LSD  The Problem-Solving Psychedelic

P.G. Stafford and B.H. Golightly

Chapter VII. LSD and Mental Health

I had a vision, and I still have this vision, of mass therapy: institutions in which every patient with a neurosis could get LSD treatment and work out his problem largely by himself. Classical psychotherapy or psychoanalytical therapy is, of course, a costly procedure, and most people do not have enough money to undertake it; nor do we have health benefits to pay for individual psychotherapy. I hope that there will eventually be health insurance funds to pay for LSD therapy.  Dr. C. H. Van Rhijn, The Use of LSD in Psychotherapy.

The prevailing system, with few exceptions, has been to remove the acutely ill of mind far from the everyday sceneto put them away in human dump heaps.... The facts so arouse a sense of guilt that, even within the mental health professions, we would rather not dwell on them.

Most of them were located in or near great centers of culture in our wealthier states such as New York, Michigan, Ohio, California, and Pennsylvania. In some of the wards there were scenes that rivaled the horrors of the Nazi concentration campshundreds of naked mental patients herded into huge, barn-like, filth-infested wards, in all degrees of deterioration, untended and untreated, stripped of every vestige of human decency, many in stages of semi-starvation.

The writer heard state hospital doctors frankly admit that the animals of near-by piggeries were better fed, housed and treated than many of the patients in their wards. He saw hundreds of sick people shackled, strapped, straitjacketed and bound to their beds; he saw mental patients... crawl into beds jammed close together, in dormitories filled to twice or three times their normal capacity.... [Albert Deutsch, The Shame of the States.]

During the first two years of our work with these compounds, we were in doubt of their value... We now consider that they give us therapeutic possibilities in areas where we were formerly powerless. In fact these drugs are of such great importance in our psychiatric instrumentarium that we can hardly think of doing without them. Indeed, this is a great step forward in psychiatry.

We are here concerned with therapy only insofar as it works by psychological methods: and for the time being we have no other.

Behind every psychoanalyst stands the man with the syringe.

Psychoanalysis never claimed that there were no organic factors in the psychoses.... It is the biochemist's task to find out what these are.... So long as organic factors remain inaccessible, analysis leaves much to be desired.

There are good reasons for believing that the LSD experience is a manifestation of the psychic unconscious, and that its material can be used in psychotherapy in the same way that dreams, phantasies and paintings can be used by the psychoanalysts.

Many therapists were outraged because of this threat to their omnipotence. Many were justifiably concerned about the irresponsible use of a powerful drug on unsuspecting patients or volunteers. As a reaction to the early reports that the answer to the problem of mental illness was here, at last, there began to appear publications stressing mostly the dangers of suicide and psychosis, and accusing those who were using LSD of charlatanry and self-deception.

Cohen... showed very well how low the relative risk of the therapy is, if it is carried out responsibly by qualified doctors. Thus, we actually are threatened less by adverse results, or severe complications, than we had to assume at the start. Our experience has shown that this risk can be reduced practically to zero in a well-institutionalized therapy, as in our clinic. This holds for the activation of depressions and schizophrenic psychoses, as well as attempted or successful suicides.

This meeting is most valuable because it allows us to see all at once results ranging from the nihilistic conclusions of some of the evangelical ones of others. Because the results are so much influenced by the personality, aims, and expectations of the therapist, and by the setting, only such a meeting as this could provide us with such a variety of personalities and settings.

We've also had psychotomimetic reactions in patients who were not psychotic before we gave them the drug. We have traced these reactions back to the effect of the attitude of the treatment personnel. We have been able to give the drug again and get a psychedelic reaction, after we have worked through with the treatment personnel what had caused the psychotomimetic reaction.

... there is already considerable evidence to suggest that the potential harm in the drug lies in its dramatic appeal to the sick therapist. I have wondered, further, if its repudiation by many is a function of too-limited experience and, in some instances, the therapist's need to control the rehabilitative process more closely than can be done under LSD.

An analysis of 43 patients treated privately in 1962, i.e., three years ago, shows that 34 are completely well and socially well-adjusted. Six are improved, one abandoned treatment, one had to leave for Africa before treatment was finished, and one failed to respond satisfactorily, so treatment was abandoned.

... keeping in mind that psycholysis is a causal therapy for most severe and previously incurable cases, to those resisting all other forms of therapy, including long years of psychoanalytic treatment, this expenditure seems slight. If we were to carefully assume that on the average our cases would have required 300 individual psychoanalytic sessions, our time expenditure is less than one fourth, completely ignoring the far greater effect. Furthermore, new indications such as sexual perversion, psychopathy and borderline cases can be treated.

