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LSD — The Problem-Solving PsychedelicP.G. Stafford and B.H. GolightlyChapter VII. LSD and Mental HealthI had a vision, and I still have this vision, of mass therapy: institutions in which every patient with a neurosis could get LSD treatment and work out his problem largely by himself. Classical psychotherapy or psychoanalytical therapy is, of course, a costly procedure, and most people do not have enough money to undertake it; nor do we have health benefits to pay for individual psychotherapy. I hope that there will eventually be health insurance funds to pay for LSD therapy. COMPARED TO OTHER public health problems, mental illness is a giant, half hidden in shadow. The statistics are appalling: an estimated 17 million persons in the United States suffer from some form of mental disorder; approximately 700,000 patients are in mental hospitals; over a quarter of a million enter mental institutions each year; an estimated 3 billion dollars is spent annually in costs to combat this problem; and to aid the mentally disordered there are only 12,000 psychiatrists practising in the entire country. Apart from the lamentable statistics, the unknown quantity of personal tragedy involved is impossible to assess. For every person suffering from mental illness, there are many others who are directly affected. The patients themselves are not simply maladjusted, unhappy people who nonetheless manage to function, but those who have little or no contact with reality, despite longing and strenuous effort. A visit to a mental hospital confirms this in a harrowing way. The fact is that in spite of the isolation of the mentally sick from the community, once hospitalized, they are still very much among us, although virtually ignored. Few beside hospital personnel and visitors are aware of the agony and terror suffered by the paranoiac; by hearing voices; by constantly fearing imminent death; by feeling that a chair is a mortal enemy; by screaming incessantly and uncontrollably; by losing all memory; and by being locked up. The steps taken in the last fifteen years in treating mental illness are large and impressive, coming, however, after centuries of unbridled growth of such disease. Inhumane treatment, bedlams, shock treatments, "snakepits," lobotomies and strait jackets are on their way out as a result of crusaders (such as Dorothea Dix, the Kennedy family and Albert Deutsch) and crusading organizations, such as the National Association for Mental Health; the widespread use of tranquilizers in treatment; increased hospital personnel; and more active public interest and awareness of the problem. For the first time in history there is sound basis for hope that mental illness can be controlled and that the disturbed individual may not be consigned for life to his sickness. Encouraging as this may be, it is a mistake to think that the end is yet in sight. In Action for Mental Health, the most comprehensive and penetrating appraisal of present-day needs (resulting from a five-year study involving 34 agencies), the situation is sharply summed up: more than 50,000 persons die in mental hospitals every year, not including 8,000 additional homicides and 16,000 suicides. As for public concern: The prevailing system, with few exceptions, has been to remove the acutely ill of mind far from the everyday scene—to put them away in human dump heaps.... The facts so arouse a sense of guilt that, even within the mental health professions, we would rather not dwell on them. Pointing in severe criticism at the current system which leaves mental care to the States, which "for the most part, have defaulted on adequate care for the mentally ill, and have consistently done so for a century," this report calls for a massive program to deal with the problem. "Expenditures for public mental patient services should be doubled in the next five years—and tripled in the next ten. Only by this magnitude of expenditure can typical State hospitals be made in fact what they are now in name only—hospitals for mental patients." (Emphasis in original. ) In 1949, Albert Deutsch, after visiting two dozen mental institutions, wrote: Most of them were located in or near great centers of culture in our wealthier states such as New York, Michigan, Ohio, California, and Pennsylvania. In some of the wards there were scenes that rivaled the horrors of the Nazi concentration camps—hundreds of naked mental patients herded into huge, barn-like, filth-infested wards, in all degrees of deterioration, untended and untreated, stripped of every vestige of human decency, many in stages of semi-starvation.There is a tendency on the part of the public to minimize such reports because it is commonly believed that "miracle drugs," particularly tranquilizers, have worked all miracles available and that there is no longer need for serious concern about the mental health problem. Actually, this is not the case. What has happened is that tranquilizers have made it possible to dispense with strait jackets, padded cells and other means of physical restraint. Also, these drugs and the energizers have made patients somewhat more accessible to psychotherapy, hence enabling them to be released in shorter periods of time than before. In New York State, which uses tranquilizers on a large scale, the average hospital stay has been cut from eight to four months. When the patients return to their communities, they are able to obtain adequate maintenance therapy, primarily through prescribed tranquilizers and energizers. (Despite complicated side effects, the anti-depressants—monoamine oxidase inhibitors—are now being used in the treatment of over four million Americans per year.) But for all this, hospital admission rates for the mentally ill continue to rise. Therefore, it is clear that these drugs now in use, and some three hundred others being clinically tested, are not solving the problem. With LSD, however, the psychiatric profession for the first time seems to have a means for dealing effectively with some of the deeper problems of mental disease which elude the tranquilizers and energizers. Medical reports indicate that LSD dramatically reaches into the roots of the disorder, rather than merely disposing of the symptoms and easing the patient. In some cases—with catatonics and autistic children, for instance—the therapist finds himself able to make contact with the patient for the first time since onset of the illness. As Dr. Gordon H. Johnsen[1] puts it: During the first two years of our work with these compounds, we were in doubt of their value... We now consider that they give us therapeutic possibilities in areas where we were formerly powerless. In fact these drugs are of such great importance in our psychiatric instrumentarium that we can hardly think of doing without them. Indeed, this is a great step forward in psychiatry. In agreement with Dr. Johnsen, a high percentage of psychotherapists who have worked with LSD believe that the drug, in many ways, may be the answer to Freud's hope for a chemical which could exercise a "direct influence... upon the amounts of energy and their distribution in the apparatus of the mind"... and thus open up "undreamed-of possibilities of therapy." Throughout his writings, Freud repeatedly deplored the fact that there were no exact tools for direct dealing with the patient's deeper disorders, and he voiced hope that the future would see this need fulfilled: We are here concerned with therapy only insofar as it works by psychological methods: and for the time being we have no other. Behind every psychoanalyst stands the man with the syringe. Psychoanalysis