The application of LSD in psychiatry
LSD as a "Consciousness-Expanding" drug
Conclusions and recommendations
Author: Graham C. TAYLOR, M.D.
Pages: 7 to 13
Creation Date: 1967/01/01
At the time of writing, the manufacturers of LSD have withdrawn the drug from the market. The drug however continues to be available from many unofficial sources. A dangerous polarization is developing. On the one hand, controls have been put on its availability for purposes of medical treatment or scientific research. On the other hand it appears to be widely available for general consumption, at least as far as the dedicated enthusiasts are concerned. Many feel that LSD, being a drug, should be administered only by physicians and restricted at this stage to investigational purposes. But in the United States there is a growing subculture in certain sectors of the intelligentsia including artists, college students, and the intellectually curious, who appear to have ready access to the drug. Opinion is thus divided very sharply into two camps: the "Establishment" and the "cultists ", if one were to use extreme terms to designate the two groups.
The general situation is one of instability and rapid change. Many claims are made which are exaggerated and unfounded. In turn, there are reactions to these claims, which are of an unwise nature. There is general agreement that the drug is potent with probably many uses still not discovered. But there is profound and basic disagreement as to who should administer the drug and with what qualifications and safeguards.
The United Nations Commission on Narcotic Drugs convened a special committee to consider and advise upon the controls that should be put on drugs which are not at present under international control. This committee, whose membership consisted of Canada, France, Federal Republic of Germany, India, Japan, Mexico, United Arab Republic, United Kingdom, United States, and Union of Soviet Socialist Republics, took a very strong position reparding LSD. On the advice of this committee, the Commission itself last December unanimously adopted a resolution (which will now go to the U.N. Economic and Social Council for endorsement) in which it has noted the increasing abuse of LSD and has found this a grave danger to health and safety, both for the individual and for society at large. It has asked governments to put LSD and similar substances under strict control so far as production, export and import are concerned, and to have them distributed only under the supervision of competent authorities. It has recommended that LSD and similar drugs "be restricted to scientific research and medical purposes and that their administration be only under very close and continuous medical supervision ". The Committee has condemmed all other usage of such substances and has urged governments to take all steps to prevent it.
This paper will deal first with the use of LSD in psychiatry, and secondly with the role of LSD as a "consciousness-expander ". An attempt will be made to evaluate the divergent points of view and to develop a balanced formulation of the problems involved. The author is very much indebted to Dr. George R. Heninger of the National Clearing House for Mental Health Information, National Institute of Mental Health - for providing an LSD Printout from Automated Data Retrieval System.
It was originally considered that LSD produced conditions similar to those of schizophrenia, and so much of the early investigation of this drug was along the lines of its producing a "model-psychosis ". It is now generally agreed that although it sometimes produces conditions resembling schizophrenia, it is not truly an imitator or a mimic of the psychotic state. Nevertheless, further investigation of LSD may add to our knowledge concerning schizophrenia.
The applications of LSD in the general field of psychiatry are primarily in the area of psychotherapy. It is also used as an aid in differential diagnosis by virtue of its tendency to intensify whatever psychopathology is present.
It must be clearly borne in mind that it is very difficult indeed to evaluate the action of this drug. This is so for many reasons. The drug itself produces many effects. The set and the setting are crucial variables. There is usually an intense atmosphere surrounding the administration of the drug. There are frequently strong expectations, amounting to convictions, on the part of the person taking the drug. It is by no means easy to assess and evaluate the bias both conscious and unconscious of the therapist and the patient involved in the transaction. Levine and Ludvig [ 1 ] observe that: "There is a great deal of emotional bias, irrationality and unsupported belief on both sides of the LSD issue. However, in view of the consistent dramatic and enthusiastic claims by LSD therapists, psychiatry cannot afford to condemn the use of this drug without first subjecting it to a fair and impartial trial." Cole and Katz [ 2] point out that "Rather than being the subject of careful scientific inquiry, these agents have become invested with an aura of magic, offering creativity to the uninspired, 'kicks' to the jaded, emotional warmth to the cold and inhibited, and total personality reconstruction to the alcoholic or the psychotherapy-resistant chronic neurotic."
