Drug Abuse

CHAPTER V

AUTOPSYCHOGNOSIA14

Psychedelic Drugs

Preparation for Autopsychognosia

Resistance to Autopsychognosia

§ 58 Autopsychognosia is a neuronal process which gives rise to emotionalintellectual realizations15 about the content of the unconscious and the motives of behaviour. Autopsychognosia is a subjective experience. A person who has not undergone the process finds difficulty in empathizing with its emotional content.

§ 59 The aim of autopsychognosia is to help R become as well acquainted with him self and his environment as possible.

§ 60 An individual decides to begin or not begin autopsychognosia after he is informed that autopsychognosia is not a method of therapy. It is combined emotional and intellectual knowledge which acquires therapeutic value only if the individual uses it in everyday life entirely on his own initiative.

R15 was asked by a very close friend of hers: 'Since you've progressed so much in your autopsychognosia, why haven't you solved your psychological problems satisfactorily?' R15 replied: 'Have you any idea what a rape feels like? Let me tell you that there is no feeling more horrible than that. If we suppose that someone has raped me, my knowing it doesn't mean that the rape is no longer a reality. What happens is that I know the rape occurred and I either reconcile myself with this emotionally painful fact or I continue to be tortured by it. Now then, the knowledge of the rape corresponds to the knowledge of autopsychognosia.'

§ 61 One way of achieving autopsychognosia is through pharmaceutical autopsychognosia sessions. Sessions may be performed with an individual or with a group. The participants in an individual Session are an R and a doctor. In a group Session, the participants are two doctors, at least three nurses and 8-15 Rs.

Because a Session is a subjective experience which concerns only a specific R and because the presence of others impedes R's concentration, the first five Sessions are individual. After this, if R so wishes, he participates in group Sessions.

PSYCHEDELIC DRUGS

§ 62 The process of the Sessions is based on the use of small doses of psychedelic drugs. The word 'psychedelic' is derived from the Greek words psyche (soul) and delo (I manifest). A psychedelic drug is a drug whose intake by the human body may bring about the manifestation or exteriorization of the unconscious. A basic pharmacodynamic property of the psychedelics is that they reactivate the memory of the nerve cells. This results in:

(a) The vivid emotional and physical revival of past events, some pleasant but most of them unpleasant (example R4 p.66).

(b) An amazing improvement in self-observation and introspection.

§63    Dosage of psychedelic drugs   For the first Session, men are given 3 mg Psilocybine or 50 mcg LSD-25, women 3 mg Psilocybine or 30 mcg LSD-25. The dose of the psychedelic for each Session thereafter is regulated according to R's reaction in the Session before. I seldom found it necessary to exceed doses of 9 mg Psilocybine or 100 mcg LSD-25. An exception is a case published in the periodical "Annales Medicopsychologiques de Paris" (t2, 121e annee, 1963, no 2, pp. 191-200). This case presented strong resistance. Owing to my lack of experience, I thought the resistance could be neutralized with a larger dose of the psychedelic. Thus, by gradually increasing the dose, I reached the colossal amount of 900 mcg LSD-25. As a result of this, not only was the resistance not neutralized but the case also presented severe confusional excitement which obliged me to terminate his Session with an intramuscular injection of 100 mg chlorpromazine.

§ 64 Environment for a Session   The room where the Session takes place must be sound-proof and arranged so that R can:

(a) Concentrate: for this reason the room is in semi-darkness.

(b) Move about freely. (R9 and R2, who felt the need to move about a great deal, preferred to lie on the floor instead of the couch.)

(c) Express his aggressiveness towards the environment in every possible way. R's original womb rejection and his frequent rejection by womb substitutes create in him anger, exasperation and the need to act destructively towards his environment and to shout with all his might. For this reason photographs of his mother, father and siblings should be in the room as well as various objects which he can destroy. In addition, paintings of various historical figures and events, known or unknown, often reactivate 'memory traces' of repressed psychotraumas and aid penetration into deeper layers of the unconscious.

General rule: During the Sessions R is encouraged to express his aggressiveness towards the external environment to the maximum.

§ 65 From 1960 -1964, I felt obliged to keep my cases (with few exceptions) in a hospital for several days after each Session because of the possible side-effects of the psychedelic. The experience of this period revealed that:

(a) The side-effects of the psychedelic were slight agitation and moderate melancholia, which abated easily with small doses of amitryptiline or chlorpromazine.

