Crisis Intervention

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Psychotherapy and Psychedelic Drugs

Crisis Intervention in Situations Related to
Unsupervised Use of Psychedelics

Stanislav Grof, M.D.

Appendix I., LSD Psychotherapy: Hunter House Publishers, Alameda California.
©1980, 1994 by Stanislav Grof, M.D.

Since the mid-sixties, when experimentation with LSD and other psychedelics moved from psychiatric institutes and clinics to private homes and public places the role of mental health professionals in regard to these substances has been drastically redefined. Instead of being in the forefront as experimenters and researchers they have become the rescuers and undertakers called upon to deal with the casualties of the psychedelic scene. This development has contributed considerably to the present attitudes of most professionals toward these drugs; the primary focus of psychiatrists and psychologists has shifted from the therapeutic potential of psychedelics to their dangers. In the highly emotional atmosphere created by sensational publicity, professionals have allowed their image of LSD to be shaped by journalists and newspaper headlines rather than scientific data generated by research. Consequently, the casualties and complications of unsupervised experimentation with LSD, instead of being attributed to irresponsible and ignorant use, have been interpreted as reflecting dangers inherent in the drug itself.
Restrictive legislation has practically destroyed scientific research of psychedelic substances, but has not been very effective in curbing unsupervised experimentation. While samples of psychedelic drugs of doubtful quality are readily available in the streets and on college campuses, it is nearly impossible for a serious researcher to get a license for scientific investigation of their effects. As a result of this, professionals are in a very paradoxical situation: they are expected to give expert help in an area in which they are not allowed to conduct research and generate new scientific information. The widespread use of psychedelics and relatively high incidence of drug-related problems are in sharp contrast to the lack of understanding of the phenomena involved; this is true for the general public as well as the majority of mental health professionals.
This situation has very serious practical consequences. Various emergencies associated with psychedelic drug use are handled in a way that is at best ineffective, but more likely counter-productive and harmful. Crisis intervention in psychedelic sessions and treatment of the long-term adverse effects of unsupervised self-experimentation are issues of such medical and social relevance that they deserve special attention. Much of the information that is essential for understanding the problems involved and for an effective approach to this area has been presented in various sections of this book. However, because of the importance of the problem I will briefly review the most pertinent data here and apply them to the area in question.

