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4. Use of LSD in Psychiatry

Soon after LSD was tried on animals, the first systematic investigation of the substance was carried out on human beings, at the psychiatric clinic of the University of Zurich. Werner A. Stoll, M.D. (a son of Professor Arthur Stoll), who led this research, published his results in 1947 in the Schweizer Archiv fur Neurologie und Psychiatrie, under the title "Lysergsaure-diathylamid, ein Phantastikum aus der Mutterkorngruppe" [Lysergic acid diethylamide, a phantasticum from the ergot group].

The tests involved healthy research subjects as well as schizophrenic patients. The dosages - substantially lower than in my first self-experiment with 0.25 mg LSD tartrate - amounted to only 0.02 to 0.13 mg. The emotional state during the LSD inebriation was here predominantly euphoric, whereas in my experiment the mood was marked by grave side effects resulting from overdosage and, of course, fear of the uncertain outcome.

This fundamental publication, which gave a scientific description of all the basic features of LSD inebriation, classified the new active principle as a phantas a phantasticum. However, the question of therapeutic application of LSD remained unanswered. On the other hand, the report emphasized the extraordinarily high activity of LSD, which corresponds to the activity of trace substances occurring in the organism that are considered to be responsible for certain mental disorders. Another subject discussed in this first publication was the possible application of LSD as a research tool in psychiatry, which follows from its tremendous psychic activity.

First Self-Experiment by a Psychiatrist

In his paper, W. A. Stoll also gave a detailed description of his own personal experiment with LSD. Since this was the first self-experiment published by a psychiatrist, and since it describes many characteristic features of LSD inebriation, it is interesting to quote extensively from the report. I warmly thank the author for kind permission to republish this extract.

The Psychic Effects of LSD

The picture of the activity of LSD obtained from these first investigations was not new to science. It largely matched the commonly held view of mescaline, an alkaloid that had been investigated as early as the turn of the century. Mescaline is the psychoactive constituent of a Mexican cactus Lophophora williamsii (syn. Anhalonium lewinii). This cactus has been eaten by American Indians ever since pre-Columbian times, and is still used today as a sacred drug in religious ceremonies. In his monograph Phantastica (Verlag Georg Stilke, Berlin, 1924), L. Lewin has amply described the history of this drug, called peyotl by the Aztecs. The alkaloid mescaline was isolated from the cactus by A. Heffter in 1896, and in 1919 its chemical structure was elucidated and it was produced synthetically by E. Spath. It was the first hallucinogen or phantasticum (as this type of active compound was described by Lewin) to become available as a pure substance, permitting the study of chemically induced changes of sensory perceptions, mental illusions (hallucinations), and alterations of consciousness. In the 1920s extended experiments with mescaline were carried out on animal and human subjects and described comprehensively by K. Beringer in his book Der Meskalinrausch (Verlag Julius Springer, Berlin, 1927). Because these investigations failed to indicate any applications of mescaline in medicine, interest in this active substance waned.

With the discovery of LSD, hallucinogen research received a new impetus. The novelty of LSD as opposed to mescaline was its high activity, lying in a different order of magnitude. The active dose of mescaline, 0.2 to 0.5 g, is comparable to 0.00002 to 0.0001 g of LSD; in other words, LSD is some 5,000 to 10,000 times more active than mescaline.

LSD's unique position among the psychopharmaceuticals is not only due to its high activity, in a quantitative sense. The substance also has qualitative significance: it manifests a high specificity, that is, an activity aimed specifically at the human psyche. It can be assumed, therefore, that LSD affects the highest control centers of the psychic and intellectual functions.

The psychic effects of LSD, which are produced by such minimal quantities of material, are too meaningful and too multiform to be explained by toxic alterations of brain function. If LSD acted only through a toxic effect on the brain, then LSD experiences would be entirely psychopathological in meaning, without any psychological or psychiatric interest. On the contrary, it is likely that alterations of nerve conductivity and influence on the activity of nerve connections (synapses), which have been experimentally demonstrated, play an important role. This could mean that an influence is being exerted on the extremely complex system of cross-connections and synapses between the many billions of brain cells, the system on which the higher psychic and intellectual functions depend. This would be a promising area to explore in the search for an explanation of LSD's radical efficacy.