LSD can aid or facilitate psychotherapy by enhancing the learning process, and also by achieving a corrective emotional experience. The proponents of LSD feel that the patient is less defensive, that the intensity of the experience permits of a stronger abreaction, and that the visual imagery enables a patient to symbolize his conflict in a more vivid and understandable way. As is known, the reality testing is impaired and in general there is a state of hyper-suggestibility. Sidney Cohen [ 3 ] states: "The part of the self that doubts, the observing ego, is in abeyance; the striking happenings and their interpretation by the therapist take on a 'realer than real' significance. An overwhelming conviction in the value of the experience is felt." Recent developments in symbolic visualization techniques in psychotherapy along the lines of Assagioli [ 4] and Leuner [ 5] as well as" the waking dream" technique of Desoille provide a valuable theoretical framework for the therapeutic use of visual imagery. Developments along these lines may well provide a breakthrough in the psychiatry of the future. Broadly speaking, LSD may be given in small doses to facilitate and enhance psychotherapy. This particular application has been more employed in Europe than in the U.S.A. It has also been given in larger doses for specific areas in intensive psychotherapy such as for alcoholism, drug addictions and the sexual psychopathies. LSD has also been used by psychiatrists themselves in order to improve their understanding of psychopathological phe- nomena such as de-personalization, de-realization, altered time sense, altered body image, and perceptual changes in general. With further reference to the role of the therapist, there may be cited the article by Kafka [ 6] to the effect that the therapist will benefit from taking LSD himself, and will be better able to understand his patients. This viewpoint has not yet been substantiated. It could be argued that the therapist, having taken the LSD, may not be so free from bias and not so objective as he might need to be, ideally. Given the present state of knowledge and experience with this drug, comparatively few generalizations can be made. However, the over-all picture appears to be as follows:
LSD given under proper conditions can be helpful in psychotherapy. Properly administered, it probably does not give rise to serious complications. Reporting on a questionnaire sent to doctors administering LSD and covering 25,000 occasions of drug administration involving 5,000 people, Sidney Cohen [ 7] )concluded that there were no serious physical complications. Anxiety and panic states were noted, particularly if the patient struggled to maintain control. Sometimes following the drug session there could be undesirable effects such as a prolongation of the state for a day or two. Apparently prolonged psychotic states occurred in one out of every 550 patients, but here there was usually a history of an emotional illness prior to the administration of the drug. Serious depressions were rare. Suicidal acts may occur weeks after unsuccessful treatment with the drug. Physical dependence does not develop, but tolerance or psychic dependence may. The paranoid person is usually considered unsuitable for psychedelic administration.
With respect to suicide, a history of attempted suicide is generally considered a contra-indication, but there are some reports to the effect that suicidal patients, if skilfully handled, may overcome their self-destructive tendencies. Psychotherapy may be enhanced by LSD by increasing insight, by more active recall, by a reliving of past and forgotten experience, and by abreaction.
There is some reason to believe that LSD is of help in providing what may be a crucial type of existential encounter leading to a new beginning or to a rebirth. It has been suggested that a death and rebirth experience under LSD may be related to the end of the power of a punitive super-ego. The patient or subject ceases to be controlled by his overly strict and infantile type of conscience. Amongst the more thoughtful members of our community there is increasing dissatisfaction with the prevailing and established values and beliefs of our technological society. This has led to a growing interest in issues such as the alienation of modern man and his search for a new faith, which in turn has led to the development of such fields as humanistic psychology, existentialism, and the philosophy and religion of the East. As a result, psychotherapy itself is in transition. To quote Robert E. Mogar [ 8] : "It may well be as some critics suggest that orthodox psychotherapy with its emphasis on early childhood conflicts and social adjustment is already obsolete. Many individuals who understand all too well the antecedents of their behaviour still feel unfulfilled and find their lives lacking in significance and purpose." A good deal of the recent literature on LSD application in psychiatry deals, understandably enough, with cases which could be considered refractory to the already established method of treatment. It is important to realize that treatment with LSD is not treatment in the conventional sense but involves a complex setting in which a powerful drug is being used in an intense psychotherapeutic milieu and very frequently the sessions will last from eight to ten hours.
