avoid imposing their expectation.
They emphasize the wide variety of different individual experiences
that can be had. Any planning must come from the subject himself.
Stage 3: Change program. The group meets
for an all-day session in a room in the prison hospital and takes
psilocybin. The main effects of the drug usually last about 3-4
hours but the group stays together all day for support and discussion.
During the session, the atmosphere is relaxed and permissive.
Beds are provided for subjects to lie down if they wish, music
is also available, the session is not interrupted by visitors
or guards. No interpretations are made, although the more experienced
group members are always ready to handle panic or paranoia by
providing a warm, supportive "reality" orientation.
To do this, it is necessary that the group leaders have experienced
the effects at some time since they would otherwise be incapable
of understanding the reactions the members of the group are having.
We have experimented with different dosages and now usually start
with 20 or 30 mg., and in subsequent sessions increase up to 50
or 70 mg. Large dosages should only be taken by an experienced
subject in a very secure situation, since they can be quite shattering.
The prison psychiatrist is always in attendance during the session
to handle any adverse physical reactions, although we have never
had any except transient minor nausea and headache. In order to
minimize suspicion on the part of the inmates and to increase
the sense of collaborative trust, we have found it advisable for
one of the group leaders to take a small amount of the drug (5-10
mg.) in initial sessions.
After the session, a series of three to four discussion meetings
is held, during which subjects work through their experiences,
compare, analyze and try to integrate into everyday life what
they have learned. Then follows a second all-day session with
psilocybin and further discussion meetings.
Our program in the major study consisted of 6 weeks of bi-weekly
meetings, with two psilocybin sessions.[3]
However, there is some evidence that a longer (perhaps 8-week)
program with at least three psilocybin sessions would be better.
Partly this is because the first session tends to be minimal in
terms of learning since subjects often spend a major portion of
the day fighting the experience off. Only when confidence in the
experience and in the group is established, through this first
experience, does real learning begin.
After the final discussion meetings the men are re-tested with
the same battery of tests and the results again fed back.
Stage 4: Pre-parole period. Around this time most
of the men come up before the parole board and will either be
given a date or deferred. If they are paroled, they move into
a special pre-parole group. In this group they discuss
the nature of parole, employment opportunities, difficulties and
legal problems they may have. We provide whatever help we realistically
can. We have been aided in this by graduate students from Harvard
University who work in Concord as part of their training in clinical
psychology. Psychologists may meet individually with inmates to
work out anticipated special problems. The rationale underlying
these procedures is to minimize abruptness, shock and difficulty
in adjusting to non-prison life.
Those men who are not paroled but have been through the program
participate as assistant group leaders in one of the next groups.
This serves both to increase inmate collaboration and responsibility
and to maintain contact with all our participants.
Stage 5: Parole. This phase of our program was never
fully developed. We now realize that it is necessary to set up
a halfway house where members of the project can meet regularly
and discuss mutual problems along Alcoholic Anonymous lines. For.
practical and material reasons we were limited to irregular individual
contacts with group members In making such contacts we have found
it necessary to "set the limits" of our contract rather
widely . Thus most ex- convicts will not come to a middle-class
institution like a university unless highly motivated. The only
alternative is for the group leader to seek out the men in the
community, e.g., in bars or homes, sometimes at unusual hours,
as the need arises.
RATIONALE OF THIS PROGRAM
The guiding principles underlying this program are that the problem
of changing behavior is not one of "curing" and "illness."
Our approach is outside of a medical framework (cf. Leary,
1961), and more in line with an existential approach. We assume
that self-defeating behavior patterns (such as recidivism) can
be overcome by recognizing the game-quality of conduct
(Szasz, 1960). A "game" is any learned behavior sequence
with roles, rules, rituals, values, specialized languages and
limited goals. Self-defeating games are maintained largely through
inability to recognize the features and rules of the game one
is involved in, and through inability to detach the self from
its actions; they are maintained further through lack of instrumental
capacity (power, knowledge) to carry out one's preferred games
successfully. Helplessness is the key obstacle to efficient game
performance.
Thus many of our procedures are designed to reduce helplessness.
Relationships which imply or emphasize power differences are avoided
as much as possible. Decisions are made collaboratively by all
group members whenever possible. Any knowledge or resources the
group leaders have are shared with the group members. This is
the rationale for feedback of the test results and interpretations.
Maximum responsibility for his own change processes is given to
each prisoner. He is encouraged to practice new games and given
the help of whatever resources we have.
New interpersonal or behavioral games can only be acquired in
shared time and space. In the field of criminology this principle
was formulated in the "differential association theory"
of Sutherland (1955). Prisoners learn their games from the two
groups that share most time and space with them, viz. other prisoners
and guards. No middle-class role-relationship could possibly compete
with or counteract that influence. Goffman (1957) has made a similar
point with reference to the role of attendants in mental hospitals.
Therefore we have stressed the importance of mutual collaborative
problem-solving at all stages of the program.