THE NATURE AND DYNAMICS OF PSYCHEDELIC CRISES

Understanding the dynamics of psychedelic experiences is absolutely necessary for effective crisis intervention. A difficult LSD experience, unless it results from a gross abuse of the individual, represents an exteriorization of a potentially pathogenic matrix in the subject's unconscious. If properly handled, a psychedelic crisis has great positive potential and can result in a profound personality transformation. Conversely, an insensitive and ignorant approach can cause psychological damage and lead to chronic psychotic states and years of psychiatric hospitalization.
Before discussing the difficult experiences that occur in psychedelic sessions, their causes, and the principles of crisis intervention, we will summarize our previous discussions about the nature and basic dynamics of the LSD process. LSD does not produce a drug-specific state with certain stereotypical characteristics; it can best be described as a catalyst or amplifier of mental processes that mediates access to hidden recesses of the human mind. As such, it activates deep repositories of unconscious material and brings their content to the surface, making it available for direct experience.
A person taking the drug will not experience an "LSD state" but a fantastic journey into his or her own mind. All the phenomena encountered during this journey—images, emotions, thoughts and psychosomatic processes—should thus be seen as manifestations of latent capacities in the experient's psyche rather than symptoms of "toxic psychosis." In the LSD state the sensitivity to external factors and circumstances is intensified to a great degree. These extrapharmacological influences involve all the factors usually referred to as ' set and setting': the subject's understanding of the effects of the drug and purpose of ingestion, their general approach to the experience, and the physical and interpersonal elements of the situation. A difficult LSD experience thus reflects either a pathogenic constellation in the experient's unconscious, traumatic circumstances, or a combination of the two.
Ideal conditions for an LSD session involve a simple, safe and beautiful physical environment and an interpersonal situation that is supportive, reassuring and nourishing. Under these circumstances, when disturbing external stimuli are absent, negative LSD experiences can be seen as psychological work on the traumatic areas of one's unconscious. It is essential for the good outcome of an LSD session to keep it internalized and fully experience and express everything that is emerging. Psychedelic sessions in which the subject does not stay with the process tend to create a dysbalance in the basic dynamics of the unconscious. The defense system is weakened by the effect of the drug, but the unconscious material that has been released is not adequately worked through and integrated. Such sessions are conducive to prolonged reactions or to subsequent "flashbacks."
The only way to facilitate the completion and integration of an LSD session in which the experiential gestalt remains unfinished is to continue the uncovering work, with or without psychedelics. It is important to emphasize that the effect of LSD is essentially self-limited; the overwhelming majority of difficult psychedelic experiences reach a resolution quite spontaneously. Actually, those states that are most dramatic and stormy tend to have the best outcome. The use of tranquilizers in the middle of a psychedelic session is a grave error and may be harmful. It tends to prevent the natural resolution of the difficult emotional or psychosomatic gestalt and to "freeze" the experience in a negative phase. The only constructive approach is to provide basic protection to the subject, and support and facilitate the process; the least one can do is to not interfere with it.
After this brief introduction, we can return to the problem of complications during unsupervised psychedelic experimentation. Although the basic principles discovered during clinical research with LSD are directly applicable to crisis intervention, it is important to emphasize the basic differences between the two situations. The LSD administered in clinical and laboratory research is pharmaceutically pure and its quality can be accurately gauged; most black market samples do not meet these criteria. Only a small fraction of a "street acid" specimen is relatively pure LSD; the black market preparations frequently contain various impurities or admixtures of other drugs. In some of the street samples that have been analyzed in laboratories, researchers have detected amphetamines, STP, PCP, strychnine, benactyzine, and even traces of urine. There have been instances where alleged LSD samples contained some combination of the above substances and no LSD whatsoever. The poor quality of many of the street specimens is certainly responsible for some of the adverse reactions that occur in the context of unsupervised self-experimentation. In addition, uncertainty about quality and dosage and the resulting fears can have a negative influence on the ability of the subject to tolerate unpleasant experiences, which are then readily interpreted as signs of toxicity or overdose rather than manifestations of the users' unconscious.
However, the quality of drug and the uncertainty about it seem to be responsible for a relatively small fraction of the adverse reactions to LSD. There is no doubt that extrapharmacological elements, such as the personality of the subject and the set and setting, are by far the most important factors.
In order to understand the frequency and seriousness of psychedelic crises that occur in the context of unsupervised self-experimentation, it is important to take into consideration the circumstances under which many people tend to take LSD. Some of them are given the drug without any prior information about it, without adequate preparation, and sometimes even without forewarning. The general understanding of the effects of LSD is poor, even among experienced users. Many of them take LSD for entertainment and have no provisions in their conceptual framework for painful, frightening and disorganizing experiences. Unsupervised experimentation frequently takes place in complex and confusing physical and interpersonal settings that can contribute many important traumatic elements. The hectic atmosphere of large cities, busy highways in the rush hour, crowded rock concerts or discos, and noisy social gatherings are certainly not settings conducive to productive self-exploration and safe confrontation with the difficult aspects of one's unconscious.
Personal support and a relationship of trust are absolutely crucial for a safe and successful LSD session, and these are seldom available under these circumstances. Not infrequently the person under the influence of LSD is surrounded by total strangers. In some other instances good friends may be present, but they are themselves under the influence of the drug or are unable to tolerate and handle intense and dramatic emotional experiences. When a group of people take LSD together, the painful experiences of one person can create a negative atmosphere which contaminates the sessions of others. There have even been episodes in which persons who took LSD or were given the drug were, for a variety of reasons, exposed to deliberate psychological abuse. It is easy to understand that such toxic circumstances are highly conducive to adverse reactions.