Leuner [ 9] reviews cases treated with LSD and recommends psycholytic treatment in the following disorders: character neurosis, anxiety neurosis, phobias, depressive states (excluding endogenous depressions) perversions and sexual neurosis, compulsive syndromes and borderline schizophrenia. He states that marked hysteric neuroses and hysteria, and stuttering neuroses and marked constitutional infantile personalities reactions do not respond to LSD.
Leuner [ 10] , in another report, also states that puberty neuroses do well. Little success was observed with sexual neuroses (note the contrast with the above Leuner report), including homosexuality and conversion hysteria. In Leuner's psycholytic therapy, treatment consists of weekly or bi-weekly five-hour sessions with LSD in the morning and an analytically conducted discussion of the experiences in a group setting in the afternoon. He feels that psycholysis produces a shortening of the time required for psycho-analysis and considers it to be more effective. He reports no relapses amongst those cases followed up over a two-year period.
As one might expect, the chronic alcoholic has been treated with this drug. In one report, that of Jensen [ 11] , the routine dosage is given as 200 micrograms, with the drug being administered in the morning, the patient remaining with the therapist throughout the day. The author states that the transcendental experience may occur one or four hours after the administration of the drug and usually with higher doses. In general, the usual dose for alcoholism is 200-600 micrograms and only a few treatments are given. The patient achieves a transcendental experience and the general aim is for him to experience a rebirth, leaving behind his drinking past and oriented towards a future with hope.
Arendsen [ 12] discusses the treatment of the criminal psychopath in group sessions and concludes that LSD is definitely of value. Patients were treated in groups of five and the drug was given once every week or two, for about ten to twenty weeks. Dosage varied from 50 micrograms to 450.
Sandison [ 13] discusses a technique of using LSD in 50 to 100 micrograms. Sandison considers that this dosage produces a temporary dissolution of the ego, accompanied by deeper insight and self-observation. Forgotten memories and experiences are relived with greater clarity. He recommends, as does Leuner, LSD for treatment of phobias.
Serving further to point out that factors other than specific pharmacological action are at issue, is the report of Unger [ 14] . He observes that psychoanalytic patients report reliving childhood experiences, Jungians find that their patients had transcendental experiences, while Harvard students grappled with age-old paradoxes. This stresses the expectations and orientations of the therapist, as well as considering the environmental setting.
The matter of follow-up is, of course, crucial and yet difficult. Savage [ 15] )reports a preliminary study of the results of psychedelic therapy utilizing questionnaire data from 113 patients. It is noted that there is a high frequency of claimed benefit, "greater awareness of ultimate reality ", through the LSD experience. It is said that the total improvement rate is above 80 per cent and reference is made to follow-ups ranging from six months to two years.
Charles Savage [ 16] deals with a study designed to examine data with regard to treatment in addition to the patient-therapist consensus. 77 persons were given LSD therapy in an outpatient setting employing a single high dose technique, including extensive preparation and follow-up period. The therapeutic effectiveness was determined by comparing results of psychological tests and clinical evaluations. The authors state: "all measures seem to indicate a shift toward more egosyntonic behaviour for most subjects."
For a valuable survey of the field of LSD in psychotherapy, reference should be made to "LSD in Psychotherapy and Alcoholism" by H. A. Abramson [ 17] .
To sum up this section, LSD is of value in exploring various manifestations of psychopathology which have a resemblance to schizophrenia. It is also of value in psychotherapy under certain conditions and in selected cases where it may be used first as an aid to psychotherapy in order to produce insight and abreaction and secondly to produce a "peak" experience employing relatively high dosages. The very complex factors involved in set and setting make evaluation difficult. Controlled studies and long-range follow-up studies are required.