The role of the drug experience. The drug used in
this project, psilocybin, is a synthetic derivative of Psilocybe
mexicana, the "Sacred Mushroom" of Mexico. It was
discovered by R. Gordon Wasson in 1954 and synthesized by A. Hofmann
of the Sandoz Laboratories in Basel, Switzerland, and is classified
with the group of drugs variously known as "hallucinogenic,"
"psychotomimetic" or "consciousness-expanding"—a
croup that also includes mescaline and LSD-25.
We have found that in a benign, supportive setting and with a
favorable set, psilocybin can produce a state of dissociation
or detachment from the roles and games of everyday interaction(cf. Leary, Litwin, and Metzner, 1963) . This detachment,
or temporary suspension of defenses, can provide insight and perspective
about repetitive behavior or thought patterns and open up the
way for the construction of alternatives. If the defenses are
abandoned in a non-anxiety provoking situation, the experience
also serves to establish a quite profound level of trust and communication
between members of the group.
If the situation is such that suspicion or fear are aroused then
the drug experience will only lead to an intensification of defensive
manoeuvres. This often happens the first time the group takes
the drug and hence it is important to prepare each group member
intensively for what he may experience. Subjects who are caught
by surprise and become afraid of the effects will attempt to fight
the experience e.g., by becoming hypochondriacal about
physiological changes, or by obsessive talking, writing or moving
around, or by paranoid accusations against the group leaders or
against people present who have not taken the drug.
This is why previous experience with drug is important. An inexperienced
person is likely to communicate his own anxiety about the reaction.
The group should be, to quote Gerald Heard (1959), ". . .concerned
but not anxious, interested but not engrossed, diagnostic but
not critical, aware of the seriousness and confidential value
of what is being conveyed and all the more incapable of coldness
or shock, aloofness or dismay. . . Any sense of fear or alienness
means that the root danger and origin of all breakdown, i.e.,
separation is present."
During the main effects of the drug, which start about half an
hour after ingestion and last 3-4 hours, a minimum of interpretative
or analysis is done; participants are best left free to explore
whatever material comes up, whether it be entirely personal or
involve interpersonal issues with other group members. Afterwards,
when ordinary reality relations have been re-established, there
is generally a very fruitful period for discussion and review.
(See Handbook on the Therapeutic Use of LSD by Blewett
and Chwelos, 1959.)
Psilocybin has the advantages over LSD and mescaline of (a) being
relatively short-lasting and (b) involving minimal somatic side-effects.
Two special problems: (1) the two or three days after an intense
insight-producing drug experience can be quite painful and depressing
as the subject attempts usually with some difficulty to integrate
the enormous quantity of material into his habitual life-patterns.
Hence group support, exchange of experience and discussion is
particularly important at this time. (2) The second problem is
that vita group psilocybin experiences that are repeated there
is a danger for certain persons to attempt to use the experience
to maintain or improve their "games" rather than to
see through them. This can express itself in narcissistic preoccupation
with one's own "profound" experiences and a certain
superior aloofness towards other less experienced group members.
This is exemplified in the case of S., described below (see Section
V), who in one session repeatedly demanded more of the drug and
when it was refused became irritated and withdrawn. It should
be the role of one of the other group members or of the leader
to point out in a calm, non-critical way whenever a person gets
caught in an ego-enhancing pattern for its own sake. Such selfishness
tends to obstruct the progress of a really therapeutic and enlightening
experience.
TWO EXAMPLES
The Case of J. J. is a 28-year old Negro who was
serving a 5-year sentence for robbery. (6 prior arrests of which
5 were for dunkenness.) He attended a school for retarded children
till the age of 17.
The group leader reported that from the start "J's behavior
in the group was cooperative and interested. Although he did not
talk a lot he followed the group program very closely." During
the first psilocybin session he experienced feelings of confusion
and isolation. In his report he wrote: " I kept saying to
myself in thought—where do you belong?" Through discussions
afterwards he gained some insight into his experience and his
relationship. The second experience, in the same group of 4 men
as before, was much more intense and emotional, with hallucinations
of colors, of positive and frightening scenes; it apparently stimulated
him to do some thinking about his life.
A few weeks later J. was released on parole. His employer was
quite satisfied with his work. At the time of the follow-up evaluation
there had been no arrests of J. since his release from prison
two years earlier and no indications of criminal involvements.
The Case of S. S. was a 48-year old white man who
was serving time on charges of being a common and notorious thief,
forgery, larceny and escape. He had a prior history of 30 arrests,
the first one being at the age of 12. The offenses were mostly
drunkenness (9) and thefts of small amounts of money by the use
of bad checks. He had served eleven prior commitments with a total
time of fourteen years in prison.
On the initial tests S. presented the classic picture of a "hardened
inmate." The Pd and Ma scales on the MMPI were both elevated—the
well-known profile of acting-out criminals.
During the first psilocybin session, S. was suspicious and attempted
to control and suppress the changes that were occurring partly
due to a competitive situation with another inmate.
