Chapter 47. LSD and psychotherapy

For a time after 1943, LSD was a drug in search of a use. The United States Army tested its usefulness for brainwashing, and for inducing prisoners to talk more freely. Later, LSD was stockpiled in very large amounts by the American armed forces for possible use in disabling an enemy force. * Military interest in LSD waned, however, when psychoactive chemicals such as BZ, capable of producing even more bizarre effects, were developed. **

* Brigadier General J. H. Rothschild, commanding general of the United States Army Chemical Corps Research and Development Command, in a book that he wrote following his retirement,  Tomorrow's Weapons (1964), noted: "It is easy to foresee that a military commander under the effects of LSD-25 would lose his ability to make logical, rational decisions and issue coherent orders. Group cooperation would fall apart.... Think of the effect of using this type of material covertly on a higher headquarters of a military unit, or overtly on a large organization. Some military leaders feel that we should not consider using these materials because we do not know exactly what will happen and no clear cut results can be predicted. But imagine where science would be today if the reaction to trying anything new had been, 'let's not try it until we know what the results will be.' "

** While most information about BZ is a military secret, the chemical is said to produce not only hallucinations, disorientation, giddiness, headache, drowsiness, and sometimes maniacal behavior, but also retention of urine and constipation. Field dispensers and bombs for delivering BZ to the enemy have been developed. A major feature of LSD, BZ, and other psychochemicals is that even very small nations can develop and stockpile them. "The psychochemicals will be the most difficult of all weaponry to control and supervise if disarmament ever comes," Dr. Sidney Cohen notes. The demobilization of United States biological warfare facilities in 1970 and 1971 did not include chemical agents.

Psychiatrists were naturally interested from the beginning in LSD effects. Many of them took the drug themselves, and gave it to staff members of mental hospitals, in the belief that its effects approximate a psychotic state and might thus lead to better understanding of their patients. Some of those who tried LSD reported that it did enable them to achieve greater empathy with their psychotic patients. It was as an adjunct to psychotherapy, however, that LSD came into widespread use.

Drs. Anthony K. Busch and Warren C. Johnson secured a supply of LSD from Sandoz in 1949, and published the first report on its psychotherapeutic use in twenty-one hospitalized psychotic patients in 1950. They concluded that "LSD-25 may offer a means for more readily gaining access to the chronically withdrawn patients. It may also serve as a new tool for shortening psychotherapy. We hope further investigation justifies our present impression." Other reports soon followed. In 1950, Rostafinski in Poland told of giving LSD to eight patients with epilepsy. In 1952 Dr. Charles Savage, who had first received LSD for use in a United States Navy project, reported lack of success in fifteen patients suffering from depression. In 1953, Liddell and Weil-Malherbe in England reported favorable effects in patients suffering from a number of mental disorders. By 1954 LSD was being used therapeutically in Baghdad. Also in 1954, Federking in Germany reported the comparative effects of 60 LSD trips and 40 mescaline trips among neurotic patients refractory to psychotherapy; he thought LSD more effective than mescaline. By 1965, it was estimated that between 30,000 and 40,000 psychiatric patients around the world had received LSD therapeutically; and additional thousands of normal volunteers had received it experimentally. Countless experiments had been run on animal species ranging from the spider and the snail to the chimpanzee. It was estimated in 1965 that some 2,000 papers on LSD effects had been published. Few drugs known to man have been so thoroughly studied so promptly.

At a 1965 LSD conference Dr. Sidney Cohen, an American authority on LSD, summed up the claims made for LSD and LSD-like drugs by psychiatrists:

1. They reduce the patient's defensiveness and allow repressed memories and conflictual material to come forth. The recall of these events is improved and the abreaction is intense.

2. The emerging material is better understood because the patient sees the conflict as a visual image or in vivid visual symbols. It is accepted without being overwhelming because the detached state of awareness makes the emerging guilt feelings less devastating.

3. The patient feels closer to the therapist and it is easier for him to express his irrational feelings.

4. Alertness is not impaired and insights are retained after the drug has worn off.

Under skilled treatment procedures, the hallucinogens do seem to produce these effects and one more which is not often mentioned. That is a marked heightening of the patient's suggestibility. Put in another way, the judgmental attitude of the patient toward the experience itself is diminished. This can be helpful, for insights are accepted without reservations and seem much more valid than under nondrug conditions.