PROFESSIONAL CRISIS INTERVENTION AND THE SELF-HELP APPROACHES

The present intervention offered by professionals in psychedelic crises is based on the medical model and usually creates more problems than it solves. The steps typically taken under these circumstances reflect a serious lack of understanding of the nature of the psychedelic experience, and are conducive to long-term complications. This is further complicated by the numerous demands on the time of a mental health practitioner and a lack of adequate facilities for handling casualties from the psychedelic scene. The tranquilizers that are routinely administered under these circumstances tend to prevent effective resolution of the underlying conflict and thus contribute to the incidence of chronic emotional and psychosomatic difficulties after the session. Instant transfer of the individual to a psychiatric facility in the middle of the LSD experience is not only unnecessary, but represents a dangerous and harmful practice. It disregards the fact that the LSD state is self-limiting; in most instances, a dramatic negative experience if properly handled will result in a beneficial resolution and the subject will not need any further treatment. The "emergency transfer" to a psychiatric facility, particularly if it involves an ambulance, creates an atmosphere of danger and urgency that contributes considerable additional trauma for a person who is already extremely sensitized by the psychedelic state and the painful emotional crisis. The same is true of the admission procedure in the psychiatric facility and the atmosphere of the locked ward which is the final destination of many psychedelic casualties.
Exposure to the routines of the psychiatric machinery while under the influence of LSD can cause a life-long trauma. The fact that psychiatric diagnosis and hospitalization may often represent a serious social stigma is another important factor to consider before proceeding with an unnecessary transfer and admission. Moreover, if the LSD process does not reach a satisfactory resolution, contemporary psychiatric care applies continued medication with tranquilizers instead of the uncovering therapy that is the preferred treatment under these circumstances.
The basic points of the above discussion can be illustrated with the following example:

When I was working in the Psychiatric Research Institute in Prague, Czechoslovakia, I was asked as consultant to see two employees of the pharmaceutical laboratories that were involved in the production of LSD. They had both suffered delayed adverse effects of an accidental intoxication with LSD, while synthesizing the drug. One of them, a man in his forties who was heading the department, showed symptoms of deep depression with occasional bouts of anxiety, a sense of meaninglessness of existence, and doubts about his sanity. He dated these symptoms to the time of his intoxication with LSD and subsequent brief hospitalization in a psychiatric facility. His assistant, a woman in her twenties who had experienced accidental intoxication with LSD several months after he did, complained about bizarre sensations in her scalp; she was convinced that she was rapidly losing her hair, although there were no objective signs to support this.
During the diagnostic interviews with them I tried to reconstruct the circumstances of their LSD experiences and the dynamics of the problems they presented. The story that I heard, although unbelievable of LSD therapists or people familiar with the nature of psychedelic states, is unfortunately a typical example of crisis intervention based on the conventional medical and psychiatric models. The pharmaceutical laboratories that were involved in the production of LSD were situated approximately two hundred miles from Prague, where most of the clinical and laboratory research with psychedelics was happening at that time. When the management received the order to start the synthesis of Czechoslovakian LSD, it was felt that, because of the nature of the substance, the staff should be informed about its effects and instructed about the necessary measures in case of accidental intoxication. The director invited from the nearby state mental hospital a psychiatrist who had no personal or professional experience of LSD and prepared himself by reading a few papers on the-model psychosis" approach to schizophrenia. During the seminar with the staff, this superficially informed psychiatrist managed to paint an apocalyptic picture of LSD. He told them that this colorless, odorless and tasteless substance could insidiously enter their system, as had happened to Dr. Albert Hofmann, and induce a state of schizophrenia. He suggested that they should keep a supply of Thorazine in their first-aid kit and in case of accidental intoxication bring the tranquilized victim without delay to the psychiatric hospital.
As a result of these instructions, both laboratory workers received Thorazine shortly after they had started to feel the effects of the drug, and were rushed in an ambulance to the locked ward of the state mental hospital. There they spent the rest of the intoxication period and a few following days in the company of psychotic patients. While under the influence of the LSD-Thorazine combination, the department chief witnessed several grand mal seizures and had a long discussion with a patient who was showing him his wounds after a suicide attempt. The fact that he was put by mental health experts in the company of severely disturbed patients contributed considerably to his fear that he might himself be developing a similar condition. Analysis of his LSD state, which was only incompletely truncated by the Thorazine medication, showed that he was experiencing elements of BPM II,* and the confinement in the locked ward and his adventures there represented a powerful reinforcement of his desperate state.
The experience of his research assistant was more superficial; her reaction to the atmosphere of the locked ward was to pull herself together and maintain control at any cost. Retrospective analysis of her experience showed that she was approaching a traumatic childhood memory, but because of the external circumstances she suppressed it and prevented it from surfacing. Her feeling of losing her hair turned out to be a symptom related to this deep psychological regression; the infantile body image corresponding to the age when she experienced the traumatic event involved hairlessness as a natural condition.
During their visit to the Psychiatric Research Institute in Prague these two pharmaceutical workers were able not only to work on their symptoms, but also to change their image of LSD and the negative feelings associated with it. We explained to them the nature of the LSD state and discussed with them our therapeutic program and the principles of conducting sessions. Before they left they had ample opportunity to discuss the effects of LSD with patients undergoing psycholytic treatment who had experienced their sessions under substantially different circumstances. I assured them that there was no reason for alarm if someone was intoxicated by LSD; as a matter of fact, we were producing situations like that routinely in our program. They were advised to have a special, quiet room where the intoxicated individual could spend the rest of the day listening to music in the company of a good friend.
Several months later, I received a call from the department chief. He told me that they had had another "accident"; a nineteen-year-old laboratory assistant had experienced a professional intoxication. She spent the day in a comfortable room adjacent to her laboratory in the company of her friend and "had the time of her life." She found her experience very pleasant, interesting and beneficial.