(b) R's confinement in the hospital was a psychological and financial strain.

(c) R's contact with the psychotraumatic family environment helped him strengthen and extend the realizations made in the Sessions.

Thus, after 1964 I changed tactics radically. The Sessions were still performed in the hospital but subsequently R returned home. Naturally, he could contact me any moment he wished. With this new procedure I did not encounter any unpleasant surprises.

§ 66 Duration of a Session    Because the duration of a Session cannot be foretold with precision, the doctor must be armed with the patience of Job.

The Sessions last about 6 - 8 hours and as a rule require the continuous presence of the doctor. I never stop a Session if R is still making realizations about his unconscious. One of the most astonishing realizations occurred during the I 1 th hour of R12's 4th Session where he described the conditions of his intra-uterine life.   For me this description was the first indication that the 'memory traces' of intra-uterine experiences are preserved by the human nervous system.

At the end of each Session R is given 25 mg chlorpromazine. The same dose is repeated two hours later if the pharmacodynamic activity of the psychedelic drug continues.   If it is necessary to stop a flashback or to terminate a Session because of severe and prolonged (more than two hours) anxiety, R is given 25 mg chlorpromazine.

§ 67 The phases of autopsychognosia    Generally speaking there are ten Sessions in the first phase of autopsychognosia, the interval between each Session being I - 3 weeks. The period before the second phase of autopsychognosia, the number of Ses sions in the second phase and the interval between each Session in the second phase depends on R's progress in his autopsychognosia.

§ 68 The selection of cases for autopsychognosia was made on the basis of the fol lowing criteria:

(a) The absence of permanent psychoticlike (psychotic) S & P. 16

(b) A certain sensitivity in communicating with their fellow man and with their envi ronment in general. A person who is narrow-minded and conservative in every aspect of his personal and social life does not constitute fertile ground for autopsychognosia. PREPARATION FOR AUTOPSYCHOGNOSIA

§ 69 R prepares for the Sessions by writing answers to a history questionnaire which consists of a general and a specific part. Here is a sample questionnaire. General questionnaire: Sex; age; educational level; profession; marital status; children; number of siblings, their sex and age; state of health of mother, father, siblings.

List your complaints, physical and mental - describe your symptoms, their intensity and duration. Describe any pharmaceutical therapy or any other kind of therapy you have undergone. What serious illnesses have you suffered?

Specific questionnaire: What events in your life can you remember? Which of these events do you consider important? What emotions did these important events produce in you? Does the way you communicate with your daily environment satisfy you? Does your environment accept you? Does it reject you? Do you feel negligible even amongst those closest to you? What are your feelings on your existence? Does your existence satisfy you? Are you pleased with yourself? with your body? Do you feel that your body is yours? Do you feel that the movements of your torso and limbs are yours? Do your thoughts, feelings, deeds disturb you? Do you accept your sex? Does your sex disturb you? How do you feel with members of the opposite sex? with members of the same sex? Do you have difficulty in communicating with them? De scribe your sexual activity, the fantasies and emotions which accompany it. Do you reach orgasm? If so, describe what you feel before, during and after orgasm. Do you always understand the motives of your behaviour? If not, give a specific example. What do you desire most in life? What are your ambitions? What are your expecta tions? What are your hopes for the future? What do you fear most? What are your other fears? Describe your recreational activities. Do you remember your dreams? Are any of your dreams repeated in a stereotyped fashion? Describe your feelings to wards your mother, father, each sibling; your feelings about the interpersonal rela tions of your mother and father, mother and siblings, father and siblings, siblings; your feelings towards persons whom you feel have played a significant role in your life. Have you ever had suicidal thoughts? If so, describe them.

Do you feel that you have concealed anything in answering the above questions? Recapitulate your problems beginning with the most important. What do you hope the Sessions will do for you? Do you have anything else to add?

§ 70 Observations on R's answers to the questionnaire The accuracy of R's answers to the general questionnaire can usually by checked through various other sources (relatives, friends). On the contrary, the absolute accuracy of R's answers to the spe cific questionnaire cannot be checked through any source but R himself. Moreover, R is not always consistent. At different moments, his answers to the same questions may vary, both in quality and intensity. Typically, oral descriptions of feelings towards his mother or father during the same or different free communication sessions (non pharmaceutical sessions) fluctuate. R's contradictory descriptions pose this question: Does his information correspond to reality or is it deliberately or unwittingly inaccu rate?