never claimed that there were no organic factors in the psychoses.... It is the biochemist's task to find out what these are.... So long as organic factors remain inaccessible, analysis leaves much to be desired. When LSD was first tested, it was given to volunteers in the hope of inducing a temporary facsimile of psychosis that could be studied. At that time clinicians thought this to be LSD's sole function. Many teams of experimenters undertook such projects in the belief that by creating schizoid-like states under controlled conditions, they would be closer to a cure. After all, malaria, yellow fever, tuberculosis and diabetes, for instance, had yielded to medical science following the artificial production of the disease, and by analogy researchers around the world hypothesized that schizophrenia might yield in the same manner. But this was not to be. First of all, it was discovered that the hallucinations produced under LSD were quite different from those of psychosis—for the most part they were visual rather than auditory. Also, it was found that certain drugs could terminate the LSD "psychosis" but were totally ineffective with natural schizophrenia Even so, through these experiments great impetus had been given to the research on mental illnesses, and investigators began to pay serious attention to the possible biochemical basis of mental abnormality, studying serotonin, epinephrine, adrenaline, the "M" substance, nicotinic acid and adrenochrome. Although the facsimile or "model" psychosis theory was eventually abandoned by most researchers, LSD was not. It was found that the drug did have an important place in therapy for, as mentioned previously, it "abreacts" the patient to early traumas, creates exceptional rapport between patient and therapist and, consequently, facilitates transference. In this regard, British psychiatrist Dr. R.A. Sandison, one of the first practitioners to recognize the potentials of LSD, made the following statement to some of his colleagues: There are good reasons for believing that the LSD experience is a manifestation of the psychic unconscious, and that its material can be used in psychotherapy in the same way that dreams, phantasies and paintings can be used by the psychoanalysts. In documenting this statement, Dr. Sandison gave evidence that the drug was, in his experience, a successful, safe treatment for intractable neurotics and that in other cases, such as the compulsive obsessive, the results were often spectacular.[2] One reason why LSD has not been more widely used in therapy—despite its demonstrable effectiveness—is that it may have been "too effective." Highly excited reports, which by now number well over two thousand, have, as Dr. Buckman put it, "succeeded in antagonizing" much of the informed psychiatric opinion: Many therapists were outraged because of this threat to their omnipotence. Many were justifiably concerned about the irresponsible use of a powerful drug on unsuspecting patients or volunteers. As a reaction to the early reports that the answer to the problem of mental illness was here, at last, there began to appear publications stressing mostly the dangers of suicide and psychosis, and accusing those who were using LSD of charlatanry and self-deception. In actuality, any contra-indications of the use of LSD in treatment of mental patients are minimal when the therapist is thoroughly educated in the drug and its action. In 1960 Dr. Sidney Cohen undertook an extensive survey of psychedelic use to determine the nature of possible drawbacks. He wrote to 62 European and American investigators who had published papers on their work in LSD therapy. Forty-four replied with detailed data on the dangers of psychedelic treatment; the accumulation represented over 5,000 patients and 25,000 sessions covering a dosage range of from 25 mcg. to 1500 mcg. In the survey, no serious physical complications were reported—even when the drugs were given to alcoholics with generally impaired health. (This was a somewhat unexpected result, since many of these individuals had diseased livers, a condition which previously it had been assumed would produce an adverse drug reaction.) There was also a surprisingly low incidence of major mental disturbances. Despite the profound psychic changes that occur while a subject is under the influence of LSD or mescaline, psychotic reactions lasting longer than 48 hours developed in fewer than 2/10ths of one per cent of the cases. The attempted suicide rate was just over 1/10th of one percent. Not one case of addiction was reported. If this sampling of five thousand drug users is divided into two classes—the mentally sound volunteers and the mentally unstable—the results seem even more encouraging. Among those who had simply volunteered for LSD or mescaline experiments, major or prolonged psychological complications almost never occurred. In this group, only one instance of a psychotic reaction lasting longer than two days was reported, and there were no suicides. Among the mentally ill given the drugs, however, prolonged psychotic states were induced in one out of every 550 patients. In this group, one in 830 attempted suicide, and one in 2500 carried the attempt through. In evaluating the statistics, it should be pointed out that at the time of the survey (1960) the proper use of the drug in therapy was not well understood, and that at least some of the negative reactions were deliberately brought about, as many of the doctors were trying to produce "model psychoses" in their patients. Nevertheless, the statistics clearly showed that contra-indications to the use of the drug were lower than those normally encountered in conventional psychotherapy. Since 1960, new LSD therapeutic techniques have been introduced and methods of administering the drug have been refined. These advances have resulted in further reduction of potential hazards. Dr. Hanscarl Leuner, an outstanding European expert on psycholytic therapy, has this to say about Cohen's report: Cohen... showed very well how low the relative risk of the therapy is, if it is carried out responsibly by qualified doctors. Thus, we actually are threatened less by adverse results, or severe complications, than we had to assume at the start. Our experience has shown that this risk can be reduced practically to zero in a well-institutionalized therapy, as in our clinic. This holds for the activation of depressions and schizophrenic psychoses, as well as attempted or successful suicides. Some of LSD's therapeutic unpopularity may be attributable to the strain put upon credulity by the use of the term "miraculous" in describing results the drug has brought about. Rauwolfia was synthesized in 1947 and chlorpromazine was manufactured in 1953; both were put into use almost immediately by physicians throughout the United States. The tranquilizers are far easier to understand in their action than are the psychedelics since they do not bring about any impressive or long-lasting behavior change. As long as the patient responds to the tranquilizers and uses them regularly, he maintains the desired well-being; should he become immune to them or give them up, he reverts. This seems reasonable enough. But with the psychedelics, change in the patient is often so radical that the ensuing case history, with its vivid content, may be viewed with suspicion by those who are unfamiliar with the field. It bears repeating that many professional researchers who have made use of the drug feel that cure has come about through what is essentially a "religious" conversion. This explanation is in itself an excellent means for alienating those medical practitioners who