The avoidance techniques developed by the self-help movement, although less harmful than the approach based on the medical and psychiatric model, are also counterproductive. Attempts to engage the subject in superficial conversations ("talking them down"), to distract them by showing them flowers and beautiful pictures, or taking them for a walk does not solve the underlying problem. This can be seen at best as playing for time—keeping the individual occupied with distracting maneuvers until the crisis subsides or diminishes with the waning of the pharmacological effect of the drug. These approaches are based on the erroneous assumption that the drug has created the problem. Once we realize that we are dealing with the dynamics of the unconscious, not a pharmacological state, the short-sightedness of this approach becomes obvious. The danger in using techniques that encourage avoidance lies in the failure to confront and resolve the unconscious material that underlies the emotional and psychosomatic crisis. LSD sessions in which the emerging gestalt is not completed are conducive to prolonged reactions, negative emotional and physical aftereffects, and "flashbacks".

COMPREHENSIVE CRISIS INTERVENTION IN PSYCHEDELIC EMERGENCIES

Having discussed the factors that contribute to the development of emergencies in unsupervised LSD sessions and described the harmful practices that characterize most professional and lay interventions, I would like to outline what I consider the optimal approach to psychedelic crises, based on the understanding of their dynamics. What constitutes an emergency in an LSD session is highly relative and depends on a variety of factors. It reflects an interplay between the subject's own feelings about the experience, the opinions and tolerance of the people present, and the judgment of the professional called upon to offer help. This last is a factor of critical importance; it depends upon the therapist's degree of understanding of the processes involved, his or her clinical experience with unusual states of consciousness, and his or her freedom from anxiety. In psychedelic crisis intervention, as in psychiatric practice in general, drastic measures frequently reflect the helpers' own feelings of threat and insecurity, not only vis à vis possible external danger, but also in relation to their own unconscious. The experience from LSD therapy and the new experiential psychotherapies clearly indicates that exposure to another person's deep emotional material tends to shatter psychological defenses and to activate corresponding areas in the unconscious of the persons assisting and witnessing the process, unless they have confronted and worked through these levels in themselves. Since traditional psychotherapies are limited to work on biographical material, even a professional with full training in analysis is inadequately prepared to deal with powerful experiences of a perinatal and transpersonal nature. The prevailing tendency to put all such experiences into the category of schizophrenia and suppress them in every way reflects not only a lack of understanding, but also a convenient self-defense against the helpers' own unconscious material.
As the sophistication and clinical experience of LSD therapists has increased, it has become more and more evident that negative episodes in psychedelic sessions should not be seen as unpredictable accidents, but intrinsic and lawful aspects of the therapeutic work with traumatic unconscious material. From this point of view the colloquial term "bummer" or "bad trip" does not make sense. To an experienced LSD therapist an unsuccessful psychedelic session is not one in which the subject experiences panic anxiety, self-destructive tendencies, abysmal guilt, loss of control, or difficult physical sensations. If properly handled, a painful and difficult LSD session can bring about an important therapeutic breakthrough. It can facilitate resolution of problems that have plagued the subject in subtle ways for many years and contaminated his or her everyday life. An unsuccessful session, however, is one in which difficult feelings begin to emerge, the subject does not fully surrender to the process and the gestalt remains unresolved. From this point of view, all psychedelic experiences in which the process is thwarted by the administration of tranquilizers and external distractions such as transfer to a psychiatric hospital are not failures because of the nature of the psychological process involved, but because the crisis management has interfered with a positive resolution.
Although LSD can induce difficult experiences even under the best circumstances, it would be a mistake to attribute all "bad trips" to the drug itself. The psychedelic state is determined by a variety of non-drug factors; the incidence of serious complications depends critically on the personality of the subject, and the elements of set and setting. This can be illustrated by comparing the incidence of complications during the early supervised experimentation with LSD, and the psychedelic scene of the sixties. In 1960, Sidney Cohen published a paper entitled, LSD: Side Effects and Complications. J. Nerv. Ment. Dis. 130:30, 1960. It was based on reports from forty-four professionals who had administered LSD and mescaline to about five thousand persons over twenty-five thousand times; the number of sessions per person ranging between one and eighty. In the group of normal volunteers, the incidence of attempted suicides after the