The Use of LSD in Psychotherapy and Alcoholism

703 Pages·2017·13.81 MB·English

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 Cohen's paper, from his

book THE BEYOND WITHIN (Ath~neum, © 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-Iysergic 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 reevaluation 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
difficul t to trea t.
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 INTRODUcrION
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.
INTRODUCTION xi
Although I had the pleasure and privilege for the second time of
organizing a conference on LSD, without the active cooperation of Dr.
Andre Rolo, Dr. Frank Fremont-Smith and the Board of Directors of South
Oaks Hospital, the conference would have been well-nigh impossible. For
their help with the infinite number of details connected with a project of
this type, I wish to thank especially Miss Polly Andrews, Miss Cornelia
Cassidy, Mrs. Gwen Neviackas, Mrs. Henriette H. Gettnp.r and other
members of the staff of South Oaks Hospital. Finally, I am grateful to my
wife, Virginia, for her help in planning and organizing many of the experi­
ments on LSD, its derivatives, and psilocybin reprinted here. Without her
aid the conference could not have been held. Incidentally, in double-blind
experiments designed to ascertain if non-psychotic normals could dis­
tinguish between LSD and psilocybin, her distinction score was the highest
of the observer's group. No statistics here-only clinical observation. May
it be with us always.
HAROLD A. ABRAMSON
Address:

THE SECOND INTERNATIONAL CONFERENCE

ON THE USE OF LSD

IN PSYCHOTHERAPY AN D ALCOHOLIS M

Andre RaIa, M.D.
Please let me welcome you on behalf of the Board of Directors and the
Staff of the South Oaks Psychiatric Hospital. It is a special pleasure for me
to be host to this distinguished body of physicians, many of whom have
traveled thousands of miles to discuss their pioneering research in the field
of psychiatry. I cannot fail to be impressed, indeed awed, by the dedication
and spirit of research which appear in the various articles and by the
remarkable unanimity of findings in different parts of the world with
regard to the use of such drugs as LSD in helping mentally disturbed
patients of many types. These observations will develop, I am sure, during
the course of this conference.
As you are aware, the conference is being held under the auspices of
the South Oaks Research Foundation, a division of South Oaks Psychiatric
Hospital. The parent organization of both these facilities is The Long
Island Home, Limited. I would like to tell you about the background of
our institution. SOilth Oaks Hospital was founded in 1882. It is now one
of the largest private psychiatric hospitals in the country. The daily census
averages 200 patients. Approximately goo patients are admitted yearly.
The entire range of psychiatric disorders is treated.
In recent years, the Research Foundation was organized as an integral
division of the hospital. Research by staff members has been encouraged.
This conference is an outgrowth of one of the major research endeavors,
the use of LSD as an adjunct to psychotherapy.
The active management of the conference will be under the direction
of Drs. Frank Fremont-Smith and Harold A. Abramson. Each participant
will receive a program that lists the order of the presentation of papers
and describes the general organization of the conference.
I would be remiss if I did not take a few moments to thank our Re­
search Director, Dr. Abramson. It is due largely to his efforts that this
second international conference is taking place. He has given more than
generously of his time, as I know you must be aware from the number of
bulletins you have received.
xiii
xiv ADDRESS
Drs. Randolf Alnaes of Norway, Keith S. Ditman of Los Angeles, Fred
W. Langner of Albuquerque, and P. Oliver O'Reilly of Moose Jaw, Canada,
unfortunately cannot be with us to discuss the papers they have written
for the conference.
I now turn over the active direction of the conference to Dr. Frank
Fremont-Smith. Dr. Fremont-Smith was for many years Medical Director
of the Josiah Macy, Jr., Foundation and, in that capacity, supported the
first international conference on uses of LSD at Princeton, New Jersey. He
is past President of the World Federation of Mental Health and Director
of the Interdisciplinary Communications Program, New York Academy of
Sciences.