are oriented to traditional therapeutic concepts. Consequently, when LSD therapists speak of their gains, they are inclined to confine themselves to the subjects of abreaction and transference, which fit conventional attitudes, rather than to refer directly to the suspect territory of the "mystical." Undoubtedly it is the "miracle cure" and "mystical" aspects that put many medical practitioners off and arouse their adverse criticism, regardless of how persuasive or elaborate the evidence. A recent, somewhat unconsidered AMA editorial reflected this when it urged that "Every effort should be made by the medical profession to block the use" of LSD and similar drugs. A third problem which interferes with general professional acceptance lies in the nature of the claims put forth by practitioners; they seem to contradict each other, and often sound unreasoning and chaotic. Nowhere is this better illustrated than at the 1959 Josiah Macy Conference, where 26 experts on LSD therapy came together. The conflict, disagreement and confusion over the four papers presented made it clear that there were approximately 26 separate opinions on how LSD should be used in treatment. Dr. Charles Savage[3] had this to say about the conference: This meeting is most valuable because it allows us to see all at once results ranging from the nihilistic conclusions of some of the evangelical ones of others. Because the results are so much influenced by the personality, aims, and expectations of the therapist, and by the setting, only such a meeting as this could provide us with such a variety of personalities and settings. At the present time, psychedelic therapy is still in an exploratory stage, with individual doctors favoring widely assorted techniques, dosages, drugs and drug mixtures. Over the past quarter century, Sandoz Pharmaceuticals spent over $3-million in developing the drug and handed out sample doses of LSD to hundreds of reputable investigators. As a result, well over 40,000 patients to date have received the drug from a "variety of personalities" and in a variety of settings. The dosage range ran from 25 mcg. to 2,500 mcg. and was taken privately or in some cases administered to whole hospital wards. Some received only one dose; others had over 120. In most instances the drug was used as an adjunct to psychotherapy, but many patients were given it as a onetime treatment. Most investigators screened out psychotics or schizophrenics, but some did not and claimed surprising success in such cases. Most patients received the treatment from only one therapist, but a number of researchers believed better results obtained when treatment was given by teams of several persons. Among the varied techniques, hypnotism was used in conjunction with LSD; some installed nurses as "parent surrogates" for the patients; others encouraged their patients to "act out" aggressions during the LSD session by giving them objects to tear up, strike, etc. There were also doctors who depended primarily upon symbolic interpretation of familiar objects and universal insignia, as well as those who concentrated on dream material. Some used LSD alone; some combined it with Ritalin, Librium, Dramamine or amphetamines of several kinds, while others added one or another of the familiar "mind-changing" drugs as well as some of the lesser known such as CZ-74. Just as the techniques and dosages differed in the extreme, so did the "variety of personalities" of the physicians guiding the sessions. Inevitably included were many who did not truly understand the characteristics of the drug's transformations and who, consequently, were inept. Tact, zeal and intuition are considered requisite in guiding a session, in addition to familiarity with the drug's action. That many "psychotic reactions" were attributable to the personality of some of the therapists is evident from the remarks of two doctors[4] who have frequently supervised the administration of LSD: We've also had psychotomimetic reactions in patients who were not psychotic before we gave them the drug. We have traced these reactions back to the effect of the attitude of the treatment personnel. We have been able to give the drug again and get a psychedelic reaction, after we have worked through with the treatment personnel what had caused the psychotomimetic reaction. ... there is already considerable evidence to suggest that the potential harm in the drug lies in its dramatic appeal to the sick therapist. I have wondered, further, if its repudiation by many is a function of too-limited experience and, in some instances, the therapist's need to control the rehabilitative process more closely than can be done under LSD. Today there is a general agreement among LSD therapists that the drug is a superior instrument for treating the whole range of neuroses, or any similar disorders, which ordinarily respond to psychoanalysis. Typical reports seem to indicate that even with severe problems only 10 or 15% fail to achieve any improvement. Hollywood Hospital in Canada, following up 89 patients for an average of 55 months, found that 55% had a total remission of the problem; 34% were improved; and 11% were unchanged. In Germany, at the University of Gottingen's Psychiatric Hospital, Dr. Leuner's results, independently rated, showed 76% "greatly improved" or "recovered" in patients with character neuroses, depressive reactions, anxiety, phobias or conversion-hysteria. And Dr. Ling states in an evaluation of his work at Marlborough Day Hospital in London: An analysis of 43 patients treated privately in 1962, i.e., three years ago, shows that 34 are completely well and socially well-adjusted. Six are improved, one abandoned treatment, one had to leave for Africa before treatment was finished, and one failed to respond satisfactorily, so treatment was abandoned. Such recovery rates speak so positively that even those LSD specialists who have definite reservations about the drug's use in therapy are, nonetheless, of the opinion that LSD should be used when accepted techniques have failed after a year or more, as long as there is high patient motivation for change. Dr. Donald Blair, an English consultant psychiatrist, says, for instance: "People who have had psychotherapy or psychoanalysis for some time, as much as eight years, and haven't gotten anywhere, do so with the drug; it does break resistance... You get neurotic patients who have been to numerous therapists, analysts, and they don't get better. Then they come to one of us who are using LSD and thanks to the effect of the drug, they do get better." In using psychedelic drugs for psychotherapy, European doctors seem to be considerably more enlightened than American doctors, and until very recently there were no legal restrictions that made these drugs difficult to obtain. Now European laws are being tightened, too. In the United Kingdom, where once any hospital could buy and dispense LSD at its own discretion, and the drug was available to approved psychiatrists, new bills restricting LSD distribution have been passed by Parliament. Since these rulings, the black market there has grown and may soon be comparable to that in America; British research and therapeutic programs are now also curtailed. The same situation may eventually spread to the Continent, where psycholytic therapy has been widely available for ten years. Based upon Leuner's successful work at the University of Gottingen, 17 centers using the psychedelic drugs in multi-session therapy were set up in Europe. Experience indicated that best results came about when the patient had had an average of 26.7 sessions. The average number of treatment hours for the