The realizations R makes during the Sessions show that his answers to the specific questionnaire were aften vague, inaccurate or incomplete even though he was convinced of their truth and accuracy. The answers were so because the roots of R's problems were unconscious or semi-conscious, unclear or incomprehensible. Despite their inaccuracy, written replies to the specific questionnaire before the Sessions are essential: they give R the possibility to realize later just how little he knew himself. Example: During her 15th Session, RIO was terrified by the vision of a ghost-like creature with green eyes, unruly white hair, white face, and wearing a green robe. Its arms were outstretched threateningly towards her. Here is what RIO said about the creature after her 19th Session:

"The feeling of being watched by some invisible 'thing' began, as far as I can remember, at age eight and has been with me every day since then. 'It' watches my every deed and knows even my innermost thoughts and emotions. Though this 'thing' is invisible, it has often been an extrememly powerful presence, so strong that I can actually 'hear' its mocking 'laughter', that is, I don't actually hear a voice, but I feel it intensely. And whatever it has to 'say' to me, I believe it is right, sometimes partly, but most often fully, and so I obey it.

This 'thing' has been with me even when I've been alone. Thus, instead of feeling free and uninhibited when I'm alone, I feel exactly the opposite - that I must conform to social behaviour. So if I do anything that one must not do in public, the 'thing' criticizes me severely. If I am depressed, frustrated, angry, desperate, it scornfully 'tells' me that I'm putting on an act. When I feel very female (which is seldom), it ridicules and mocks me: "Who are you trying to fool?" When I feel and behave like a man: "What a fool!" On the rare occasions when I feel relatively happy it 'says', "This won't last long," or "You won your happiness under false circumstances."

If I am in a room, the'thing' is in an upper corner of the room.   If I am out in the open air, the 'thing' is up in the air at a certain fixed point, again as if in an upper corner of a room. I have often tried to use my logic to tell myself that there is nothing up in the corner of the room watching me since it cannot be seen or grasped with the hands. But this has never worked.   From the very first second of feeling it,

nothing I can say to myself can break its iron grip on me.   And my very same logic tells me that though this 'thing' cannot be seen, it doesn't mean that it's not there. It is there and it is real. I feel its presence as so much a part of my life that, despite the fact that it tortures me, I consider it as something natural and so it did not occur to me that I should mention it in the questionnaire before beginning the Sessions. Now, after 19 Sessions, I realize that the invisible 'thing' is the green creature of Session 15, that is the green womb - the womb which doesn't want me, which constantly threatens my existence, which knows and sees I'm in agony but yet continues to bombard me mercilessly with rejecting messages, which laughs at me for being a 'woman' and mocks my efforts to become a man."

Note: The factors which negatively influence the 'sincerity' of R's answers to the specific questionnaire also influence his answers in psychometric tests. None of the psychometric tests used on the 16 prior to the Sessions could predict that memories of intrauterine life are retained by the nervous system.

RESISTANCE TO AUTOPSYCHOGNOSIA

§ 71 Although the Sessions are subjective in nature and cannot be grasped through mere descriptions, it is nevertheless essential that prior to the Sessions R be familiarized with two basic elements which are vital to the positive evolution of autopsychognosia:

(a) Conscious and unconscious resistance to penetrating into the unconscious.

(b) The means of neutralizing resistance.

§ 72 Some causes of resistance The person who is to undergo Sessions feels shame and vague fear. Before her first Session R8 said, 'I'm afraid I might see myself as more despicable that what I imagine.'

One cause of R's resistance is his fear of revealing to the doctor terrible inner thoughts and shameful deeds. Revealing them to the doctor is like revealing them to the whole world. These thoughts and feelings constitute conscious and unconscious resistance to confiding in the doctor and are not easily neutralized. Even when R has decided to express his every thought to the doctor, there is always something that he will hide from the latter and from himself.

§ 73 The thought that autopsychognosia might transform his character and emotions makes R feel anxious.

Examples:   On the eve of his first Session R12 was worried that autopsychognosia might change his feelings towards certain beloved friends. R9 feared that autopsychognosia might alter his feelings towards a certain young woman. This fear prevented progress in his Sessions until he realized that the woman symbolized his only link with the external environment, For foetus R9, communication with the original external environment, the womb, was his only means of survival. For R9 the adult, the external environment was symbolized by the young woman. Thus, cutting his communication with her would have been like sentencing himself to death.