In this section we will be concerned with a critique of the "mystico-religious" and "perception-intensifying" properties claimed for the drug.
It is generally agreed that the set and the setting are of the greatest importance in the use of LSD. The set of course refers to the anticipations, preparations and expectations of the person taking the drug, and the setting to the prevailing inter-personal relations and general emotional climate and surroundings at the time of taking it. It is obvious that there will be a very striking difference between the administration of the drug by a psychiatrist to patients in a mental hospital and ingestion of the drug in a non-medical setting by a group of people who have gathered together to "turn on ". The most important variables in the setting would seem to be an atmosphere of trust and harmony both between therapist and patient and between members of a group who are taking LSD together. Any personal fears or animosities can predispose one to a "bad trip ". Thus the set and setting must always be borne in mind in attempting to assess the descriptions of the behaviour and experiences of those taking the drug.
One of the most important of the many effects of the LSD experience is the increased sensitivity to sensory stimuli, and the frequent presence of visual hallucinations and illusions. There is also produced a rather complex reaction which may include feelings of de-personalization, de-realization, alteration of the body image, feelings of detachment, and a sense of unreality. Another action of the drug is the bringing into awareness of sensations, feelings or material previously unknown to the subject. There may be an upsurge of material from the unconscious as well as a generally heightened consciousness of certain types of experience. These experiences are often felt as being visionary or transcendental. Some subjects actually experience what many would regard as a mystic state. Certainly, many of the reactions are dramatic "peak experiences ". As noted earlier in this article, the set and the setting are of crucial importance. The preparation and the background and the expectations of the subject play a vital role. It has been observed that these mystical-type experiences occur fairly frequently and, indeed, provide much of the motivation for the taking of the drug. It has been suggested that those taking it are in search of "instant mysticism".
In human history there are many instances in all major cultures of the ritual ingestion of substances which produce altered states of consciousness. Sometimes these products were ingested by the priest, witch doctor or shaman and sometimes they were taken by the group involved. These substances played a role in sacred ceremonies, in divination, prophecy, clairvoyance and in tribal rituals. Mystical states have also been sought throughout history by such other means as fasting, meditation, flagellation, and sensory deprivation. The use of drugs is only one aspect of "provoked mysticism". The search for the mystic's special type of awareness is one of mankind's most deeply-rooted quests.
The question immediately arises as to the genuineness of the alleged mystical experience following LSD ingestion. On this, authorities are divided. Writers such as Stace, Watts, and Huxley all would contend that LSD can give rise to a genuine mystical experience, whereas Zaehner and most traditional spiritual masters would hold the contrary view. Aldous Huxley, writing in 1954 on his experiences with mescaline, proposed his well-known theory that the action of these drugs tends to act as a reducing valve and diminishes the control of the cortical or purely thinking function of the human brain, thus allowing other activities in the nervous system to become dominant. Later [ 18] , he argued for the use of the "harmless psychedelics" to act as the "solvents of conceptual sludge ". Huxley believed that aesthetic and visionary consciousness could deepen into mystic consciousness. He felt that the ability of the drug to create a fresh view of experience could enable the individual to put aside his verbal apparatus and perhaps thus to come more directly into relationship with the universe. One is reminded here of the teachings of the Zen masters.
Dr. W. T. Stace [ 19] Professor Emeritus at Princeton University and well-known author of Mysticism and Philosophy, is reported as having said of the LSD experience: "It's not a matter of its being similar to mystical experience, it is mystical experience."
R. C. Zaehner [ 20] argues that these drugs never induce theistic states of religious and mystical experience and at most he would consider them to be an inferior state of religious awareness.