doctor amounted to 55.5 per patient, in addition to about ten hours of pre-treatment and after-care. Sixty-five therapy hours per patient may seem a disproportionate amount of attention, but as Dr. Leuner explains it: ... keeping in mind that psycholysis is a causal therapy for most severe and previously incurable cases, to those resisting all other forms of therapy, including long years of psychoanalytic treatment, this expenditure seems slight. If we were to carefully assume that on the average our cases would have required 300 individual psychoanalytic sessions, our time expenditure is less than one fourth, completely ignoring the far greater effect. Furthermore, new indications such as sexual perversion, psychopathy and borderline cases can be treated. Another advantage to LSD therapy is that the patient need not necessarily be institutionalized, even if his case is severe. Such therapy has the advantages of speed and intensity as well. Dr. Ling cites an illustrative example: A senior executive of an international advertising agency who had had two years of analysis, four days a week, stated that he had derived more insight in his third LSD session than in the two years' analysis. As a busy man, he made it clear he was not going to spend "endless hours" between sessions in view of his failure to improve previously with one of the leading orthodox analysts in London. As with traditional methods of therapy, one of the basic components of psycholytic LSD therapy is abreaction, i.e., the patient's recall of events in his life in which negative and threatening experience was dominant and never subsequently resolved. When such material is repressed, the individual's emotional and intellectual maturation may be stunted. Freud, in fact, was of the opinion that no symptoms of any kind were removable unless abreaction occurred. If these traumatic events also happen during critical growth periods in a person's life, their effect will be even more serious—and more elusive. This is particularly true when treatment is on the verbal level only. In the successful session with LSD, abreaction is spontaneous and almost inevitable. In addition, this process can be elicited and abetted by means of "props," such as Panda bears given to the patient to fondle, hot water bottles, dolls, mirrors; and the creation of homelike atmosphere and practices such as reading children's stories aloud to the patient, tucking him in bed, "cooing," calling the patient by a childhood nickname, etc. Because the LSD experience produces vacillating states of past and present (or co-existing past and present), the patient can bring his mature viewpoint to bear on a problem that occurred in childhood; thus what might have heretofore seemed incomprehensible, unfair or cruel can—in the light of the LSD insight—seem perfectly natural or of no adult importance. Abreaction, however, is only part of the story. Dr. Jack Ward has some discerning remarks to make which are pertinent here: It is my conviction that in both the Psychodramatic[5] and LSD treatment experiences the forces leading to growth are somehow concentrated in greater intensity than in other forms of therapy.... In both forms of treatment there is no room for the "as if" operation. In Psychodrama, if the protagonist, group or auxiliary egos are acting instead of living what they are doing, the session will be almost useless. If the converse is true, the session is very productive. In LSD there is no "as if" experience. One is not "like" something; one is. It is not as if one were looking at one's self; one looks at one's self. It is not as if one had a heart attack like that which killed father; one has it and so convincingly that on one occasion an empathic physician present felt the same acute physical symptoms himself....So far, the majority of successful reports on the treatment of mental patients with LSD are those which deal with neurotic patients who have had at least reasonable motivation to get well. There seems to be a tacit agreement among therapists that LSD will not be effective in the psychoses, and those practitioners who undertake LSD treatment of schizophrenics are often regarded by many as brave and/or reckless. In general, it is true that LSD does not work particularly well with the patient whose mental derangement is well developed. It may, in fact, precipitate a worsened condition. Nevertheless, there are indications that those who have administered LSD in such instances have nonetheless obtained positive reactions that are impressive and worthy of broader consideration. Dr. Fred W. Langner, who has had wide experience with LSD, has used the drug effectively with severely disturbed persons whose disorder was preponderantly schizophrenic. His conclusions, after using LSD in over two thousand patient sessions, are that pseudo-neurotics and paranoid schizophrenics do not respond favorably, and may, in fact, suffer regression; but that schizoid personalities, whose egos are not too brittle, may through LSD have their first experience with "feeling." One of his patients said, "I know now that I never knew what people were talking about when they talked about feelings till I took LSD. I didn't know till toward the end of my second year of therapy that feelings could be good as well as Dr. Edward F. W. Baker of Toronto has also found LSD "extremely effective" in treatment of acute psychoses. After he presented a paper on his work with schizophrenics and others, Dr. Savage commented: I really admire Dr. Baker for his courage in using LSD with involutional manic-depressives and paranoids. It suggests to me that perhaps we have been a little too fearful and timid in our approach. Have we been threatened by others in the hostile field with which we have been surrounded? While many physicians are reluctant to give LSD to psychotics who are out of contact with reality, latest indications are that more will eventually come to agree with Dr. Savage (seeing that it is a matter of "bedside manner" with these badly regressed patients, and that trust and understanding in LSD application may be the sine qua non for positive results). It is clear now that spectacularly beneficial changes can be obtained, even in severe cases where prognosis has been poor. The present conflict of opinion closely resembles the earlier arguments concerning LSD and the treatment of alcoholics who had liver damage. Many were emphatic on the subject at the time and said a definite contraindicant was a diseased liver. But when alcoholics—who had been abandoned as hopeless because of advanced liver deterioration—received the drug, it was found that no deleterious effects resulted. Ironically, another reservation about the wisdom of giving LSD to the psychotically disturbed is fear that the initial jolt that the drug brings to the state of consciousness may so alarm the patient that he will become further disoriented. This attitude, however, fails to acknowledge the fact that LSD's action resembles the psychotic state itself, and that the psychotic mind regularly wanders in and out of everyday reality. Consequently, the psychotic might actually be a more likely and appropriate candidate for this treatment than the average person, because he is already familiar with oscillations of consciousness and can more easily accept them. It is to be hoped that a thorough systemization of sundry techniques and methodologies will soon be undertaken so therapists in the field will have a clearer picture of the directions being taken, their significance, and a delineation of future avenues of investigation. Such a clarification may prove of vital importance to the mental health movement.
