The Use of LSD in Psychotherapy and Alcoholism

723 Pages·1967·9.78 MB·English

by  Harold A. Abramson (ed.)

The Use of
LSD in Psychotherapy
and Alcoholism
Edited by Harold A. Abramson, M.D.
Introduction by Dr. Frank Fremont-Smith
FROM THE TABLE OF CONTENTS
SOCIAL AND PARA-MEDICAL ASPECTS OF HALLUCINOGENIC DRUGS,
William H. McGlothlin, Ph.D., Research Associate, Department
of Psychology, University of Southern California
DOLPHIN-HUMAN RELATION AND LSD 25, John C. Lilly, M.D.,
Director, Communication Research Institute, Miami; St.
Thomas, V.I.
THEORETICAL ASPECTS OF LSD THERAPY, Dr. John Buckman,
M.R.C.S., L.R.C.P., D.P.M., Senior Hospital Medical Officer,
Marlborough Day Hospital, London
THE USE OF LSD 25 IN PERSONALITY DIAGNOSTICS AND THERAPY
OF PSYCHOGENIC DISORDERS, Stanislaw Grof, M.D., Research
Psychiatrist, Psychiatric Research Institute, Prague
LSD FACILITATION OF PSYCHOANALYTIC TREATMENT: A CASE
STUDY IN DEPTH, Charles Clay Dahlberg, M.D., Training and
Supervisory Analyst, William Alanson White Psychoanalytic In-
stitute, New York City
A CASE OF CHANGE AND PARTIAL REGRESSION FOLLOWING ONE
LSD 25 TREATMENT, Jack L. Ward, M.D., Staff Psychiatrist, New
Jersey Reformatory at Bordentown, Mercer Hospital
A PROGRAM FOR THE TREATMENT OF ALCOHOLISM: LSD, MAL-
VARIA AND NICOTINIC ACID, Abram Hoffer, M.D., Director, Psy-
chiatric Research, Department of Public Health, Saskatchewan
A COMMENT ON SOME USES OF PSYCHOTOMIMETICS IN PSYCHI-
ATRY, Humphry Osmond, M.R.C.S., L.R.C.P., D.P.M., F.W.A.,
Director, Bureau of Neurology and Psychiatry, New Jersey
Neuropsychiatric Institute
IS LSD OF VALUE IN TREATING ALCOHOLICS?, Ruth Fox, M.D.,
Medical Director, National Council on Alcoholism
PSYCHOTHERAPY WITH LSD, Sidney Cohen, M.D., Chief, Psycho
somatic Medicine, Veterans Administration Hospital, Los
Angeles
PRELIMINARY METHOD FOR STUDY OF LSD WITH CHILDREN,
Andre Rob, M.D., Director, Leonard W. Krinsky, Ph.D., Direc-
tor, Psychological Service, Harold A. Abramson, M.D., Director
of Research, L. Goldfarb, M.D., Clinical Director, South Oaks
Psychiatric Hospital, Amityville, New York
Front Back
jacket jacket
flap flap
$17.50 continued from front flap
In May 1965, Dr. Harold A. Abramson
called together at South Oaks Hospital,
The Use of
Amityville, N.Y., fifty doctors, scientists,
LSD IN and psychiatrists from all over the Western
PSYCHOTHERAPY world (and from behind the Iron Curtain)
and Alcoholism to deliver papers on their work with this
remarkable drug.
Included in the book are discussions of
Edited by Harold A. Abramson, M.D. the thirty-six papers by the participants in
the conference. Their questionings, agree-
Introduction by Frank Fremont-Smith, M.D.
ments, and disputes lead inevitably to con-
troversy, but it is an unmistakably pro-
In the midst of the nation-wide front-page
ductive one.
furors over the indiscriminate public use
of LSD (lysergic acid diethylamide) one
THE AUTHOR
fact remains clear. There is an interest un-
Dr. Harold A. Abramson—Director of Re-
precedented in recent history in the drug's
search at South Oaks Hospital and a
effects—whether they are thought to be
pioneer in the field of combined psychiatric
mind-damaging or, as most experienced and
and chemical research—practices psychi-
responsible investigators claim, perhaps the
atry in New York City. He has written sev-
greatest breakthrough in psychotherapy in
eral highly regarded professional books,
the last sixty years.
edited eleven more for the Josiah Macy,
Beneath the near-hysterical headlines,
Jr., Foundation, and is editor of the Journal
beneath the allegations of thrill-seeking and
of Asthma Research. Dr. Abramson served
cultism, it is sometimes mentioned that in-
in the Office of the Chief, Chemical War-
formed, expert, and methodical research
fare Service, from 1942 to 1946, and there-
into the therapeutic applications of LSD has
after for ten years was a consultant in
been taking place for more than twenty
psychology to the Department of the Army.
years.