"It is curious," Dr. Cohen added,

how under LSD the fondest theories of the therapist are confirmed by his patient. Freudian symbols come out of the mouths of patients with Freudian analysts. Those who have Jungian therapists deal with the collective unconscious and with archetypal images [two key Jungian concepts]. The patient senses the frame of reference to be employed, and his associations and dreams are molded to it.

Dr. Cohen did not conclude, however, that this curious LSD phenomenon invalidates LSD results. Instead, he called attention to an explanation first offered by a California psychoanalyst, Dr. Judd Marmor, who pointed out that while the technical terms used by different therapists may vary,

each interpretation has a definite relationship to the life pattern of the patient. A Freudian may express it in terms of unresolved Oedipal complexes, a Jungian will speak of archetypes, a Rankian of separation anxiety, and a Sullivanian of oral dynamisms. Marmor's point is that they are all structuring the data in their own terminology, but that a common core of reality underlies each of the explanations.

Dr. Daniel X. Freedman, chairman of the department of psychiatry at the University of Chicago-Pritzker School of Medicine, has pointed out yet another feature of the LSD experience, one which he calls "portentousness": the sense that something–– even a trivial platitude–– is fraught with a cosmic significance too profound to be adequately communicated. * Whether or not LSD does in fact enable users on occasion to grasp significant new insights into themselves or the world about them–– a much debated issue–– the drug certainly gives many users a feeling that they have achieved profound new insights.

* Ether was once thought to have a similar effect. Dr. Oliver Wendell Holmes, it will be recalled (see Chapter 43), took ether in the hope of achieving a mystical insight into the nature of the universe and felt that he had in fact achieved one. The insight, laden with a sense of portentousness, he recorded verbatim: "A strong smell of turpentine prevails throughout."

LSD was tried for the treatment of alcoholism at several research centers after 1952. The early reports suggested that a single large dose of LSD, given under appropriate circumstances, might profoundly affect drinking patterns and even produce total abstinence–– reports curiously paralleling nineteenth-century and recent accounts of abstinence from alcohol among Indians entering the peyote cult. One LSD report of this kind from the Mendocino State Hospital in Talmadge, California, in 1967 concerned the effects of large doses (400 to 800 micrograms) of LSD on 71 women alcoholics with an average of 7.8 years of uncontrolled drinking:

Most of the women enjoyed the music though some wanted it turned off later in the day. Most lay quietly on the lounge and showed some feelings. Some thought of issues as large as the meaning of life and their place in it, while many considered tearfully their relationship to husband, children or boyfriends.... They often lay peacefully from 8 to 1 o'clock with a little leisurely moving about from 1 to 3 or 4 p.m..... Only three sessions [out of 82] were terminated early because of the subject's reaction.... Most indicated 110 physical discomfort or fear of dying and found the experience intensely memorable and real. Almost none felt suspicious of others or unduly influenced by the others present. They felt a high level of trust and affection... 75 percent felt a spiritual bond with others, 72 percent felt a unity of all things and that they were part of this unity, which 60 percent were willing to call God; 80 percent felt they gained a more complete acceptance of others; 84 percent felt their own understanding was enhanced.

Bad trips occasionally occurred when LSD was used in psychotherapy –– but these, too, were sometimes therapeutic. At a Wesleyan University LSD conference in 1967, Dr. Albert A. Kurland of the Maryland Psychiatric Research Center cited a remarkable example from among the 177 patients whom he and his associates–– Drs. Charles Savage, John W. Schaffer, and Sanford Unger–– had treated up to that time. This patient was a forty-year-old male alcoholic, black, brought to the hospital from jail after ten days of uncontrolled drinking. He had dropped out of the fourth grade at the age of twelve and had an I.Q. of 70. "He had been draining whiskey barrels at his place of work, a distillery. He gave a history of excessive alcohol consumption over the past four years.... The only limit on his drinking was his low income and the need to support five children. During these years his marriage had deteriorated."