Work with autistic children was also considered forbidden territory
for LSD, but in the past few years research has broadened surprisingly—however
quietly—and using the drug on autistic children is only one
of the new areas which has come under LSD exploration. Casework
has also been done with juvenile delinquents and potential suicides—and
even with such unlikely subjects as dolphins.
PATIENT: (Lying on cot) I haven't had the same opportunity as those outside. I had to learn by my surroundings... (Referring to the staff) Their expressions tell me what they think... (Referring to patients) The worst one to watch for is the quiet type. They can talk but won't talk... THERAPIST: How would you feel if you were a whitecoat? PATIENT: If I took a liking to a particular patient, I would not show this in front of the other patients. It is just the way you would treat your own children. You should not favor one over the other. THERAPIST: Do you think that a lot of the patients here need help? PATIENT: Not a lot of them, all of them... One little word of kindness sparks a whole new world of love... I would like to talk to you in 3 or 4 weeks, after the drug has worn off. Then compare what I say then and what I say now.... You people talking to me after 30 years is like the world coming to an end... Other boys feel this way. It is like a key is opening a door and the light is flowing in. And this means a great deal to me.... THERAPIST: When he goes through these gates, what do you think that he should do first? PATIENT: He should get to know others. There is no return. Do not look back, go ahead... Find a girl who feels the same way you do and maybe get married... Why have you given me your time when nobody ever did before? OBSERVER: How much is enough time? PATIENT: Eternally... I don't know whether to laugh or cry ... Do you get the feeling of closeness as humans, instead of like man and patient?... If I get out, write and let me know when you have helped another patient... At this point, the discussion turned to religion. The patient told the therapist that as a psychologist he should have a Bible in his office, which he did not. PATIENT: I feel sorry that you don't know the Bible. You are never too old to learn and you'll never learn any younger. If you want to know the patients, read the 5th chapter of Matthew. Work out these verses, verse by verse. OBSERVER: Unfortunately we can't do that. PATIENT: (Shouting) Can't or won't. The truth hurts. I want it to hurt you as it hurts me... You have to give kindness in order to get it. You won't get kindness by poking somebody ... Following this episode, the patient grew increasingly critical and verbally aggressive. Possibly this could have been avoided had the observer humored the patient about the Bible verses. (In the original report it was noted that one alert observer, visiting temporarily, did bring in a copy of the New Testament when the subject of religion was first mentioned. In any case, the session deteriorated from that time on and did not fulfill its original promise.) At the same institution, another patient who was "opened" by the LSD treatment responded more positively. Like the patient in the previously cited case, he also seemed to enjoy himself at times during his LSD session. He responded with laughter, displayed intuitive ability and made some rather sharp observations. The second case is especially interesting in that through the patient's LSD sessions, the therapist was made aware that such patients, although suffering from advanced mental disorders, may—within their virtually impregnable mental "fortress"—be far more alert and rational than is generally assumed. If this is true, it becomes obvious that great care must be exercised in dealings with such patients, for it may well be that they are so oriented to minutiae that even an inadvertent blink of the doctor's eye can destroy trust that has been established and close the patient up once again. "These are human beings," the therapist remarked, "not vegetables." As a result of this particular session, the therapist reported that he has gained a number of other insights as well. He found the patient's response to religious material and to music indicative that much more daily attention should be paid to these interests and that a music therapy program might be of considerable benefit to such patients. Additionally, the therapist stated that this case presented, in a new light, the importance that work and doing a job successfully has for these patients. It became apparent that rotating jobs for the patients was ill-advised. Continuing on the same project helped the patients define themselves and establish at least an island in reality. Work therapy was the institution's primary means for helping the patients pass time, yet as a result of this patient's LSD session, the doctor realized that mere employment was an inadequate answer to the patients' needs. The doctor was able to see that the patients would benefit from exposure to the same diversions as those found in life outside the institution: Once these people are oriented to outside living and are trained in specific skills which they can offer the community, they must not be tossed out of the institution like a man swept off of a ship into the raging sea. They need to feel the security of companionship while in the new environment—to learn to share the pleasant experiences of Christmas, Easter, Thanksgiving, Mother's Day, Father's Day, birthdays, picnics in the park, and all those little things which give value to living. It is not enough to train them for a job—this is only a part of the outside world, a very essential and important part, but only a part of the whole.Repeatedly the "need for love" is stressed by LSD therapists. At the Amityville LSD Conference, for instance, the "plea for love" was made 60 frequently that the moderator, Dr. Frank Fremont-Smith, commented on it: It is a great advance to have people who are courageous enough in a scientific meeting to speak of love. I am delighted... It is crucial.... But for doctors to admit they have to give love of the appropriate kind, as described by Dr. Kramer, to their patients is something we are afraid of. Because of the suffering of patients and the call upon us as medical students for a kind of love that we don't know how to manage, we don't know how to put it in the right frame of reference. We have had no training in this respect at all. We tend, rather, to build up our defenses against it.... We have to make it respectable in the nursing profession, in the medical profession, and in the whole therapeutic team. The appropriate way to manage an expression of love is not only highly respectable but absolutely a demand. One of the most unusual bits of evidence suggesting that LSD can create affection and end alienation is to be found in the work Dr. John Lilly and his associates have done with dolphins. An experiment conducted in the Virgin Islands included a female dolphin who had been accidentally injured and thus had developed a phobia for human beings that lasted for two years, i.e., until she was given 100 mcg. of LSD. Prior to that she had remained on the far side of the pool, remote and isolated. Given LSD, she proved a particularly interesting subject for Dr. Lilly, one of many scientists experimenting with dolphins (because of their superior intelligence) in an effort to "communicate" with them in their language and ours. Forty minutes after the dolphin's LSD injection, she approached Dr. Lilly and looked him in the eye for ten minutes without moving. This reaction was exciting because it was totally without precedent on her part. To test her further, Dr. Lilly began to circle the tank—and she followed him right around the edge. When an assistant took over, the dolphin followed him also. Now she approaches Dr. Lilly to within five feet instead of maintaining the twenty-foot distance she had kept between them previously. One English case-worker who learned of this response, Mary S. Wicks, likened it to her own experience in working with delinquents and others whose reaction to past experience had rendered them incapable of trust and mutuality: I know from... working with these people for years, who never give in, and who always hit back at society, and I have had the same experience you had. After one or two treatments with LSD they are feeling for the first time that they are actually relating, and that it is possible to get near someone, and that it is all part of the process of loving—and then being able to accept love. Among those most alienated from the rest of humanity are the incipient suicides. According to statistical prediction, some 20,500 Americans this year will elect to die. This group presents an especially baffling mental health dilemma because often there are no warning signals that suicide is contemplated. However, LSD has been known to identify latent suicidal tendencies and alleviate them. Such instances may be found throughout the LSD literature. The majority of doctors who use LSD in practice are exceedingly cautious in treating known potential suicides because there are on record a number of cases in which the drug may have actually pushed the patient over the edge. In fact, this is one of the few areas in the LSD controversy where specialists are in general agreement. Yet, at the same time, such contraindicant persons are known to have responded well to the drug when it has been given in instances where histories of past suicide attempts have been concealed from the therapist. Dr. Baker, for example, in discussing a suicide case he had treated also mentioned four other patients who were suicidal (and had, in fact, been in barbiturate coma when admitted to his hospital), who later, after LSD, lost their suicide drive. In the case where an actual suicide had occurred, Dr. Baker said that he did not know whether it could be ascribed to the LSD interview which had taken place two weeks earlier, to the patient's schizoid personality or to other unknown factors. Dr. Cohen, when asked to compare LSD-induced suicide with that brought about through the therapeutic use of other drugs or other forms of treatment, replied: The comparison can't be made. If a group of potentially suicidal patients has any kind of therapy, a few will commit suicide, and many will be rescued. If a drug is involved, it will be of less importance than the skill, alertness, and devotion of the therapist. In explaining how LSD has upon occasion helped to subvert suicide, two rationales are generally given. The first focuses upon the drug's ability to produce a state of euphoria at the same time it creates the fantasy of death and rebirth—which together can replace and satisfy the suicidal urge. Some people seem to feel attracted to death by suicide from early childhood, and in such cases there is as a result good theoretical justification for the LSD experience. One example of such a case occurred when Masters and Houston were conducting their research. It concerned a businessman in his late forties who had definitely decided to kill himself and who took LSD as a last resort. However he did not mention suicide to his guide either before or during his session. Even after the drug began to take effect, he gave no sign that anything out of the ordinary was happening to him except when, for a while, he assumed the foetal position. Only two weeks later did the subject confess his chronic suicide compulsion, stating that previous treatment with various therapists had actually intensified it. But after taking LSD, he found himself free of his depressions. During his session he felt as if he had died and been reborn, and consequently no longer needed to kill himself. Here are the subject's own words, describing his feelings before and after: It was absolutely essential that I die. It was not the depression alone that created this urgent need within me. I had lived with the depression for years and while it was extremely painful it was not beyond my ability to endure. No, there was something else that I cannot explain beyond saying how I felt. There was this inescapable and irresistible feeling that I must die. I am absolutely certain that had I not "died" in the LSD session I would have had to die in some other way, and that could only have meant really dying. Committing suicide, destroying myself, as I surely would have done. A second way in which LSD seems to eradicate suicidal promptings is to bring forth long-repressed death wishes which might have tragically surfaced in dramatic fashion. One of Dr. Sandison's patients, who was in a state of depression, describes her experience: I had the sensation... of a snake curling up around me.... I then began to see serpents' faces all over the wall—then I saw myself as a fat, potbellied snake slithering gaily away to destruction. I felt horrified and thought, "Whose destruction?" I then realized it was my own destruction—I was destroying myself. I seemed to be having a battle between life and death—it was a terrific struggle, but life won. I then saw myself on the treadmill of life—a huge wheel was going round and round with hundreds of people on it. Some were on top going confidently through life, others were getting jostled and trodden on but still struggling to go on living (I saw myself as one of these people) and then there were the others who just couldn't cope with life and were being crushed to death in the wheel. I had another realization of how I was destroying myself—by carrying on this affair with this married man.... I knew it must cease and knew that I must never see him again. It is clear that in the case just cited the problem centered in a drive toward self-destruction, but it took an LSD session for these impulses to emerge; all that was specifically known before was that this patient was "deeply depressed"—a diagnosis which might never have been understood in enough detail, even with lengthy treatment under ordinary analysis. Sometimes when LSD has not been used for therapy itself, analysts have employed small quantities of the drug as a diagnostic tool. Prior to actual treatment, as an exploratory measure, the candidate was given a sample dosage, along with standard psychometric tests to establish the nature and depth of the patient's disorder. This served to clarify in the therapist's own mind the nature of the patient's problem—and the patient himself, gaining insight under the drug, became more cooperative. One particular patient who had been oblivious to all of her symptoms, cried out, during her second diagnostic LSD session, "I am a sex maniac," much to her own astonishment. Her therapist, Dr. Baker, commented on this outcry and the relation it bore to her "gun-phobia," for which she had entered treatment: [It] brought her