session was less than one in a thousand cases, and that of prolonged reactions lasting over forty-eight hours was 0.8 per thousand. The numbers were somewhat higher when psychiatric patients were used as subjects; in every thousand patients there were 1.2 suicide attempts, 0.4 completed suicides and 1.8 prolonged reactions lasting over forty-eight hours. In comparison with other methods of psychiatric therapy, therefore, LSD appeared to be unusually safe, particularly when contrasted with other procedures used routinely in psychiatric treatment at that time, such as electroshocks, insulin comas, and psychosurgery. These statistics contrast sharply with the incidence of adverse reactions and complications associated with unsupervised experimentation. During my visit to the Haight-Ashbury clinic in San Francisco in the late sixties, I was told by its director David Smith that they were treating an average of fifteen "bad trips" a day. Although this does not necessarily mean that all these clients had long-lasting adverse effects from their psychedelic experiences, it illustrates the issue in question.
The experience and sophistication of psychiatrists and psychologists in relation to psychedelics was certainly not great during the early years and the settings were far from ideal. However, the sessions reported in Dr. Cohen's paper were conducted in protected environments, under reasonable supervision and by responsible individuals. In addition, those who had difficult experiences were in a place that was equipped to provide help in case of need and they did not have to be subjected to the absurd ordeal of transfer to a psychiatric facility.
The psychedelic crisis is caused by a complicated interplay of internal and external factors. The therapist has to distinguish which of the two sets of influences is more important and proceed accordingly. The first and most important step in handling a psychedelic crisis is to create a simple, safe and supportive physical and interpersonal environment for the subject. In cases where external factors seem to have played a crucial role, it is important to remove the individual from the traumatic situation or change it by active intervention. If the crisis occurred in a public locale, he or she should to be taken to a quiet, secluded place. If the incident happens during a party in a private residence, it is important to simplify the situation by moving to a separate room or asking the guests to leave. A few close friends who appear sensitive and mature may be asked to assist in the process. They can provide group support or help the subject to actively work through the underlying problem during the termination period of the session. The techniques of group involvement in psychedelic sessions have been discussed earlier in this book (p. 145).
After creating a safe environment the next important task is to establish good contact with the subject. A relationship of trust is probably the most significant prerequisite for the positive outcome of a psychedelic session in general and for successful handling of a crisis in particular. A person asked to intervene in a crisis triggered by LSD is at a great disadvantage as compared to an LSD therapist facing a similar situation in the course of psychedelic treatment, because the therapeutic session is preceded by a drug-free preparation period during which there is enough time to establish good contact and a relationship of trust. If a difficult situation arises in the course of an LSD series, the client can also draw on his or her memories of previous sessions where painful experiences had been successfully worked through and integrated with the help of the therapist.
In contrast, the professional dealing with a crisis outside of the therapeutic context walks into the emergency situation as a stranger, usually without any previous contact with the subject and other persons involved. Trust and cooperation have to be established in a very short time and often under dramatic circumstances. Freedom from anxiety, an ability to remain centered, deep empathy, and intimate knowledge of the dynamics of psychedelic states are the only means of generating trust under these circumstances.
It is essential to convey a sense of safety and security by emphasizing the self-limiting nature of the LSD experience. No matter how critical the condition appears to be, in most instances it will be resolved spontaneously five to eight hours after the ingestion of the drug. This time limit should be clearly communicated to the subject and other people present; until that time there is absolutely no reason to panic or worry, however dramatic the emotional and psychosomatic manifestations might be. It is also of great advantage to keep the subject in a reclining position, but this should be attained without using physical force and open restraint. With a little experience, one can develop a technique with which it is possible to effectively restrain the individual using a context of support and cooperation rather than conflict.