The nature of LSD's activity could lead to numerous possibilities of medicinal-psychiatric uses, as W. A. Stoll's ground-breaking studies had already shown. Sandoz therefore made the new active substance available to research institutes and physicians as an experimental drug, giving it the trade name Delysid (D-Lysergsaure-diathylamid) which I had proposed. The printed prospectus below describes possible applications of this kind and voices the necessary precautions.

The use of LSD in analytical psychotherapy is based mainly on the following psychic effects.

In LSD inebriation the accustomed world view undergoes a deep-seated transformation and disintegration. Connected with this is a loosening or even suspension of the I-you barrier. Patients who are bogged down in an egocentric problem cycle can thereby be helped to release themselves from their fixation and isolation. The result can be an improved rapport with the doctor and a greater susceptibility to psychotherapeutic influence. The enhanced suggestibility under the influence of LSD works toward the same goal.

Another significant, psychotherapeutically valuable characteristic of LSD inebriation is the tendency of long forgotten or suppressed contents of experience to appear again in consciousness. Traumatic events, which are sought in psychoanalysis, may then become accessible to psychotherapeutic treatment. Numerous case histories tell of experiences from even the earliest childhood that were vividly recalled during psychoanalysis under the influence of LSD. This does not involve an ordinary recollection, but rather a true reliving; not a reminiscence, but rather a reviviscence, as the French psychiatrist Jean Delay has formulated it.

LSD does not act as a true medicament; rather it plays the role of a drug aid in the context of psychoanalytic and psychotherapeutic treatment and serves to channel the treatment more effectively and to shorten its duration. It can fulfill this function in two particular ways.

In one procedure, which was developed in European clinics and given the name psychotytic therapy, moderately strong doses of LSD are administered in several successive sessions at regular intervals. Subsequently the LSD experiences are worked out in group discussions, and in expression therapy by drawing and painting. The term psycholytic therapy was coined by Ronald A. Sandison, an English therapist of Jungian orientation and a pioneerof clinical LSD research. The root -lysis or -lytic signifies the dissolution of tension or conflicts in the human psyche.

In a second procedure, which is the favored treatment in the United States, a single, very high LSD dose (0.3 to 0.6 mg) is administered after correspondingly intensive psychological preparation of the patients. This method, described as psychedelic therapy, attempts to induce a mystical-religious experience through the shock effects of LSD. This experience can then serve as a starting point for a restructuring and curing of the patient's personality in the accompanying psychotherapeutic treatment. The term psychedelic, which can be translated as "mind-manifesting" or "mind-expanding," was introduced by Humphry Osmond, a pioneer of LSD research in the United States.

LSD's apparent benefits as a drug auxiliary in psychoanalysis and psychotherapy are derived from properties diametrically opposed to the effects of tranquilizer-type psychopharmaceuticals. Whereas tranquilizers tend to cover up the patient's problems and conflicts, reducing their apparent gravity and importance: LSD, on the contrary, makes them more exposed and more intensely experienced. This clearer recognition of problems and conflicts makes them, in turn, more susceptible to psychotherapeutic treatment.

The suitability and success of LSD in psychoanalysis and psychotherapy are still a subject of controversy in professional circles. The same could be said, however, of other procedures employed in psychiatry such as electroshock, insulin therapy, or psychosurgery, procedures that entail, moreover, a far greater risk than the use of LSD, which under suitable conditions can be considered practically safe.

Because forgotten or repressed experiences, under the influence of LSD, may become conscious with considerable speed, the treatment can be correspondingly shortened. To some psychiatrists, however, this reduction of the therapy's duration is a disadvantage. They are of the opinion that this precipitation leaves the patient insufficient time for psychotherapeutic working-through. The therapeutic effect they believe, persists for a shorter time than when there is a gradual treatment, including a slow process of becoming conscious of the traumatic experiences.