to realize the male genital symbolism involved (you must believe that this was not suggested by the therapist). At the same time she realized her own marked, hitherto repressed, genital sexual drive. LSD has proved useful, too, in determining whether certain homosexual patients have such a deep-set disorder that their only hope is to accept it, or whether the condition can be corrected and the patient's life situation thereby brought into normal focus. This prognostic ability of LSD also applies to neurotics; the drug helps the therapist gauge the patient's amenability to psychotherapy. Dr. Johnsen on this subject says: If we get sexual perverts, for example, we may question what kind of treatment to give them; we want to find out a little more about them. We could use three or four weeks finding out, but we shorten that and say we will try if we can find out more with one or two LSD sessions. We use small doses then. We find that the symptoms are clearer; they are willing to speak more openly to us; we can get a clearer picture of the diagnosis. We have used it in that way to save time. A second indication for limited LSD use is in the termination of regular analytic treatment. LSD will be administered in small doses when the therapy is nearing its end to bring about a clarification and emotional summary of the preceding gains. It may also bring to light any important material that has been overlooked. Just as in technical and creative problem-solving, LSD seems to synthesize and provide a fuller understanding of stored-up intellectual matter previously apprehended primarily on a verbal level. It forces an emotional crisis in those who have over-intellectualized, and makes their cure sounder, on an unsuperficial level. That LSD can benefit others beside the patient involved was indicated earlier in speaking of what therapists have learned of "feeling the psychotic experience" instead of simply witnessing the performance from the outside. Through clearer understanding of the schizophrenic process, valuable and entirely new tests have been devised, based upon a closer look at the details of mental disorder, unavailable before. The Hoffer-Osmond Diagnostic Test (the HOD Test) explores the experiential world of the schizophrenic, and though it is a crude instrument, it is unexpectedly effective. An ex-schizophrenic said of the HOD Test, "I wish you had had this test when I was ill. I would have known you knew something about my illness." And, as might be expected, artists and other creative people have contributed their personal psychedelic findings to the drug's growing body of literature at the disposal of the clinician. Henri Michaux, the distinguished French painter-poet, used his experiences with mescaline, psilocybin and cannabis to picture for the layman the difficulties and problems encountered by the mentally deranged. In the "Chasm-Situations" section of his book, Light Through Darkness, and in the "Experimental Schizophrenia" section of another volume, Miserable Miracle, he vividly describes what it is like to be a "model psychotic." His work is of great value to psychologists and medical students. Perhaps the outstanding instance of creative problem solving lending itself to therapeutic implementation occurred when Kyoshi Izumi, a prominent architect, was asked to design a mental hospital in Canada and decided to take LSD in search of better insight into the problem. In his words: Psychiatrists talk one language and I talk another. They knew what they wanted but someone had to translate their wishes into architecture. To me there was really no other way. If I were to really understand the fears and problems of the schizophrenic, I would have to look at things the way they did. Consequently, when he took LSD, Izumi paid extensive visits to old mental institutions in an attempt to see them through the eyes of derangement. He found himself terrified by literally dozens of standard hospital accoutrements and features which had always been taken for granted as adequate. The tiles on the wall glistened eerily, thereby projecting hideous fantasies that sprang at him from the cracks.[7] The recessed closets seemed to yawn like huge, dark cavities, threatening to swallow him alive. The raised hospital beds, too high for a patient to sit on and at the same time touch the floor, were like crags jutting out over abysses. There was no privacy, and the time sense was nil, due to the absence of clocks, calendars or any other measuring device which might help a patient find his bearings. The bars on the windows were a constant reminder of incarceration. But worst of all were the long, endless corridors[8] leading into more of Nowhere which, nevertheless, had to be traversed. After his LSD insights, Mr. Izumi was able to design what has been called "the ideal mental hospital." The first was built in Yorkton, Saskatchewan, and five others have been modeled upon it elsewhere in Canada. There is a similarly-inspired hospital in Haverford, Pa., and because commendation has been made for this outstanding architectural advancement by the Joint Information Service of the American Psychiatric Association, it is possible that the present outdated hospitals will give way to new ones resembling Izumi's designs. The Yorkton hospital consists of small, cottage-like clusters of rooms, thirty to a unit, joined together by underground passageways. Seen from the air, the entire structure resembles a Maltese cross.[9] There are many windows, low and unbarred, eliminating the old, dismal barnlike aspect of mental hospitals. The walls are painted in pleasant, flat colors, and each patient has his own room in one or another of the clusters, rather than a bed in an austere, nearly bare ward. The beds are low to the floor, and the rooms are furnished with regard to making it easier to define the floor as a mere floor, not a pit. Also, the furniture is comfortable and not unlike that with which the patient is familiar at home. The closet problem has been solved by installing large, moveable cabinets which the patient can clearly see possess both a back and a front. Clocks and calendars abound, while floor tiles are sparingly used. The emphasis throughout puts patient needs foremost, without sacrificing utility. Izumi's ingenious designs for mental hospitals are monuments to humanitarianism, making it clear that LSD can be not just a "mind-or consciousness-expanding" drug, but a "conscience-expanding" one as well. For so many centuries the doors to compassion for the mentally ill have been closed, barred by fear, superstition and misunderstanding. One doctor [Dr. Savage], who had thought himself reasonably kind and understanding, made an explicit statement regarding the therapeutic and humanitarian implications that have flowed from experience with LSD: First, I would suggest that we be more alert for the early onset of schizophrenia, which is commonly accompanied by strong feelings of unreality and perceptual distortions. Very often the schizophrenic makes early appeals for help, often repeatedly calling his friends or his family, yet he is so blocked that he does not get his message across. Such patients make frequent appeals to the doctor.... I believe that if we can recognize them at this point and somehow reduce the level of anxiety, we can materially impede the perceptual distortions and the rapid disintegration of the ego....It