Given a week of preparation and a single large dose of LSD, this patient felt (among other things) that be was being chased, struck with a sword, run over by a horse, and frightened by a hippopotamus–– a quite typical "bad trip." His own verbatim report of his trip then continued:

I was afraid. I started to run. but something said "Stop!" When I stopped, everything broke into many pieces. Then I felt as if ten tons had fallen from my shoulders. I prayed to the Lord. Everything looked V better all around me. The rose was beautiful. My children's faces cleared up ' I thought of alcohol and the rose died. I changed my mind from alcohol toward Christ and the rose came back to life. I pray that this rose will remain in my heart and my family forever. As I sat up and looked in the mirror, I could feel myself growing stronger. I feel now that my family and I are closer than ever before, and I hope that our faith will grow forever and ever.

This patient was given psychological tests both before and after his LSD experience. His score on the Eysenck neuroticism scale before LSD had been in the eighty-eighth percentile–– highly neurotic. One week after LSD his score had swung to the normal portion of the scale. His pre-LSD depression, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), had lifted and his score was greatly improved. Tested a third time, six months after LSD, his depression score on the NIMPI was still within normal limits. More important–– "He had been totally abstinent, and his wife reported that there was a peace and harmony in the home that had never existed before and that he had never been better." A full year after the single LSD treatment, "the family picture remains the same. He is still sober, although there has been one brief break in abstinence following the loss of his job."

The credit for this and similar one-shot successes with alcoholics, Dr. Kurland believes, is traceable only in part to the LSD experience itself. "This particular patient was fortunate in having a family that reinforced his newfound feeling of love and affection for them. A patient who goes back to a rejecting family is very likely to return to drink." Observations such as this have led some therapists to offer the LSD experience to the spouses of patients as well as to the patients themselves.

"What seems striking about this particular case," Dr. Kurland concluded, "is not only that an alcoholic's drinking has been arrested, but that an illiterate, culturally deprived man of low intelligence could apparently be reached through a psychotherapeutic procedure.... "

Another field in which LSD has been used at a number of medical Centers is the palliation of terminal cancer.–– Beginning in 1964, a Chicago anesthesiologist, Dr. Eric C. Kast of Cook County Hospital, published a series of reports on LSD given to 128 terminal cancer patients in great pain. LSD proved about as effective as the usual opiates in relieving this pain–– and the effect was much longer-lasting. Indeed, the pain relief continued even after the LSD-trip terminated. More remarkable still, many patients retained their equanimity for several weeks after the pain returned; they no longer considered the pain  important.

Dr. Kast's findings were confirmed by Dr. Sidney Cohen in his work with terminal cancer patients, and by Dr. Kurland and his associates in Maryland. The Maryland research was launched under dramatic circumstances.

"A professional member of our own research department, a woman in her early forties, developed a progressive neoplastic disease [cancer]," Dr. Kurland explained at the 1967 Wesleyan University conference. "She had undergone radical mastectomy [breast removal], and subsequent surgery had revealed inoperable metastases to the liver. Although still ambulatory, she was in considerable physical distress–– unable even to breathe deeply without severe pain. She was fully aware of the gravity of her condition, and her depressed and distraught psychological state was steadily worsening." In these desperate straits, the patient requested LSD therapy. "After discussion with her husband and her surgeon, and with the approval of all concerned, a course of psychedelic therapy was initiated."

A week was devoted to preparation. Then LSD was administered. Two days later the patient went on a two-week vacation with her husband and children. Upon her return she wrote the following report:

The day prior to LSD, I was fearful and anxious. I would, at that point, have gratefully withdrawn. By the end of the preparatory session, practically all anxiety was gone, the instructions were understood, the procedure clear....

The morning was lovely–– cool and with a freshness in the air. I arrived at the LSD building with the therapist. Members of the department were around to wish me well. It was a good and warming feeling.

In the treatment room was a beautiful happiness rosebud, deep red and dewy, but disappointingly not as fragrant as other varieties. A bowl of fruit, moist, succulent, also reposed on the table. I was immediately given the first dose and sat looking at pictures from my family album. Gradually my movements became fuzzy and I felt awkward. I was made to recline with earphones and eyeshades. At some point the second LSD dose was given me. This phase was generally associated with impatience. I had been given instructions lest there be pain, fear or other difficulties. I was ready to try out my ability to face the unknown ahead of me, and to triumph over any obstacles. I was ready, but except for the physical sensations of awkwardness, and some drowsiness, nothing was happening.