Dr. Walter N. Pahnke [ 21] carried out a very carefully designed study to test the claim that psychedelic drug experience may resemble mystical experience. He set up a nine category typology of the mystical state of consciousness based upon the work of W. T. Stace. The categories were as follows:
Unity both internal (loss of usual sense impressions and loss of self without loss of consciousness) and external (the "all is one" feeling),
Transcendence of time and space,
Deeply felt positive moods,
Sense of sacredness,
Objectivity and reality,
Persisting positive changes in attitude and/or behaviour.
The factor of suggestion was controlled by means of a double blind technique, so that neither the experimenter nor any of the participants (leaders or the subjects who were theology students) knew whether they were given a placebo or psilocybin - a psychedelic drug similar to, though less powerful than, LSD. He concluded that: "Those subjects who received psilocybin experienced phenomena which were indistinguishable from, if not identical with, the categories defined by our typology of mysticism."
There are a number of other studies which show that the psychedelic drugs do tend to produce experiences which many subjects feel as deeply religious.
One of the most enthusiastic of the "cultists", Timothy Leary [ 22] , states that of over one thousand subjects he has worked with: "it is conservative to state that over 75 per cent of these subjects report intense mystico-religious responses, and considerably more than half claim that they have had the deepest spiritual experience of their life."
A study by Ditman and Hoyman [ 23] utilizing a supportive environment without religious stimuli reports religious-type experiences in over 40 per cent of the subjects.
Another study by Savage [ 24] et al. utilizing a supportive environment with some religious stimuli reports religious experiences (defined as "a greater awareness of God or a Higher Power, or an Ultimate Reality") in 90 per cent of the subjects.
An excellent critical review of the literature on LSD and religious experience has recently been published by Houston and Masters [ 25] . These writers challenge, on the basis of their own research, the remarkably high percentages of "religious" or "mystical" experiences that other researchers have reported. They feel that inadequate criteria may be used by many investigators, that many experiences that subjects describe as "religious" may actually be superficial thrills, producing euphoria, spiritual pride, self-indulgence and loss of the sense of responsibility. They believe that a distinction should be made between these superficial or illusory experiences and what they call "integral level" experience - "of direct and unmediated encounter with the source level of reality, felt as Holy, Awful, Ultimate, Ineffable" (page 266). In integral level experience there is a transformation of the Self, a "death and purgation of some part of the subject's being and his rebirth into a new and higher order of existence"(page 267). In the integral mystical experience, there is a passing beyond the sensory and symbolic level which are so prominent in the lower stages. The authors note that much of which passes for mystical experience among the cultists is really "an ecstatic experience of Nature and Process" which they term "Cosmological Mysticism" but which rarely transforms a person and in their opinion is not genuine religious experience. Out of their total of 206 subjects, only 6 met their criteria (Walter Stace's quoted above) for a genuine "introvertive mystical" experience. And all of these subjects were exceptionally well-prepared for it in terms of their intelligence, maturity, and long interest in integral levels of consciousness. It was interesting, however, that contrary to the integral "religious" experiences, the integral "mystical" experiences "rarely yield any such radical transformation of the subject's inner and outer life". The authors advance two possible hypotheses in explanation: 1. that the subjects had already actualized most of their potential and 2. that they tend to minimize psychodynamic material, thereby precluding the possibility of personality change. One might question, however, the authors' conclusions if these subjects fail to meet one of their own criteria: namely, transformation of the self.
The issue of the validity of psychedelic religious experience is a complex matter, and too little is known of the psychology of religion and mysticism to be able to provide a definitive answer at the present time. It may be that ingestion of LSD may, upon occasion, induce genuine religious experience, at least on a certain level.
But it should be remembered that the vast majority of spiritual teachers of all traditions advise against the use of drugs for spiritual advancement and caution against the dangers of confusing altered states of consciousness and visionary phenomena with profound religious experience. Allen Y. Cohen [ 26] of the Department of Social Relations at Havard has recently quoted Avatar Meber Baba, an Indian spiritual teacher as saying: "The experiences which drugs induce are as far removed from Reality as is a mirage, from water. No matter how much you pursue the mirage, you will never quench your thirst, and the search for Truth through drugs must end in disillusionment."