is difficult to imagine "madness" with any sense of accuracy or intensity. One can imagine blindness, to some extent, by simply closing the eyes;[10] one can empathize with another "normal" personality, regardless of sex or idiosyncrasies. But the acute derangement of the senses falls beyond the imaginative and empathetic powers of most individuals. This is, perhaps, the explanation for the paucity of "inside understanding" of schizophrenia and the general feeling of revulsion towards the insane. It may be that LSD is on the verge of changing all this. Just as the LSD therapists who worked with alcoholics found that the drug brought about cooperation both with the patients and among themselves, so those who have used psychedelics in treatment of mental disorder are finding the same rewards and gaining new and vital knowledge. Dr. Savage, as quoted above, has been joined by similar spokesmen in this branch of medicine. Dr Robert C. Murphy, Jr., in a paper entitled, "A Psycho therapist's Debt to LSD," gives the drug credit for enabling him to become better acquainted with his patients and to "give freely and unguardedly" of himself. Appreciation for this progress in physicians' under standing of their patients (and the ensuing shifting of personal attitudes toward the patient) was recently voiced by Norma McDonald, a former schizophrenic: [11] One of the most encouraging things which has happened to me in recent years was the discovery that I could talk to normal people who had had the experience of taking mescaline or Iysergic acid, and they would accept the things I told them about my adventures in mind without asking stupid questions or withdrawing into a safe smug world of disbelief. Schizophrenia is a lonely illness and friends are of great importance. I have needed true friends to help me to believe in myself when I doubted my own mind, to encourage me with their praise, jolt me out of unrealistic ideas with their honesty and teach me by their example how to work and play. The discovery of LSD-25 by those who work in the field of psychiatry has widened my circle of friends. Today government restrictions make further LSD therapy and experimentation virtually impossible, no matter how grave the need or plentiful the evidence that LSD can be effective in reversing the upward trend of mental disease.[12] (Of all the promising projects that were in process, only six conservative investigations into the area of human response have been allowed to proceed at this writing.) There is now a general despondency among LSD practitioners—who have the feeling that they have been needlessly "laid off" and will continue so until the governing agencies can come to grips with the nature of the disagreement and realistically define the role of LSD in therapy. Dr. Langner, for instance, asks, "Do I feel any patients are being denied an experience of significant value as a result of non-acceptance of LSD as a therapeutic tool?" and answers, "Yes, I do."
Footnotes1. Dr. Johnsen of Modum Bads Nervesantorium in Norway, has treated about 200 patients in 1500 sessions with LSD, psilocybin and CZ-74. (back)2. An account of Dr. Sandison's work with LSD can be found in The Hallucinogenic Drugs and Their Psychotherapeutic Use (C. C. Thomas, Inc.), edited by Crocket, Sandison and Walk. (back) 3. [At that time] Director of Research, Spring Grove State Hospital, Maryland. (back) 4. Dr. Kenneth Godfrey, and Dr. Fred W. Langner of Albuquerque, New Mexico. (back) 5. Psychodrama is a technique developed by Dr. J. L. Moreno in which the "acting out" of problems in group therapy is the principal method used. (back) 6. This work was carried out at the Saskatchewan Training School, Saskatchewan, Canada. (back) 7. Dr. Humphry Osmond describes the effects of curious moldings and other standard hospital decorations upon the mentally ill: "When you look at them with LSD, you suddenly realize how very strange they are. In many mental hospitals there are literally thousands of square feet of nicely polished tiles on the walls, which act like distorting mirrors at a fun fair. These are illusion-producing machines par excellence, and very expensive ones at that. If your perception is a little unstable, you may see your dear old father peering out at you from the walls and you may become extremely frightened, particularly if it happens you didn't get on too well with him. And even If you got on very well, it would be a little upsetting, if he has been dead a few years." (back) 8. Dr. Osmond also indicates how the mental patients constancy of perception becomes disorganized when he looks down a long corridor: "One of the best places to see this without taking LSD is at the TWA Building at Kennedy Airport. In one of the octopus-like legs of that contraption, we have inadvertently produced a machine for destroying constancy of perception. You cannot be sure whether the people walking toward you, along those sinuous corridors, are dwarfs close by or normal-sized people far away. And in such a corridor, when people walk toward you, instead of getting closer (our normal way of describing things), they merely seem to become larger, and if you don't realize what is happening, this can be quite frightening. The architect who has become sensitive to these matters, quickly recognizes the need to avoid vague and strange spaces." (back) 9. Such a design, influenced by psychedelics, may only coincidentally embody religious symbolism. Certainly, however, it has an intriguing metaphorical aptness. It is interesting to note that the Maltese cross was the symbol of the order of the Knights of Malta (Knights Hospitalers), who in the eleventh and twelfth centuries were noted for ministering to the sick and wounded. (back) 10. The difficulties in describing unfamiliar colors even to those who have their sight are yet formidable. For instance, Webster (Third New International, Unabridged) is put to some pains to describe "onionskin pink": "a light brown that is stronger and slightly redder and darker than alesan, stronger and slightly yellower and darker than blush, lighter, stronger and slightly redder than French beige; and redder, stronger, and slightly lighter than cork." (back) 11. From The Inner World of Mental Illness, R. Kaplan, ed. (N.Y., Harpers, 1964) (back) 12. Some of the evidence fits well in current psychological testing. Indications are, for instance, that the Rorschach, while not a very good guide to the selection of patients, does reflect LSD recoveries by a definite change in the approach to the test. "We think the Rorschach test definitely points to a permanent alteration of outlook in a significant number of cases," says Dr. Sandison, "and it will be interesting to see whether this correlates with permanent freedom from neurosis. Looking through the results, I have been impressed by the quite remarkable changes that have taken place in the tests over a period of 12 months." Dr. Savage has this to say about the effect of LSD on the depression scale of the Minneapolis Multiphasic Personality Inventory: "I am coming more and more to the conclusion that LSD might be the treatment of choice with depressions, because according to MMPI data, at any rate, it moves the depression scale down further than anything else being used. It stays down; it doesn't come shooting right back up." (back) Table of Contents
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