When adequate contact has been established, a positive framework should be offered for the difficult LSD experience. It is essential to present it as an opportunity to face and work through certain traumatic aspects of one's unconscious rather than as an unfortunate and tragic accident. A person assisting in a psychedelic crisis should make consistent attempts to internalize the experience of the LSD subject and encourage him or her to face the critical issues involved. The LSD subject should be encouraged to keep his or her eyes closed and confront the experience, whatever it is. The therapist should repeatedly communicate to the subject that the quickest way out of this difficult state is through surrendering to the emotional and physical pain, experiencing it fully and finding appropriate channels to express it. This process of surrendering can be greatly facilitated by music. If a good high-fidelity stereo set is available, and the subject is open to it, music should be introduced into the situation as soon as possible.
When good rapport has been established, it is possible to offer active assistance using comforting physical contact, elements of playful struggle, and pressure on or massage of the parts of the body where the energy appears to be blocked. This should not be done if the trust bond is precarious or absent; it is absolutely contraindicated if the subject is paranoid and includes the people present among his or her persecutors. In some instances simply being with the client and playing for time might be the only solution. Under such circumstances, it is essential to use any possible means and existing resources to keep the LSD subject from hurting himself or others and causing serious material damage. While following this basic rule, occasional attempts should be made to establish rapport and gain the individual's cooperation.
If the gestalt of the experience remains unfinished when the effect of the drug is subsiding, psychological and physical activity should be used to facilitate integration. Ideally, the subject should complete the session feeling comfortable and relaxed, without any residual emotional or psychosomatic symptoms. The two techniques that have proven useful in this context—the abreactive approach and the cleansing hyperventilation—have been discussed earlier in this book (pp. 144-5, 147-8). After the subject reaches a psychologically and physically comfortable state, it is important to create a safe and nourishing atmosphere for the rest of the day and night. Ideally, a person who has been through a psychedelic crisis should not be left alone for at least twenty-four hours after the ingestion of the drug. After this time the therapist should see the client again, reevaluate the situation and, depending on his or her condition, choose the future strategy. In most instances no further provisions are necessary if the crisis was properly handled. It is useful to discuss the LSD experience in detail and facilitate its integration into the client's everyday life. If significant emotional and psychosomatic complaints have appeared as a result of the LSD experience, arrangements should be made for follow-up uncovering therapy and body work. An individualized selection of meditation techniques, Gestalt practice, neo-Reichian approaches, guided imagery with music, controlled breathing, polarity massage or rolfing should be offered to the client.
Where the clinical condition remains precarious despite all the uncovering work, this treatment may have to be continued on an in-patient basis. If all the above approaches prove ineffective, integration can be facilitated by chemical means. Ideally, a supervised psychedelic session should be scheduled after adequate preparation. This approach might seem paradoxical to the average mental health professional, since it involves administration of the same drug or category of drugs that apparently brought the client trouble in the first place. Yet judicious use of psychedelics under these circumstances is the preferred treatment. Clinical experiences have shown that it is extremely difficult to restore defenses by the use of covering techniques such as tranquilizers, once the unconscious has been opened by a powerful psychedelic substance. It is much easier to continue the uncovering strategy and facilitate completion of the unfinished gestalt.
Psilocybin, methylene-dioxy-amphetamine (MDA), tetrahydrocannabinol (THC), and dipropyltryptamine (DPT) are viable alternatives to LSD. They have the same general effects and are less contaminated by bad publicity. MDA and THC seem to be particularly useful in this context, because of their gentle effect and selective affinity to positive governing systems in the unconscious. Effective psychological work with these substances involves less emotional and psychosomatic pain than when LSD is used.
Since the above psychedelics are not readily available, and obtaining permission to use them involves tedious administrative procedures, a session with Ritaline (100-200 milligrams) or Ketalar (100-150 milligrams) might be a more feasible approach. Tranquilizers should not be used in any condition related to the use of psychedelic drugs until all the above uncovering approaches have been tried and have failed.
Powerful non-drug approaches could also be used in lieu of tranquilizers in all those cases where a poorly resolved LSD experience results in a long-term psychotic condition and psychiatric hospitalization lasting months or years. If these do not bring about sufficient clinical improvement, psychedelic therapy, using the substances mentioned above, is the next logical choice. Ketalar, a drug that is legally available and has been used in a medical context for general anesthesia could prove promising in these otherwise desperate cases.
I would like to conclude this discussion of psychedelic crisis intervention with a description of the most dramatic situation of this kind I have encountered in my professional career.