For the second session in the same group, he was given a larger
close (40 mg.) since he was a very heavily-built individual. Out
of the shell of the hardened criminal emerged a sensitive, lonely,
child-like human being. "At the time of the peak of the drug's
effect I had a terrific feeling of sadness and loneliness, and
a feeling of great remorse of the wasted years.... It seemed to
me that I was crying inside of me and a feeling as if tears were
washing everything away. And I was hollow inside. with just an
outer shell standing there watching time stand still."
He continued in a second group as assistant group leader. With
a group of three younger inmates it was possible for him to assume
a role of responsible and encouraging leadership. In the two sessions
with this group he was able to experience and explore certain
more alien and unacceptable aspects of his personality. In one
it was the fear of death which he envisioned in the form of a
summoning figure; in the other it was his own selfishness (in
demanding drugs). After both experiences he reported feeling very
detached from prison life, uninterested in gambling or even talking
to anyone except those in his group.
In describing the influence of the project experience on his life,
S. wrote: ". . . before taking this drug my thinking always
seemed to travel in the same circles, drinking, gambling, money
and women and sex as easy and I guess a fast life ....Now my thoughts
are troubled and at times quite confusing, but they are all of
an honest nature, and of wondering. I know what I want to be and
I am sincere in my mind when I say I will try very hard to make
it so. I also know that the mushroom drug, in group discussions,
and tests, the group therapy is most important. Because there
is then also an opening of the mind, and you also get a better
understanding of yourself and also the people who are in your
group. You feel more free to say and discuss things, which you
generally do not do."
He was discharged some weeks later, unexpectedly released from
several outstanding warrants and was rather disoriented by the
sudden change. However, he obtained a job with a construction
company, he worked ten to thirteen hours a day and one month later
was promoted to assistant foreman of a small crew. He and two
friends subsequently started an auto body paint shop. A few months
later he became assistant cook in a large restaurant. Two years
later he was still out of prison and working successfully.
Evaluation: Our evaluation research was designed
as follows. After a series of pilot group experiences involving
a total of nine inmates, the main treatment group of 12 men was
run through the program from September to October, 1961. The men
met in 4 groups of 3 inmates each, with one psychologist and one
inmate from the pilot groups serving as group leaders. A control
group of ten men was given the pre- and post-tests at the same
time as the treatment group, but did not have any other contact
with the program. After the first six-week program they then became
the second experimental group, with members of the first group
serving as assistant leaders.
The Design Diagrammatically:
| TESTS | SIX WEEKS | TESTS | SIX WEEKS | TESTS |
| Experimental Group | I | TREATMENT | II | — | — |
| Control group | I | NOTHING | II | TREATMENT | III |
The actual results will be presented separately for the three
sets for data—personality tests, behavior ratings and return
rates.
A. Personality Tests. Table I
shows the MMPI scores from
pre- and post-tests for the pilot and experimental groups.
It should be remembered that the schedule and time-period intervening
between pre- and post-tests for the pilot subjects was somewhat
longer and more variable than for the experimental subjects. The
number of subjects involved in the analysis is less than the total
sample owing to incomplete test-protocols or subject dropout.
All means are based on T-scores, except for the ego-strength scale,
which is based on raw scores. It will be seen that although on
several of the scales (D, Pd. Sc, Ma) there are changes in the
expected direction, these are not significant. The drop in the
psychopathic deviate scale is almost significant at the .05 level.
The significant decreases in the two validity scales (L and F)
indicate that subjects are less likely to put on a good front
or answering at random after the treatment program.
Table II shows the MMPI scores for the Control
group before the control period (I), at the end of the control period and before
treatment (II), and after treatment (III). Three comparisons were
made, all using Wilcoxon signed-rank tests and 2-tailed probability
levels. Comparing I and II no difference was predicted and none
was found. Comparing the changes from I to II with the changes
from II to III it was predicted the latter would be greater. However,
the differences were not significant on any of the scales. It
will be noted that on several of the scales (Hy, Pd. Pt. Sc) there
is a U-shaped trend, with a tendency for scale scores to rise
on the third testing after the treatment. This might reflect some
peculiar effects due to repeated testing. The fact that the mean
F-score did not change also indicates that the validity of these
post-treatment scale scores is somewhat doubtful. When I and III,
i.e., first and last tests are compared, only the D-scale shows
a significant decrease (p < .02 ) .
Table III
shows the mean scale scores from the CPI (California
Psychological Inventory) for the pilot and experimental groups.
Again, significance of change was estimated for the experimental
group alone and for pilot and experimental groups combined. Significant
increases are shown on 12 out of 18 scales, the most marked being
on Sociability, Sense of Well-Being, Socialization, Tolerance
and Intellectual Efficiency. The socialization-maturity scales
(Re, So, Sc) and the achievement scales (Ac, Ai, Ie) as a group
all show significant increases. Table IV
shows pre- middle- and
post-tests for the control group. None of the changes from I to
II are significant except an increase in Good Impression ( p<
.01), which occurs also in the experimental group. Except for
this scale then, the treatment group changed significantly more
than the control group. For the final testing (III) only 7 subjects
were available, hence the comparison of changes from I to II with
changes from II to III, as well on the overall change from I to
III becomes very unreliable. In fact, none of the differences
are found to be significant, although they are in the predicted
direction. There is however a significant increase from I to III
on the Dominance scale for the control group (p < .05).