It may be true that psychedelic experience has a role to play in opening doors, in introducing certain persons to new levels of meaning and reality, but the real test of the experience and the real work lies in the individual's own efforts to translate his vision into the reality of everyday life.
At present LSD is a highly sensational and controversial topic, and is likely to remain so for some time. There is reason to believe that the psychedelic drugs will not prove in the long run to have wide appeal for the population at large and that sustained interest in them will be generally confined to the intellectual classes. However, if spurious curiosity concerning these drugs is stimulated through sensational coverage in the mass communication media and unwise prohibitive measures, it may happen, ironically, that the very measures designed to curtail the abuse of the drug will have the opposite effect.
LSD must be made available as soon as possible for thorough-going investigation and research by competent workers. The range of potential applications of these drugs is such that a multi-disciplinary approach will be required. It is probable that the main value of LSD will be in the exploration of the nature of the normal mind rather than in the area of psychopathology. Fields of investigation opened up include such areas as the genesis of myth, ritual, symbolism, questions of epistemology and ethics, the nature of perception, time and space orientation, creativity and problem-solving, values, religious, and mystical experience, and altered states of consciousness in general as well as psychiatric diagnosis and psychotherapy. Thus it is important that specialists in the fields of psychology, anthropology, theology, comparative religion, philosophy, and education as well as medicine and psychiatry be vitally involved in shaping future policy and conducting necessary research.
In every instance when the drug is administered, the services of a physician familiar with the drug should be available. Only the medically trained person can evaluate the state of general health, the reactivity and balance of the automatic nervous system, the biological state of certain target organs, the relationship of the dosage to previous doses of psychedelic drugs or other medication, allergic phenomena, and states of fatigue, anxiety, or other factors which might influence the experience.
The matter of control is important and difficult. The best long-term solution would appear to be the creation of an international committee of experts called by the UN and WHO to study the entire range of problems presented by the LSD family of drugs. One must bear in mind, as Dr. Stanley Yolles, Director of the National Institute of Mental Health, recently stated before a US Senate subcommittee, that "the next five or ten years will see a hundredfold increase in the number and types of drugs capable of affecting the mind ". The solution adopted to deal with LSD will set a precedent for the many similar drugs to appear in the near future, and we cannot afford an ill-considered solution which will stifle the growth of knowledge and lead to abuse of these drugs under dangerous conditions.
This commission would deal with problems of research design, priorities for investigation, and problems of distribution and control. We repeat, no one profession is competent to act as arbiter in this crucial matter. We require many divergent points of view: governmental and non-governmental, university and non-university, medical and non-medical to provide a sane and democratic system of checks and balances - so necessary if we are not to become the victims of vested interests of whatever persuasion.
Pending the creation and decisions of such a commission, there should be a resumption of the production of the drug, with its distribution handled as best as possible by responsible personnel, including the medical profession. Obviously some type of governmental control will need to be exercised concerning the production and availability of the drug.
We must gradually develop a network of facilities having staff with the requisite knowledge and skills where people could be given LSD for serious purposes under the best conditions followed up with due rigour. It should be obvious that in the modern, sophisticated, democratic society of North America, legislation will not be able to control the use of a drug which is colourless, odourless, tasteless, and which can easily be manufactured at home and sold on a blackmarket basis. Unnecessarily restrictive measures will inevitably drive the drug underground and the profitable black market trade will no doubt attract organized crime. Far more effective in controlling abuse of these drugs will be the establishment of facilities where the drug can be administered under adequate supervision as part of a well-designed research programme.
In order to staff such centres for controlled research, it will be necessary to train personnel competent to administer these drugs - persons who can provide the optimum set and setting for the experiment under adequate medical supervision.
The understanding and study of altered states of consciousness will doubtless assume a key position in the psychology and psychiatry of the next few years, and hence there is an urgent need for the development of trained investigators in this field.
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