A senior executive of an international advertising agency who had had two years of analysis, four days a week, stated that he had derived more insight in his third LSD session than in the two years' analysis. As a busy man, he made it clear he was not going to spend "endless hours" between sessions in view of his failure to improve previously with one of the leading orthodox analysts in London.

It is my conviction that in both the Psychodramatic[5] and LSD treatment experiences the forces leading to growth are somehow concentrated in greater intensity than in other forms of therapy.... In both forms of treatment there is no room for the "as if" operation. In Psychodrama, if the protagonist, group or auxiliary egos are acting instead of living what they are doing, the session will be almost useless. If the converse is true, the session is very productive. In LSD there is no "as if" experience. One is not "like" something; one is. It is not as if one were looking at one's self; one looks at one's self. It is not as if one had a heart attack like that which killed father; one has it and so convincingly that on one occasion an empathic physician present felt the same acute physical symptoms himself....

.... the intense experiences of the LSD patient are basically common to all of us. This is probably the reason why the LSD patient feels that he has shared with the observers a basic experience even though he often has not spoken about it while going through it. It is obvious that everyone has an exquisite perception of the reaction of those about him when he is undergoing the effects of the drug. Negative comments often bring out paranoid reactions as in one patient who said to a physician who was his friend and who began to probe, "Your fingers are growing long and claw like. It's amazing how someone can change in one minute. I'm not going to answer anybody's questions from now on." More usual, if one has a skilled LSD "Audience," is the unexpected comment, "Thank you for being here and going through this with me."

Impressive in both techniques is the amount of spontaneity that human beings are capable of under favorable conditions.... the individual is freed or forced to experience a great outpouring of feeling often far beyond his conception of his own emotional capabilities. Sometimes the patient becomes so overwhelmed by the unexpected extent of his own spontaneity that he experiences acute (fortunately temporary) panic because of his own "lack of control." However, such feelings are usually followed by a feeling of great peace, a result which is also similar to many successful Psychodrama sessions.

I really admire Dr. Baker for his courage in using LSD with involutional manic-depressives and paranoids. It suggests to me that perhaps we have been a little too fearful and timid in our approach. Have we been threatened by others in the hostile field with which we have been surrounded?

Work with autistic children was also considered forbidden territory for LSD, but in the past few years research has broadened surprisinglyhowever quietlyand using the drug on autistic children is only one of the new areas which has come under LSD exploration. Casework has also been done with juvenile delinquents and potential suicidesand even with such unlikely subjects as dolphins.

Early in 1966, The New York Times picked up a story from the American Journal of Psychiatry concerning the LSD treatment of five-year-old twins who had almost completely withdrawn from human contact; this was the first case reported in a series of eighteen at the Neuropsychiatric Institute at UCLA. The twins, after receiving the drug, "markedly reduced their bizarre repetitive movements, their preoccupation with mechanically rhythmic activities," and indications were that for the first time they might be reached. As the Times reported it, "One reason why childhood autism has been so resistant to treatment is that its victims can make no contact or express any interest in the people who try to help them. There is little eye contact, no speech, lack of concentration on everything but mechanically repeated activities." This study was especially important not only because the twin boys became subjectively more accessible, but also because the procedure was witnessed by independent observers unaware that the pair had been given LSD. The Times report on this study was significant, for it constitutes one of the first accounts of such work to appear in a newspaper of wide circulation.

In the following case, which concerns an adult who had been institutionalized since childhood for retardation, the therapist took the drug along with the patient, and there was a psychologist present as an observer.[6]

PATIENT: (Lying on cot) I haven't had the same opportunity as those outside. I had to learn by my surroundings... (Referring to the staff) Their expressions tell me what they think... (Referring to patients) The worst one to watch for is the quiet type. They can talk but won't talk...

THERAPIST: How would you feel if you were a whitecoat?

PATIENT: If I took a liking to a particular patient, I would not show this in front of the other patients. It is just the way you would treat your own children. You should not favor one over the other.

THERAPIST: Do you think that a lot of the patients here need help?

PATIENT: Not a lot of them, all of them... One little word of kindness sparks a whole new world of love... I would like to talk to you in 3 or 4 weeks, after the drug has worn off. Then compare what I say then and what I say now.... You people talking to me after 30 years is like the world coming to an end... Other boys feel this way. It is like a key is opening a door and the light is flowing in. And this means a great deal to me....