A different method of analysis is to compute change-scores for
each subject and compare mean change-scores in the experimental
and control groups, using the Mann-Whitney U-Test. This is a direct
estimation of the significance of difference in change, rather
than the indirect method of comparing pre- and post-test scores
in the two groups. On the MMPI only the decreases on the F and
K scales are significantly greater in the experimental than the
control group (p. 10). On the CPI the increase in Tolerance (To)
for experimental subjects (N = 20) is significantly greater than
for control subjects (N = 12); the two-tailed p-value is <.05.
The increase in Achievement via Conformity (Ac) is significantly
greater for experimental subjects (N = 12) than for the control
subjects (N' = 12); the two-tailed p-value is <.10.
Interpretation. There are two problems which make
the interpretation of these data difficult. One is artificial,
one is substantive. The artificial problem is that the
final test scores (III) of the control group are not apparently
very reliable, and hence the within-group comparison cannot be
made adequately. The substantive problem is that given
the existence of significant changes after the treatment program
on the CPI it is not known which features of the program are responsible
for the changes. Firstly, the fact that most participants are
about two to three months removed from parole introduces some
ambiguity. Wheeler ( 1961 ) has shown that there is increasing
conformity to staff and community norms in prisoners' attitudes
just prior to release. However, two facts make this explanation
of the data implausible: (1) the changes observed by Wheeler occurred
in the last six months prior to parole—there is no evidence
to suggest that this trend is continued linearly over such short
periods as 6 weeks; (2) this general norm-shifting effect should
apply to the control group also, which, as we have seen, does
not change. A second factor is the possibility that the feedback
of results has simply made the subjects "test-wise"
and this can account for all the variance. Although the tests
were taken honestly i.e., there was no possibility of memorizing
all the items of a scale and their direction, it is true that
we do not know whether the feedback alone could have produced
these results. We can only say now that this requires further
analysis. For example, eventually, it will be possible to correlate
success on parole with changes in personality tests. Ferdinand
(1962) reports similar CPI changes in a group of juvenile offenders
treated by "milieu therapy."
The Sentence Completion Test used here (cf. Watt
and Maher, 1958) consists of the responses to 41 sentence stems,
coded according to a five-point scale from "extreme disapproval,
non-conformity, very negative" (1) to "praise, approval,
conformity, extremely positive" (5). The content of the stems
covered a variety of social institutions, e.g., law, family,
sports, arts, business. etc. Three scores were computed for each
person: (1) mean across all items, (2) frequency of very positive
responses4's and 5's, and (3) frequency of very negative
responses1's and 2's. Table V
shows the means for two groups—the pilot plus experimental and
the control group. On the mean "positive
attitude" score the experimental and the controls increase,
but the experimental group more. When only the extreme positive
or negative 'responses are counted the experimental group changes
(positively), the control group does not. Again the results from
the third test are bedeviled by sample shrinkage. Since this test
was not used in the feedback program, it is not subject to the
same confounding variables as the MMPI and CPI. It would seem
that a concomitant of the program is a decrease in cynical and
hostile attitudes towards a variety of social institutions.
B. Behavior Ratings. Two types of behavior ratings
by independent observers were collected, but both are subject
to many sources of unreliability. (1) The regular quarterly institutional
work reports, by the inmate's work-instructor are six rating
scales covering work competence, industry, co-operativeness, etc.
When July, September and December work reports were examined there
were not consistent trends on any of the scales over the period
of the program; nor were there any significant differences between
experimental and control groups. However, the samples in this
analysis are very small (4 to 9) and the ratings are made by different
observers. Thus the absence of discernible trend is not really
surprising. (2) A special rating sheet for officers was
constructed on eleven areas of interaction and behavior (see Appendix).
The "experimental group" here consists of 13 men still
in the prison who had gone through the program; the "control
group" are a matched sample, selected according to the same
criteria, but never having had any contact with the project at
all. Again, there is the problem of the effects of different raters,
and their possible bias about the project affecting their judgments.
With these reservations in mind, Table VI
provides some suggestive
evidence. The results are given in mean ratings (the scales were
either four- or five-point) and the significance of differences
was computed by means of chi-square. None of differences between
the groups are significant, but 4, 5. 6. (which approach significance)
very tentatively suggest that participants are seen as less excitable
and as getting along better with officers and with other inmates.
C. Return Rates. One and a half years after termination
of the project (18-26 months after release from prison). The recidivism
rate in this project does not differ from the expected rate derived
from base-rates for the Concord Reformatory as a whole (Metzner
& Weil. 1963). In that study 56% of the 311 men released from
Concord during 1959 had returned two and a half years later. Out
of the 32 men involved in the project, four are still in prison
and one escaped. These must therefore be omitted. Of the 27 men
released, 11 are still on the street and 16 have returned, a return
rate of 59%.