It is this thorough, important research
and its meaningful findings that are re-
ported, with neither preconceived bias nor JACKET DESIGN BY QUENTIN FIORE
sensationalism, in The Use of LSD in Psy-
chotherapy and Alcoholism.
THE BOBBS-MERRILL COMPANY, INC.
continued on back flap PAU BSLUISBHSEIRDS I/A IRnYd iOaFn aHpOolWisA •R KDa Wns. aSsA CMitSy &• NCeOw., YINorCk.
E
The Use of
LSD in
Psychotherapy
and Alcoholism
Edited by Harold A. Abramson, M. D.
Introduction by Frank Fremont-Smith, M. D.
THE BOBBS - MERRILL COMPANY, INC.
A Subsidiary of Howard W. Sams & Co., Inc.
Publishers—Indianapolis New York Kansas City
Copyright © 1967 by Harold A. Abramson
All Rights Reserved
ACKNOWLEDGMENTS
The paintings illustrating Dr. Charles Savage's
paper are by Harriette Frances, and are reproduced
with the permission of The International Foundation for
Advanced Study.
Dr. Sidney Cohens paper, from his
book THE BEYOND WITHIN (Atheneum, © 1964), is
reproduced with the author's and publisher's permission.
The paper by W. H. McGlothin, © 1964, is reproduced
with the author's permission.
Library of Congress Catalog Card Number 66: 25284
Printed in the United States of America
To my wife Virginia
who assisted me in all ways during the early years of
experiments with psychotomimetic compounds
H.A.A.
Introduction
In May, 1965, a group of investigators in the field of psychiatry met at
South Oaks Hospital, in Amityville, New York. The purpose of the meeting
was to exchange information and discuss problems regarding the use of a
remarkable drug that has been a focus of research in psychiatry for more
than twenty years. This drug, LSD-25, commonly called LSD, is a deriva-
tive of d-lysergic acid. Lysergic acid itself is the basis of many ergot
compounds used daily in medicine. But LSD has a unique property which
differentiates it from all other drugs. Even in extremely small doses, LSD
produces a disturbance in mentation—in thinking processes, in perception
of sound, light and color, in emotional reaction, in ideation. This disturb-
ance is reversible. After a certain number of hours, the effect of LSD itself
wears off.
Contrary to assertions in the popular press, when LSD is administered
as part of a therapeutic medical program, "irreversible psychotic changes"
and "brain damage" do not occur. Certain irresponsible statements that
it does produce such adverse effects have not been supported by valid
scientific evidence.
The effect of LSD on many people resembles a psychotic state. The
reason for this is that LSD creates an emotional storm during which a
person frequently is able to recall forgotten—or repressed—events and
early experience. Outwardly it may seem that the person is psychotic.
Actually he is undergoing a complete re-evaluation of his self-image.
LSD, if taken without proper supervision and under undesirable cir-
cumstances, can produce a reaction in unstable people which presents an
alarming appearance and can lead to dangerous behavior. Like any other
drug, LSD belongs in the hands of responsible medical authorities. In
responsible hands, LSD is a valuable tool in hastening successful results
of psychotherapy, as seen particularly with alcoholics, a group notoriously
difficult to treat.
How small is a small dose of LSD? Throughout this volume the reader
will encounter the abbreviation, mcg. Mcg stands for microgram, singular
or plural, as mg stands for milligram and kg for kilogram. One mcg is one
thousandth of a milligram, or one millionth of a gram. In terms of a familiar
weight, one pound, one mcg equals about one-half a billionth of a pound.