Psycholytic and especially psychedelic therapy require thorough preparation of the patient for the LSD experience, to avoid his or her being frightened by the unusual and the unfamiliar. Only then is a positive interpretation of the experience possible. The selection of patients is also important, since not all types of psychic disturbance respond equally well to these msthods of treatment. Successful use of LSD-assisted psychoanalysis and psychotherapy presupposes speclflc knowledge and experience.

In this respect self-examination by psychiatrists, as W. A. Stoll has pointed out, can be most useful. They provide the doctors with direct insight, based on firsthand experience into the strange world of LSD inebriation, and make it possible for them truly to understand these phenomena in their patients, to interpret them properly, and to take full advantage of them.

The following pioneers in use of LSD as a drug aid in psychoanalysis and psychotherapy deserve to be named in the front rank: A. K. Busch and W. C. Johnson, S. Cohen and B. Eisner, H. A. Abramson, H. Osmond, and A. Hoffer in the United States; R. A. Sandison in England; W. Frederking and H. Leuner in Germany; and G. Roubicek and S. Grof in Czechoslovakia.

The second indication for LSD cited in the Sandoz prospectus on Delysid concerns its use in experimental investigations on the nature of psychoses. This arises from the fact that extraordinary psychic states experimentally produced by LSD in healthy research subjects are similar to many manifestations of certain mental disturbances. In the early days of LSD research, it was often claimed that LSD inebriation has something to do with a type of "model psychosis." This idea was dismissed, however, because extended comparative investigations showed that there were essential differences between the manifestations of psychosis and the LSD experience. With the LSD model, nevertheless, it is possible to study deviations from the normal psychic and mental condition, and to observe the biochemical and electrophysiological alterations associated with them. Perhaps we shall thereby gain new insights into the nature of psychoses. According to certain theories, various mental disturbances could be produced by psychotoxic metabolic products that have the power, even in minimal quantities, to alter the functions of brain cells. LSD represents a substance that certainly does not occur in the human organism, but whose existence and activity let it seem possible that abnormal metabolic products could exist, that even in trace quantities could produce mental disturbances. As a result, the conception of a biochemical origin of certain mental disturbances has received broader support, and research in this direction has been stimulated.

One medicinal use of LSD that touches on fundamental ethical questions is its administration to the dying. This practice arose from observations in American clinics that especially severe painful conditions of cancer patients, which no longer respond to conventional pain-relieving medication, could be alleviated or completely abolished by LSD. Of course, this does not involve an analgesic effect in the true sense. The diminution of pain sensitivity may rather occur because patients under the influence of LSD are psychologically so dissociated from their bodies that physical pain no longer penetrates their consciousness. In order for LSD to be effective in such cases, it is especially crucial that patients be prepared and instructed about the kind of experiences and transformations that await them. In many cases it has proved beneficial for either a member of the clergy or a psychotherapist to guide the patient's thoughts in a religious direction. Numerous case histories tell of patients who gained meaningful insights about life and death on their deathbeds as, freed from pain in LSD ecstasy and reconciled to their fate, they faced their earthly demise fearlessly and in peace.

The hitherto existing knowledge about the administration of LSD to the terminally ill has been summarized and published by S. Grof and J. Halifax in their book The Human Encounter with Death (E. P. Dutton, New York, 1977). The authors, together with E. Kast, S. Cohen, and W. A. Pahnke, are among the pioneers of this application of LSD.

The most recent comprehensive publication on the use of LSD in psychiatry, Realms of the Human Unconscious: Observations from LSD Research (The Viking Press, New York, 1975), likewise comes from S. Grof, the Czech psychiatrist who has emigrated to the United States. This book offers a critical evaluation of the LSD experience from the viewpoint of Freud and Jung, as well as of existential analysis.

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