Expected Rate of Return by Type of Return
In the base-rate study half of the recidivists were returned for
parole violations and half for new offenses. These two types were
then combined for further calculation of predictive categories.
In other words we would expect 28% of the released men to be returned
as parole violators and 28% as new offenders. When we look at
the figures actually obtained, we see that only two out of the
27 men (7%) were returned for new offenses, while 14 out of 27
(52%) were returned as parole violators. This discrepancy has
a probability of less than .01 of occurring by chance, using the
binomial distribution. In other words there is a significant reduction
in the rate of new crimes and a significant increase in the rate
of parole violations. This dual effect accounts for the lack of
difference when the overall rate of return is considered.
One may speculate about the reasons for the rise in parole violation.
Perhaps the men on the psilocybin project received an extra careful
degree of parole supervision. The project had aroused a lot of
interest in the Department of Correction, and it was impossible
to prevent the parole officers from knowing which of their charges
had been involved in it.
Expected Rate of Return by Prognostic Categories
In the base-rate study referred to above, expectancies were computed
for six different sub-classes of offenders. The categories were
obtained empirically on the basis of their predictive efficiency.
Thus for example, men with no prior arrests and no prior commitments
have an expected return rate of 22%. Men with prior commitments,
who committed offenses against a person (but not sex offenders)
or against property and who are non-white, have an expected return
rate of 86%. Thus, these categories enable one to obtain a more
precise expectancy for any particular sample than simply the overall
rate.
Table VII
compares for each category the percentage returning
in the experimental and base-rate samples.
Although the experimental subsamples are too small to make statistically
valid comparisons, the figures indicate a reduced return rate
in groups (1) and (6) and an increased rate in group (2). It should
be remembered that these figures for new offenses and parole violations
are combined and therefore do not enable one to specify in what
category a significant reduction of new crimes occurred.
Conclusion. Of the three types of evaluation, the
most important is the rate of return. It is a completely objective
behavioral index, not subject to any of the distortions of personality
tests and clinical impressions. The main conclusion can be stated
as follows: One and one half years after termination of the program
the rate of new crimes has been reduced from 28% to 7%, although
if parole violations are counted the overall return rate has not
changed. It is proposed that these results warrant further research
into the potentials of the methods used, especially since no other
method of reducing the crime rate exists.
FUTURE DEVELOPMENTS
From our experience in this project we would offer the following
suggestions for an improved rehabilitation program designed to
decrease the recidivism rate of offenders with relatively short
sentences.
If the core of the rehabilitation or change process is some form
of intense group experience designed to bring about insight then
it is essential that the environment in which this insight takes
place is supportive of applying such insights to behavior. The
ideal solution to this problem is to involve the entire institution,
officers, psychologists, as well as inmates, in a joint change
process, as in the Herstedvester Center in Denmark (Stürup,
1959). We have attempted to tackle this problem by placing some
responsibility for stimulating behavioral change on older, more
experienced inmates.
It is highly undesirable to have an inmate return to the same
frustrating environment after experiencing an internal liberation.
An alternative would be to have the group experience (whether
it involves drugs or not) occur outside of the prison, immediately
after release, in a special transitional center. This would serve
both as a sort of retreat for internal change and as a halfway
house to prepare the convict for regular life on the streets.
The second suggestion concerns the importance of the follow-up
period. Many convicts are reluctant to get involved in middle-class
activities. The doctor-patient model, in which a client regularly
visits the office of a professional, is simply not applicable.
In practical terms, the "therapist" must be prepared
to visit his clients at all times of the day or night in bars
or homes, to help find employment, to lend money, etc., because
these are the accepted "tests" of a trusting relationship.
This is not to say that there should be no structure at all to
the relationship, but the structure should come from a definite
contractual agreement about the purposes of contacts—and not
from arbitrarily imposed space-time limits. For further elaboration
of these two ideas see the discussions by Leary (1961), Schwitzgebel
(1961) and Eissler (1950) .