Micrograms are really too small to be visualized readily but it helps to
remember that there are 300, 000 mcg of aspirin in the ordinary tablet. We
now may ask how many mcg of LSD are needed for the drug to make itself
felt? The first, or threshold dose, may be about 25 mcg. Under desirable
conditions a dose of about 100 mcg produces a dramatic reaction, often
vii
viii INTRODUCTION
resembling a psychotic state in nearly everyone. I use the term desirable
because, if the setting in which LSD is given to the patient seems threat-
ening, the reaction may be distressing to the patient and frightening to
the people with him.
If 100 mcg of LSD is administered to a group of so-called normal
subjects, each member of the group will react differently, according to his
personality structure and to the setting, or milieu, in which the drug is
given. The attitude of the physician who administers the drug exerts a
significant influence. An anxious physician inevitably produces an anxious
subject. The disagreements and opposition to LSD therapy voiced by inex-
perienced or anxious investigators can easily be understood when seen in
the context of these complicated variables.
In the results of experiments published more than ten years ago, my
co-workers and I found that symptoms frequently reported by fourteen
non-psychotic subjects who received LSD included memory difficulties,
mood changes and difficulty in concentration. Feelings of unsteadiness,
inner trembling and dizziness were reported as well as peculiar sensations
in the hands, the feet and on the skin; dream-like feelings were common,
as were heaviness in the hands and feet, drowsiness, and difficulty in
focusing vision. Anxiety occurred often. Depersonalization was observed.
There were occasional paranoid reactions. Some reported a peculiar sensa-
tion of the lips being drawn back, as in an involuntary smile. With dosages
as low as 100 mcg, hallucinations were rarely reported. As a matter of fact,
I am still somewhat surprised when LSD is described as an hallucinogenic
drug, since what is intended is, more accurately, heightened perception or
illusion.
More important than the pseudo-hallucinations produced by the drug
is the fact that LSD and similar compounds may be used in psycholytic and
psychedelic therapy. Both forms of therapy are discussed at length in the
papers which follow.
In spite of the complicated symptoms and signs produced by LSD,
even when given in a suitable setting, the drug's action leads to an extraor-
dinary and somewhat paradoxical integrative process in the patient's
psyche, because of the nature of his relationship with the therapist. The
unpleasant and peculiar storm taking place in the nervous system is
accompanied by a remarkable state of ego enhancement occurring simul-
taneously with ego depression. During the LSD reaction the therapist may
manipulate this dual change in ego. The ego enhancement produced may
be employed by the therapist for the benefit of the patient. In other words,
the patient reacts to the LSD and to the therapist, not to the LSD alone.
Some of the characteristics of the therapeutic process may include intense
awareness of the treatment period with good memory of the experience;
increased fantasy; limited regressive ideation; facilitated interpretation of
symbolic processes; acute awareness of the need to maintain conscious
control of self; mounting anxiety; difficulties in the struggle to control
feelings; fluctuating depression and euphoria; fluctuating disturbances in
perception; rare hallucinatory episodes, almost always accompanied by
simultaneous awareness of reality and by mild sexual stimulation. The
INTRODUCTION ix
reader will see clearly that the therapist himself must be relatively free of
anxiety if he is to be successful in treating the patient who is undergoing
this multifaceted psychic upheaval.
The non-medical reader may wonder what compounds related to LSD
are commonly used in medicine. These are familiar drugs: Ergonovine
Maleate, Methyl Ergonovine Tartrate, Ergotamine Tartrate as well as
Methysergide. Crude extracts of ergot were used by midwives as far back
as the seventeenth century for its effect on the uterus. Other plant extracts
have been employed for more than 3, 000 years for their effects on the
mind, usually in connection with ritualistic, religious and sociological ex-
periences. Perhaps the broad use by primitive peoples of the drugs similar
to LSD in order to satisfy some need for cultural stability and adaptive
processing may find a parallel in the modern use of LSD in psychoana-
lytically oriented psychotherapy.