At about this time, it seems, I fused with the music and was transported on it. So completely was I one with the sound that when the particular melody or record stopped, however momentarily, I was alive to the pause, eagerly awaiting the next lap in the journey. A delightful game was being played. What was coming next? Would it be powerful, tender, dancing, or somber? I felt at these times as though I were being teased, but so nicely, so gently. I wanted to laugh in sheer appreciation.... And as soon as the music began I was off again. Nor do I remember all the explorations.

Mainly I remember two experiences. I was alone in a timeless world with no boundaries. There was no atmosphere; there was no color, no imagery, but there may have been light. Suddenly, I recognized that I was a moment in time, created by those before me and in turn the creator of others. This was my moment, and my major function had been completed. By being born, I had given meaning to my parents' existence.

Again in the void, alone without the time-space boundaries. Life reduced itself over and over again to the least common denominator. I cannot remember the logic of the experience, but I became poignantly aware that the core of life is love. At this moment I felt that I was reaching out to the world–– to all people–– but especially to those closest to me. I wept long for the wasted years, the search for identity in false places, the neglected opportunities, tile emotional energy lost in basically meaningless pursuits.

Many times, after respites, I went back, but always to variations oil the same themes. The music carried me, and sustained me.

Occasionally, during rests, I was aware of the smell of peaches. The rose was nothing to the fruit. The fruit was nectar and ambrosia (life), the rose a beautiful flower only. When I finally was given a nectarine, it was the epitome of subtle, succulent flavor.

As I began to emerge, I was taken outdoors to a fresh, rain-swept world. Members of the department welcomed me and I felt not only joy for myself but for having been able to use the experience these people who cared wanted me to have. I felt very close to a large group of people.

Later, as members of my family came, there was a closeness that seemed new. That night, at home, my parents came, too. All noticed a change in me. I was radiant, they said. I seemed at peace, they said. I felt that way too. What has changed for me? I am living now, and being. I can take it as it comes. Some of my physical symptoms are gone. The excessive fatigue, some of the pains. I still get irritated occasionally and yell. I am still me, but more at peace. My family senses this and we are closer. All who know me well say that this has been a good experience.

Psychological tests were administered to this patient both before and after LSD therapy. "The retesting indicated a significant reduction on the depression scale and a general lessening of pathological signs." The patient "returned to work and appeared in relatively good spirits" for five weeks. Then she was hospitalized for accumulation of fluid caused by the cancer, and died three days later.

"Investigation of the utility of psychedelic therapy with terminal patients is continuing," Dr. Kurland concluded his 1967 report, "with the collaboration of staff at the Sinai Hospital in Baltimore...."

Through the years of LSD psychotherapy from 1949 to the mid-1960s, psychiatrists and others relearned the lesson American Indian users of LSD-like drugs had learned long before: that the setting in which the drug is given, the expectations aroused in the patient prior to the experience, the people and objects present during the experience, the reassurance given the patient as the trip progresses, and countless similar ancillary factors are as significant in molding the experience as the drug itself–– and are essential safeguards against adverse effects.

Ultimate pharmacological proof of the effectiveness of LSD in psychotherapy has not been established. Ideally, candidates for therapy should be divided at random into two groups, one of which is given the medication while the other is treated in exactly the same way except that it is given a placebo instead. To guard against bias, moreover, the procedure must be "double-blind"; neither doctor nor patient must know whether the patient is receiving the active drug or a placebo. The effects of LSD are so obvious, however, that the "double-blind" requirement is utterly impractical; any physician will recognize within a very short time whether a patient has in fact received LSD.

Despite lack of a control group, both patient and psychiatrist may conclude that the patient's life pattern has improved under treatment. The patient is in this respect his own control: a comparison of his condition before and after therapy takes the place of a comparison between treated and untreated patients. So it was with the use of LSD in psychotherapy. It survived and spread in the United States from 1949 into the mid-1960s, and continues in use in other countries, because psychiatrists and patients alike have been impressed by the changes experienced. As Dr. Sidney Cohen points out, "No method of using LSD therapeutically has as yet met rigid scientific requirements, which include long-term follow-up and comparison of patients receiving LSD with a control group who receive identical treatment except for the LSD. But, in truth, no other type of psychotherapy has been fully tested by these exacting methods."