Footnotes
1. The help, advice and encouragement of the
following persons are gratefully acknowledged: Edward W. Grennan,
Superintendent of Massachusetts Correctional Institution, Concord;
David C. McClelland, Ph.D., Director of the Center for Research
in Personality, Harvard University; Norman A. Neiberg, Ph.D.,
Director of Psychological Research in the Division of Legal Medicine;
and David Houghey, Ph.D., Director of Psychological Research in
the Department of Correction; Bernard Dee, Institutional Parole
Officer; William P. Ryan, head Correctional Social Worker; Cornelius
Twomey, Chairman of the Parole Board and Martin Davis, Chief of
Parole Division The following graduate students contributed actively
to this program: Stephen Berger, Jonathan Clark, Don Fowles, Rudolf
Kalin, David Kolb, George Litwin, Jonathan Shay, James Uleman;
and Michael Hollingshead. (back)
2. Grateful acknowledgment is also made to
Sandoz Pharmaceuticals, and its director, Carl Henze, M.D., for
supplying us with psilocybin and for his continued interest and
cooperation in our program. (back)
3. The pilot group usually had three sessions;
some of the later group members also participated as assistant
group leaders, hence the number of psilocybin sessions is not
constant. The actual distribution is as follows: 15 had two sessions,
9 had three, 4 men had four and 5 had five. One man, a chronic
alcoholic and multiple parole violator, was given the drug once
outside of the regular program; he is not included in the main
sample. We feel that alcoholics present a special problem and
have not attempted to cope with it here. Other investigators,
however, (Chwelos. et al., 1959) have reported considerable
success using LSD-25 with alcoholics. (back)
Tables
Table I
Mean Minnesota Multiphasic Personality Inventory Scores of Pilot and Experimental Groups(back to text)
| Pilot Group (N=8) | Experimental Group (N=11) | Significance* |
|---|
| Scale | pre | post | I—pre | II—post | A | B |
| L | 50.1 | 50.1 | 54.9 | 49.6 | p<.01 | NS |
| F | 64.7 | 50.2 | 60.5 | 53.1 | p<.05 | p<.01 |
| K | 57.1 | 51.1 | 52.4 | 51.0 | NS | NS |
| Hs | 51.0 | 45.5 | 47.5 | 46.6 | NS | NS |
| D | 61.1 | 50.1 | 58.8 | 52.7 | NS | NS |
| Hy | 58.0 | 56.1 | 53.0 | 54.7 | NS | NS |
| Pd | 77.8 | 73.6 | 71.1 | 60.0 | NS | near |
| Mf | 50.9 | 50.7 | 62.3 | 62.7 | NS | sig.<.05 |
| Pa | 50.1 | 50.5 | 56.1 | 56.6 | NS | NS |
| Pt | 50.6 | 50.4 | 56.9 | 51.5 | NS | NS |
| Sc | 62.1 | 50.6 | 58.2 | 52.7 | NS | NS |
| Ma | 65.0 | 65.6 | 66.8 | 64.2 | NS | NS |
| Si | 50.2 | 46.1 | 47.4 | 49.2 | NS | NS |
| Es | — | 50.0 | 47.2 | 46.9 | NS | NS |
Col. A: Significance of difference from pre- to post-test for Experimental Group
Col. B: Significance of difference from pre- to post-test for Pilot and Experimental Goups combined
* All significance estimates made with Wilcoxon signed-rank test. Probability levels are two-tailed.
(back to text)
(back to text)
Table II
Mean Minnesota Multiphasic Personality Inventory Scores of Control Group
| Controls (N=9) |
|---|
| Scale | I | II | III |
| L | 44.3 | 34.8 | 43.1 |
| F | 65.1 | 64.9 | 63.9 |
| K | 45.7 | 48.3 | 48.7 |
| Hs | 49.4 | 47.8 | 48.7 |
| D | 62.2 | 59.7 | 57.1 |
| Hy | 53.0 | 49.7 | 53.9 |
| Pd | 76.8 | 68.8 | 79.7 |
| Mf | 56.4 | 52.7 | 55.4 |
| Pa | 54.7 | 56.8 | 59.9 |
| Pt | 61.8 | 58.9 | 62.1 |
| Sc | 66.3 | 61.9 | 65.7 |
| Ma | 67.8 | 67.8 | 72.3 |
| Si | 57.3 | 55.9 | 53.1 |
| Es | 44.4 | 46.1 | 46.4 |
(back to text)
(back to text)
Table III
Mean California Personality Inventory Scores of Pilot and Experimental Groups
| Pilot Group (N=8) | Experimental Group
(N=12) | Signif.* | Signif. |
|---|
| Scale | pre | post | I—pre | II—post | Exp. gr. | Pilot & Exp.
N=20 |
|---|
| Do | 49.1 | 56.4 | 50.4 | 51.0 | NS | NS |
|---|
| Cs | 54.3 | 61.0 | 49.1 | 54.6 | NS | p< .01 |
|---|
| Sy | 53.4 | 58.5 | 47.3 | 56.0 | p< .02 | p< .01 |
|---|
| Sp | 57.5 | 62.4 | 52.4 | 59.5 | p< .02 | p< .01 |
|---|
| Sa | 63.0 | 61.0 | 56.3 | 56.3 | NS | NS |
|---|
| Wb | 46.1 | 54.5 | 43.0 | 52.5 | p< .01 | p< .01 |
|---|
| Re | 34.4 | 47.0 | 33.2 | 41.0 | p< .05 | p< .01 |
|---|
| So | 32.6 | 41.8 | 31.9 | 40.4 | p< .02 | p< .01 |
|---|
| Sc | 42.8 | 48.9 | 38.9 | 46.3 | p< .05 | p< .01 |
|---|
| To | 42.2 | 52.1 | 41.8 | 49.5 | p< .02 | p< .01 |
|---|
| Gi | 45.5 | 53.4 | 40.2 | 48.5 | p< .01 | p< .01 |
|---|
| Cm | 53.8 | 56.4 | 52.6 | 54.6 | NS | NS |
|---|
| Ac | 45.6 | 54.6 | 39.9 | 47.2 | NS | p< .01 |
|---|
| Ai | 48.0 | 53.6 | 44.0 | 49.0 | NS | p< .02 |
|---|
| Ie | 48.1 | 57.4 | 43.5 | 52.3 | p < .05 | p< .01 |
|---|
| Py | 44.0 | 51.2 | 46.8 | 47.1 | NS | NS |
|---|
| Fx | 50.8 | 52.0 | 51.4 | 48.3 | NS | NS |
|---|
| Fe | 50.0 | 48.3 | 52.2 | 51.6 | NS | NS |
|---|
*Wilcoxon signed rank test two-tailed.