§ 74 The 'memory traces' of fears, anxiety and primitive terror caused by various psychotraumatic stimuli become associated and form a compact system of rejection (§ 50). Because psychedelic drugs reactivated the compact system of rejections, R is overcome by a fear which he senses will intensify until it is unbearable. To avoid this, he consciously or unconsciously represses his fear and so blocks the evolution of the Session. There are many tactics of resistance.   For instance, at any point in the Session R may announce that he wants to smoke: smoking, however, is a means of emotional self-control and if R is permitted to satisfy his desire the process of the Session breaks down.

Beforehand, R must know that the intensity of his fear-anxiety will increase during the Session and that if he wishes to learn the causes of his mental disturbance he must not neutralize the fear-anxiety, even if he feels that he will die.

§ 75 From the general principle that the nervous system selects the'best' way of reacting to stimuli, one concludes that mental disturbance17 is the 'best defence' against rejecting stimuli. Naturally, then, R fights autopsychognosia which tends to neutralize his mental disturbance.

§ 76 The doctor's presence may be another cause of resistance in the Sessions and occurs even when R's communication with the doctor is satisfactory. This is due mainly to shame. Forewarned of this, R should not hesitate to ask the doctor to leave the room if he wants to be alone and to call him back when he needs him.

Clearly, the doctor must be at R's disposal during the Sessions if he is to help R effectively. The doctor can achieve this only when he has fully grasped the process of the Sessions and accepts his secondary role.

Example: During his second Session R5 wanted to be alone. Without hesitation I left the room. Half an hour later he called me back and confessed embarrassment at assuming the foetal position in my presence. Applying the general principle that he must

express everything he feels, R5 had found the courage to ask me to leave. As a result of my immediate departure, R5 took the foetal position, began to rock himself to and fro and finally felt that he was in the womb. He then relived experiences of periodic rejection during intra-uterine life and the severe trauma of his expulsion-birth. After this Session R5 admitted his need to take the foetal position in the first Session as well, but he had not dared express his wish to be alone. This had prevented his 'return' to the womb.

§ 77 Before the Sessions I inform R that he is not anaesthetized by the psychedelic: on the contrary he retains his senses and is fully aware of what he is thinking, saying and doing. In addition, he can remember almost all details of a Session when it is over. If R has no objection, the Sessions are recorded. On the subject of recording R9 said, 'Listening to the taped Session I relive the past once again and reinforce the realizations I made during the Session.' The tapes belong to R and he retains them for his own private reference. Even if R consents to the recorder, its presence may inhibit him. If this happens, recording is stopped.

§ 78 The psychedelic is given in minute doses. Thus, if he wished, R may neutralize its pharmacodynamic activity completely and obstruct the progress of a Session (example R4 p.71).

§ 79 Neutralization of resistance - examples   If unpleasant emotions accompany a thought or image in R's mind during a Session, then the thought or image is related to his psychological traumas. In this case R tends to repress rather than to express what he is thinking and feeling. Thereby, the process of the Session breaks down. If, however, he expresses his thoughts and feelings, then the series of ideas which follows will lead him to the root of his mental conflict. The expression of the original thought is like the beginning of Ariadne's thread which guides R through the labyrinth of the unconscious.

Example: One hour into his first Session, R2 describes the following image: 'I see myself as a small child holding my mother's hand. I'm very happy. Suddenly the image of my father appears. He's furious with me. His very presence terrifies me. I'm very afraid.'

At this point R2 stopped speaking. After a few minutes' silence he began describing some minor conflicts with his only sister and finally stopped speaking altogether. His prolonged silence was a clear indication of resistance and thus I urged him repeatedly to recall the image of his angry father.   Finally R2 responded:   "I can see my father, angry again. His image disappears and in its place comes another. It's me in front of an enormous vulva which is protecting me. I feel safe and secure. It's my mother's vulva.'

From this image R2 realized that his sexual desires for his mother sprang from his need for security. He was afraid to exteriorize these sexual desires: their expression would have implied confrontation with his father, all-powerful rival and master of his mother. He would have annihiliated R2's existential identity/selfpreservation.

§ 80 During a Session two images of different content may alternate and hinder the progress of the Session if R does not continue expressing his thoughts.