Footnotes
Chapter 47

1. J. H. Rothschild, Tomorrow's Weapons (New York: McGraw-Hill, 1964), quoted in Seymour M. Hersh,  Chemical and Biological Warfare: America's Hidden Arsenal (New York: Doubleday Anchor, 1969), p. 50.

2. Victor W. Sidel and Robert M. Goldwyn, "Chemical Weapons, What They Are, What They Do,"  Scientist and Citizen, 9 (August-September, 1967): Table 1, p. 144.

3. Ibid., pp. 45-48.

4. Sidney Cohen,  The Beyond Within: The LSD Story (New York: Atheneum, 1968), p. 237.

5. A. K. Busch and W. C. Johnson, "Lysergic Acid Diethylamide (LSD-25) as an Aid in Psychotherapy,"  Diseases of the Nervous System, 11 (1950): 204.

6. M. Rostafinski, "Experimental Hallucination in Epileptic Patients,"  Rocznik Psychiatryczny (Poland), 38 (1950): 109; summarized in  Bibliography on Psychotomimetics, 1943-1966 (U.S. Department of Health, Education and Welfare, Public Health Service, 1966), p. 5.

7. Charles Savage, "Lysergic Acid Diethylamide (LSD-25): A Clinical-Psychological Study,"  American Journal of Psychiatry, 108 (1952): 898.

8. D. W. Liddell and H. Weil-Malherbe, "The Effects of Methedrine and of Lysergic Acid Diethylamide on Mental Processes and on the Blood Adrenalin Level,"  Journal of Neurology, Neurosurgery and Psychiatry (British), 16 (1953): 7, summarized in  Bibliography on Psychotomimetics p. 10.

9. J. D. P. Graham and Alaa Iddeen Khalidi, "The Action of d-Lysergic Acid Diethylamide (LSD 25), Part 1, General Pharmacology,"  Journal of the Faculty of Medicine (Baghdad), 18 (1954): 1, summarized in  Bibliography on Psychotomimetics, p. 20.

10. Ibid., p. 14.

11. John Buckman, "Theoretical Aspects of LSD Therapy," in Harold A. Abramson, ed.,  The Use of LSD in Psychotherapy and Alcoholism (New York: Bobbs-Merrill, 1967), p. 96.

12. Ibid.

13. Sidney Cohen, "Psychotherapy with LSD: Pro and Con," in  The Use of LSD, pp. 581-582.

14. Ibid., p. 578.

15. Ibid.

16. Daniel X. Freedman, "On the Use and Abuse of LSD,"  Archives of General Psychiatry, 18 (March, 1968): 331.

17. Oliver Wendell Holmes,  Mechanism in Thought and Morals, Phi Beta Kappa Society address, Harvard University, June 29, 1870 (Boston: J. R. Osgood and Company, 1871).

18. Wilson Van Dusen, Wayne Wilson, et al., "Treatment of Alcoholism with Lysergide ,"  Quarterly Journal Studies on Alcohol, 28 (1967): 299, 302.

19. Albert A. Kurland et al., "The Therapeutic Potential of LSD in Medicine," in  LSD, Man and Society, ed. Richard C. DeBold and Russell C. Leaf (Middle town, Conn.: Wesleyan University Press, 1967), p. 23.

20. Ibid.

21. Ibid., p. 24.

22. Ibid.

23. Ibid.

24. Ibid.

25. E. Kast, "Pain and LSD-25: A Theory of Attenuation of Anticipation," in  LSD: The Consciousness-Expanding Drug, pp, 239-254.

26. Sidney Cohen, "LSD and the Anguish of Dying,"  Harper's, 231 (September, 1965): 69-78.

27. Albert A. Kurland et al., p. 31.

28. Ibid., pp. 31-33.

29. Ibid., p. 33.

30. Sidney Cohen in  Harper's, p. 71.