(back to text)
(back to text)
Table IV
Mean California Personality Inventory Scores of Control Group
| Controls (N=12) |
|---|
| Scales | I | II | III (N=7) |
|---|
| Do | 34.1 | 34.7 | 40.7 |
|---|
| Cs | 38.9 | 40.2 | 46.0 |
|---|
| Sy | 37.9 | 41.9 | 46.6 |
|---|
| Sp | 49.8 | 52.2 | 51.6 |
|---|
| Sa | 55.0 | 52.7 | 53.3 |
|---|
| Wb | 32.7 | 38.1 | 43.6 |
|---|
| Re | 25.8 | 26.4 | 32.0 |
|---|
| So | 22.6 | 27.8 | 26.3 |
|---|
| Sc | 31.5 | 38.5 | 41.0 |
|---|
| To | 32.7 | 33.3 | 42.7 |
|---|
| Gi | 33.3 | 40.6 | 42.1 |
|---|
| Cm | 46.7 | 48.1 | 50.4 |
|---|
| Ac | 27.5 | 31.7 | 34.0 |
|---|
| Ai | 38.5 | 40.2 | 45.6 |
|---|
| Ie | 28.4 | 32.3 | 39.7 |
|---|
| Py | 37.2 | 42.3 | 44.6 |
|---|
| Fx | 58.3 | 56.4 | 52.9 |
|---|
| Fe | 48.0 | 50.8 | 54.3 |
|---|
(back to text)
(back to text)
Table V
Sentence Completion Test Data
| Pilot & Experimental Groups (N=19) | Control Group (N=11) |
|---|
| Measure | Pre | Post | Signif.* | I | II | III
(n=6) | I vs II | II vs III |
|---|
| Mean | 2.99 | 3.15 | p<.01* | 3.05 | 3.13 | 3.20 | p<.05* | NS |
|---|
| Freq. Pos. | 10.7 | 13.6 | p<.01** | 12.8 | 13.3 | 14.5 | NS | NS |
|---|
| Freq. Neg. | 10.9 | 9.5 | p<.01** | 7.8 | 7.4 | 8.7 | NS | NS |
|---|
*t-test, 2-tailed
**Wilcoxon sign rank test, 2-tailed
(back to text)
(back to text)
Table VI
Means of Officers' Ratings
| Question | Exp. X(N=12) | Control X(N=12) |
|---|
| 1. Cooperative | 3.5 | 3.5 |
| 2. Hardworking | 2.8 | 3.2 |
| 3. Responsible | 3.0 | 2.8 |
| 4. Not excitable | 2.8 | 2.4 |
| 5. Getting along with officers | 3.0 | 2.7 |
| 6. Getting along with inmates | 3.1 | 2.5 |
| 7. Influence | .75 | 1.0 |
| 8. Talk with officers | 1.5 | 1.8 |
| 9. Friends | 1.6 | 1.7 |
| 10. Parole success | 2.5 | 2.6 |
| 11. Estimate of proiect | 2.0 | 1.8 |
(back to text)
(back to text)
Table VII
Rates of Return by Prognostic Categories
| Description | Base-Rate Sample | Psilocybin Sample |
|---|
| N | % Return | N | % Return |
|---|
| 1. No prior commitments; no prior arrests | 23 | 22 | 2 | 0 |
2. Some prior commitments sex offender or parole violator
whose age at last commitment was more than 24 | 27 | 30 | 3 | 100 |
| 3. No prior commitments but some prior arrests | 59 | 37 | 3 | 33 |
4. Sex offenders or parole violators with prior
commitments aged 24 or less at last commitment | 44 | 61 | 3 | 67 |
5. Some prior commitments; offense against person (except sex),
against property or combination; whites | 137 | 69 | 13 | 62 |
6. Some prior commitments; offense against person (except sex)
against property or combination; other ethnic group | 21 | 86 | 3 | 67 |
| Combined | 311 | 56 | 27 | 59 |
(back to text)
References
ABRAHAMSON, H. A. "Lysergic acid diethylamide (LSD-25): III.
As an adjunct of psychotherapy with elimination of fear of homosexuality,"
J. Psychol., 39, 127, 1955.
BLEWETT, D. B., & CHWELOS, N. Handbook for the therapeutic
use of lysergic acid dietltylamide-25: Individual and group procedures,
1959. CAMPBELL., D. T. "Factors relevant to the validity
of experiments in social settings." Psychol. Bull.