In my third year in Big Sur, California, I was awakened at 4:30 one morning by a telephone call. It was the night guard from the nearby Esalen Institute asking for help. A young couple called Peter and Laura, who were traveling down the coast, had parked their VW camper on coastal route 1 in the vicinity of the Esalen Institute and had decided to take LSD together. They rolled out the bed in their car and shortly after midnight both of them ingested the drug. Laura-s experience was relatively smooth, but Peter progressively developed an acute psychotic state. He became paranoid and violent, and after a period of verbal aggression he started throwing things around and demolishing the car. At this point Laura panicked, locked him in the car and sought help at Esalen. She appeared at the guard shack completely naked, holding the car keys in her hand. The night guard knew about my previous work with psychedelics and decided to give me a call; he also woke up Rick Tarnas, a resident psychologist who had done his dissertation on psychedelic drugs.
While the guard was taking care of Laura, who calmed down and had a pleasant, uncomplicated LSD experience, Rick and I walked to the camper. As we approached the car we heard loud noises and shouting; when we came closer we noticed that several of the windows were broken. We unlocked the car, opened the door and started talking to Peter. We introduced ourselves and told him that we had had considerable experience with psychedelic states and had come to help him. I tentatively stuck my head inside the door and looked into the camper; a half-gallon bottle missed me by about four inches and landed on the dashboard. I repeated this several times, and two more objects came flying in my direction. When we felt that Peter had nothing more to throw, we quickly moved into the camper and lay down on the roll-out bed on either side of him.
We continued talking to Peter, reassuring him that everything would be all right in an hour or two; knowing that he and his girlfriend had taken LSD after midnight, we could give him this definite time limit. It became obvious that he was in a paranoid state and saw us as hostile FBI agents who had come to fetch him. We held his arms in a comforting and reassuring way, changing this into a firm grip whenever he made an attempt to escape, but avoiding real physical antagonism and struggle. All the while, we kept talking about having had difficult experiences ourselves, and finding them retrospectively useful. His condition oscillated for about an hour between mistrust with anxiety-laden aggressive impulses, and episodes of relief when it was possible to connect with him.
As time went by and the LSD state became less intense, Peter slowly developed trust. He was more and more willing to keep his eyes closed and face the experience, and we were even able to start working carefully on the blocked parts of his body, encouraging full emotional expression. By seven o'clock all negative elements completely disappeared from Peter's LSD experience. He felt cleansed and reborn, and was thoroughly enjoying the new day. His previous hostility turned into deep gratitude and he kept repeating how much he appreciated our intervention.
At about half-past-seven Laura appeared at the camper and joined us; she was herself in very good condition, but was naturally concerned about Peter. Rick and I helped dispel the negative aftermath of the dramatic events of the night and facilitated their reunion. We advised them strongly against driving that day. They spent a leisurely day by the Pacific Ocean and the next day continued their journey south. They were both in good spirits, although somewhat worried about the bill for the repair of their damaged camper.