The stresses of modern living and the lengthy procedure of psycho-
analysis have made us all aware of the need for less time-consuming tech-
niques to give the patient the confidence and ability to face his own
problems. The use of LSD to enable the patient to shorten this process has
been termed psycholytic therapy in Europe. Low doses of LSD are used in
psycholytic therapy. It was clearly distinguished from psychedelic therapy
by the investigators present at the South Oaks conference. Psycholytic
therapy has as its goal greater maturity, with increasing social and physi-
ological adaptive mechanisms. Psychedelic therapy, the method usually
applied in this country, commonly makes use of doses of at least 300 mcg
of LSD and the doses may go as high as 2000 mcg. The principal focus in
psychedelic therapy is to attain the extraordinary experience produced by
the drug itself, which is essentially independent of psychoanalytic therapy.
This experience is variously described as "mystical, " "ecstatic" or "apoca-
lyptic. " Regardless of the description, the LSD experience leads to a symp-
tomatic type of cure in terms of an immediate change in behavior. At least
25% of alcoholics who have been treated by psychedelic LSD therapy
have remained abstinent for six months following the treatment.
The reader of this volume will find considerable controversy concern-
ing the use of statistical methods when evaluating the results of psycho-
therapy with LSD and similar drugs. The term "double-blind" will be
frequently encountered. The double-blind experiment is one that is ar-
ranged with two groups of patients who are simultaneously treated.
Neither patient nor doctor knows which group has received LSD while
the matched group has been given another drug, or some harmless sub-
stance. It should seem fairly obvious that it would be unlikely for a patient
who had been given a placebo, or sugar pill, to believe that he had taken
LSD. It is true that when studying the effect of the drug on the human
organism the investigator should endeavor to be uninfluenced by his own
expectations. The therapeutic nihilist rarely acknowledges the value of a
drug. The enthusiastic therapist hopefully searches for a positive result. To
minimize the anticipations of both nihilist and enthusiast, the double-
blind type of experimental procedure in clinical trials has been widely
adopted. The procedure and its results depend upon statistics. Personal
X INTRODUCTION
bias is supposed to be eliminated. The method involves either a suitably
large sample of subjects or special mathematical assumptions if the
sample is small.
The effects of drugs which are of importance to research in psycho-
pharmacology can hardly be studied by the double-blind technique alone.
Certainly, whenever the psyche is involved, at least equal weight must be
given to the intensive study of drug effects in a single patient. It is difficult
to understand how the result of extensive study, based on patient group
averages rather than on individuals, can have direct implications with
respect to improvement in the psychotherapy of patients. Judgments re-
garding indications for treatment derived from the single case study may
be more meaningful than those derived from a large sample. The psyche is
always involved, whether we like it or not! It is important to remember
that statistics developed from systematic observations of the patient under
treatment may be more useful than statistics concerning a somewhat vague
patient population. Only by direct clinical observations or clinical judg-
ment can we really learn about the patient. This can be the focal point of
many hypotheses, and it is such observations which may provide a proper
basis for subsequent clinical research by statistical analysis.
Both clinical judgment and the double-blind method are important.
However, the intensive study of the patient must be continued by the
practicing physician. No rigid governmental or academic agency will ever
take the place of the clinical judgment of the practicing physician. Without
his clinical judgment dangerous shoals lie ahead.
Are we entering a new machine age of medicine, engendered not by
the industrial revolution, but by the computer revolution? May physicians
and investigators, unable to deal with the turbulent feelings of their
patients, search for a fashionable refuge in statistics which provide a non-
threatening haven? A recent article in one of the Sunday weekly supple-
ments portrays how the author, a pathologist, and a reporter support their
violent opposition to the use of LSD by distorting statistics and by rele-
gating clinical observations to a minor position. It will be tragic, indeed,
for all of us when a pathologist becomes our authority for the value of
psychotherapeutic procedures!
It was important to arrange for those registered members of the South
Oaks Conference who were coming from nine foreign countries to know in
advance what would be the contributions of the other members. Papers
on psychiatric subjects are necessarily lengthy and difficult to follow at
meetings lasting several days. This obstacle to clarity of communication
between the members of the conference was overcome in the following
way. Almost all papers were sent to me well ahead of the meeting. Copies
of the manuscripts then were sent to all members weeks in advance. In
this way nearly all the data to be presented were familiar to the group
before the conference. Language barriers were thus essentially overcome.
Each author was given ten minutes to summarize his views. Twenty
minutes were allotted to discussion. Thanks to the excellent way in which
Dr. Frank Fremont-Smith chaired the conference, all the summaries were
presented with suitable discussion periods.