54, 297-312, 1957.
CARTWRIGHT, D. Achieving change in people. Hum. Rel., 14,
38l-392, 1951.
CHEWELOS, N., BLEWETT, D. B., SMTTH, C., & HOFFER, A. "Use
of LSD-25 in the treatment of chronic alcoholism." Quart.
J. Stud. Alcohol., 20, 577, 1959.
CUTNER, M. Analytic work with LSD-25. Psychtiat. Quart.
33, 715-757, 1959.
DUCHE, D. J., & LAUT, J. "Effets de la psilocybine dans
un cas d'hysterie. Annales Medico-Psychologiques, 119 (3),
590, 1961.
EISSLER, K. Ego-psychological implications of the psychoanalytic
treatment of delinquents. Psychoanal. Study of the Child,
5, 97-121, 1950.
EYSENCK, H J. The effects of psychotherapy. In Handbook of
Abnormal Psychology, ed. H. Eysenck, New York: Basic Books,
1961.
FRANK, L. K. Change through group experience. Social Welfare
Forum, Proc. Nat. Conf. Soc. Welfare, Chicago, New York: Columbia,
1958. Pp. 225-268.
FERDINAND, T. N. An evaluation of milieu therapy and vocational
training as methods for the rehabilitation of youthful offenders.
J. Crim. Law, Criminol., Police Sci., 53, 49-54, 1962
FOX, V. Group methods in criminology. Group Psychother.
15, 40-45, 1962.
GOFFMAN, E. Characteristics of total institutions. In Symposium
on Preventive and Social Psychiatry, 43-84. Washington, D.C.:
Walter Reed Army Institute of Research, 1957.
HEARD, G. Training for a Life of Growth Santa Monica: Wayfarer
Press, 1959.
JENKINS, D. H. Feedback and group self-evaluation. J. Soc.
Issues, 4, 50-60, 1948.
KONOPKA, G. Group Work in the Insitution. New York: Morrow,
1954.
KONOPKA, G. The generic and the specific in group work practice
in the psychjiatric setting. H.B. Trecker, (ed.) New York: Whiteside,
1956.
LEARY, T. How to change behavior. In: G. Nielsen (ed.) Intern.
Congr. of Appl. Psychol., Copenhagen, 1961. (Vol. IV)
LEARY, T., LITWIN, G., & METZNER, R. Reactions to psilocybin
in a supportive environment. J. nerv. ment. Dis. 1963 (in
press), 137, 567-578.
LEVIT, G., & JENNINGS, H. H. Learning through role playing.
In: Planning of Change. Bennis, W. G., Benne, K. D. &
Chin, R. (eds.), New York: Holt, 1961. Pp 706-710.
Massachusetts Commissioner of Correction. Statistical Report.,
1959.
McCORKLE, L. W., ELIAS, A. & BIXBY. F. L. The Highfields
Story: An Experimental Treatment Project for Youthful Offenders.
Next York: Holt, 1958.
METZNER, R., & WEIL, G. Predicting Recidivism: Base Rates
for Massachusetts Correctional Institution Concord. J. Crim.
Law, Criminol., Police Sci., 1963, 54, 307-316.
MORENO, J. L. Psychodrama. In: S. Arieti, (ed.), American Handbook
of Psychiatry. New York: Basic Books, 1959. Pp. 1375-1396.
O'HALLORAN, W. Group psychotherapy and the criminal---an introduction
to reality. Am. J. Correction 1961.
ROSOW, H. M. Some observation on group therapy with prison inmates.
Arch. Crim. Psychodyn. 1955.
SANDISON, R. A. Psychological aspects of the LSD treatment of
the neuroses. J. Ment. Sci., 100, 508, 1954.
SCHWITZGEBEL, R. Critical analysis and evaluation of the experimenter-subject
role relationship in the reduction of known male adolescent crime.
Ed.D. Dissertation, Harvard University, 1962.
SLATER, P. E. Displacement in groups. In: Planning of Change.
Bennis, W. G., Benne, K. D., & Chin, R. (eds.), New York:
Holt, 1961. Pp. 725-786.
STÜRUP, G. Group therapy with chronic criminals. Acta
Psychother. 7, (Suppl.), 377-385, 1959.
SUTHERTLAND, E. H. Principles of Criminology, Philadelphia:
Lippincott, 1955.
SZASZ, T. The Myth of Mental Illness. New York: Hoeber-Harper,
1961.
TENNENBAUM, B. Group therapy with LSD-25. Dis. Nerv. Syst.,
22, 459-492, 1961.
WATT, N., & MAHER, B. A. Prisoners' attitudes toward home
and the judicial system. J. Crim. Law., Criminol., Police Sci.,
49, 327-330, 1958.
WHEELERS S. Socialization in correctional communities. Amer.
Sociol. Rev. 26, pp. 697-712, 1961.
|