Example: During her second Session R15 saw two alternating images. First Image: 'I see myself at the age of twelve chasing butterflies in the garden.' Moderate anxiety accompanied the image. Second image: 'Again I'm twelve years old. I'm lying on my bed.' Moderate anxiety also accompanied this image.

The alternation of the images was repeated a few times and finally R15 fell silent owing to resistance. I urged her to return to the images. She asked me which image she should follow. I suggested she choose the image that felt more significant.

In a co-operative effort to neutralize resistance, she insisted that I choose one for her. Because I thought a traumatic sexual experience would more likely follow from the second image, I proposed this one. R15 complied and the image evolved as follows: her older sister enters the room, sits on the bed and starts talking about a dress she wants to buy. R15 remarks, 'I don't feel that this image goes anywhere.' This image was the result of resistance, its aim to block the Session.

I recommended that she return to the first image. R15 complied and continued, 'I am in the garden chasing butterflies ... The image changes. Now I'm eight years' old and in the same garden. Here is our gardener ... (anxiety) He invites me to follow him. He says he wants to show me some beautiful flowers in the green-house ... (anxiety increases) There, he begins to caress me ... He exposes his penis and rubs it against me. 1 don't resist. His penis touches my genital organs ... I feel pleasure and terrible shame ... (severe anxiety) Oh God, I'm not a virgin.'

This example shows that even if R follows the wrong path momentarily, he finally finds the right one if only he expresses whatever he feels.

§ 81 R must be informed that a Session leaves 'memory traces' in his nervous system which may be reactivated automatically without the psychedelic. This important process, which may occur from anywhere between a few days to many years later, is called a flashback. It is easily neutralized either at will or with 25 mg chlorpromazine. During the flashback R may function as he does in a Session and progress on to realizations (§ 17).

§ 82 The doctor's role during the Sessions

(a)   The doctor's view of his role    Many years of experience have shown me that R needs someone who stands by him as a person during the Session and who acts as a doctor if the Session needs to be stopped.   It is R who has the primary role in a Ses sion: it is he who must find the painful road to his unconscious. The doctor sits pa tiently at R's side regardless of the duration of the Session.

If R shows signs of resistance in his stream of thought during a Session, I intervene by asking questions related to the source of resistance. If R's anxiety increases, I encourage him not to neutralize it even if he feels that he is approaching death. If severe anxiety lasts for two hours, I stop the Session with an intramuscular injection of 25 mg chlorpromazine.

If the doctor's presence inhibits R's stream of thought, he should leave the room and return only when R calls him.

(b) R's view of the doctor's role The doctor acts upon R as an external stimulus which reactivates 'memory traces' of past rejecting or accepting stimuli. This process stems from the mechanisms of projection and/or identification.

Example: During his 19th Session, R5 feels he is about to relive the very painful experience of near-suffocation during his expulsion-birth and asks me to turn on the light. 'I want you to see me suffering,' he says and continues: 'The agonizing moments of the past that I relive are proof that I suffer. You're to blame for all my suffering because you gave me the injection (of the psychedelic drug which reactivated the past). Yes, you're my mother and my father. You're the rejecting womb. You do whatever you like with me. You try to fool me. You gave me an injection of tap water, not medicine. You want to make fun of me.   I feel the drug working strongly and yet I believe that you didn't give me a real injection. Yes, but 1 can fool you too. Everything that you see, everything that you hear (he means muscular contractions, groaning and screaming from the agony of suffocation) is an act, a comedy. It's bullshit. I want to progress. I want to show you that I'm progressing in the Session, that I make realizations and that the Session is succeeding. Perhaps that way you'll be happy and stop rejecting me.'

Here we see that RS's feelings towards the womb are projected to the doctor whom he tries to fool just as he tries to fool the rejecting womb.

14 In contrast to autopsychognosia is autognosia, a term for the ancient Greek saying that total knowledge of oneself leads to total knowledge of the universe and the gods.

15 In contrast to subjective emotional-intellectual realizations are plain intellectual realizations which leave R indifferent from an emotional point of view. The remark made by R7, who had undergone psychoanalysis before coming to me for autopsychognosia sessions, is typical: 'With my psychoanalyst's help, I learned how to make intellectual realizations about the motives of my morbid behaviour, but the whole thing just left me cold.'

16 R1, R4, R6, R8, R9, R10 and R14 mentioned in their history psychoticlike S & P which, as a rule, diminished with the Sessions.

17 For definition of mental disturbance, see § 110.

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