THERAPIST: When he goes through these gates, what do you think that he should do first?

PATIENT: He should get to know others. There is no return. Do not look back, go ahead... Find a girl who feels the same way you do and maybe get married... Why have you given me your time when nobody ever did before?

OBSERVER: How much is enough time?

PATIENT: Eternally... I don't know whether to laugh or cry ... Do you get the feeling of closeness as humans, instead of like man and patient?... If I get out, write and let me know when you have helped another patient...

PATIENT: I feel sorry that you don't know the Bible. You are never too old to learn and you'll never learn any younger. If you want to know the patients, read the 5th chapter of Matthew. Work out these verses, verse by verse.

OBSERVER: Unfortunately we can't do that.

PATIENT: (Shouting) Can't or won't. The truth hurts. I want it to hurt you as it hurts me... You have to give kindness in order to get it. You won't get kindness by poking somebody ...

Once these people are oriented to outside living and are trained in specific skills which they can offer the community, they must not be tossed out of the institution like a man swept off of a ship into the raging sea. They need to feel the security of companionship while in the new environmentto learn to share the pleasant experiences of Christmas, Easter, Thanksgiving, Mother's Day, Father's Day, birthdays, picnics in the park, and all those little things which give value to living. It is not enough to train them for a jobthis is only a part of the outside world, a very essential and important part, but only a part of the whole.

It is not enough to have a social or guidance worker drop around to see how you are doing occasionallythese people need real love and understanding, the love and understanding which seems to come through LSD. Maybe it is an artificial way of achieving it, but if it achieves the end of a fuller life, then this, in my opinion, is good.... If LSD has brought this idea to a more prominent place in my thinking, then although it may have its drawbacks, it is beneficialat least for me.

If all nursing staff was administered one shot of LSD under suitable conditions, we may have the growth of a new approach to the mentally handicapped, an emptying of our overfull garbage cans.

It is a great advance to have people who are courageous enough in a scientific meeting to speak of love. I am delighted... It is crucial.... But for doctors to admit they have to give love of the appropriate kind, as described by Dr. Kramer, to their patients is something we are afraid of. Because of the suffering of patients and the call upon us as medical students for a kind of love that we don't know how to manage, we don't know how to put it in the right frame of reference. We have had no training in this respect at all. We tend, rather, to build up our defenses against it.... We have to make it respectable in the nursing profession, in the medical profession, and in the whole therapeutic team. The appropriate way to manage an expression of love is not only highly respectable but absolutely a demand.

I know from... working with these people for years, who never give in, and who always hit back at society, and I have had the same experience you had. After one or two treatments with LSD they are feeling for the first time that they are actually relating, and that it is possible to get near someone, and that it is all part of the process of lovingand then being able to accept love.

The comparison can't be made. If a group of potentially suicidal patients has any kind of therapy, a few will commit suicide, and many will be rescued. If a drug is involved, it will be of less importance than the skill, alertness, and devotion of the therapist.

It was absolutely essential that I die. It was not the depression alone that created this urgent need within me. I had lived with the depression for years and while it was extremely painful it was not beyond my ability to endure. No, there was something else that I cannot explain beyond saying how I felt. There was this inescapable and irresistible feeling that I must die. I am absolutely certain that had I not "died" in the LSD session I would have had to die in some other way, and that could only have meant really dying. Committing suicide, destroying myself, as I surely would have done.

I had the sensation... of a snake curling up around me.... I then began to see serpents' faces all over the wallthen I saw myself as a fat, potbellied snake slithering gaily away to destruction. I felt horrified and thought, "Whose destruction?" I then realized it was my own destructionI was destroying myself. I seemed to be having a battle between life and deathit was a terrific struggle, but life won. I then saw myself on the treadmill of lifea huge wheel was going round and round with hundreds of people on it. Some were on top going confidently through life, others were getting jostled and trodden on but still struggling to go on living (I saw myself as one of these people) and then there were the others who just couldn't cope with life and were being crushed to death in the wheel. I had another realization of how I was destroying myselfby carrying on this affair with this married man.... I knew it must cease and knew that I must never see him again.

[It] brought her to realize the male genital symbolism involved (you must believe that this was not suggested by the therapist). At the same time she realized her own marked, hitherto repressed, genital sexual drive.

If we get sexual perverts, for example, we may question what kind of treatment to give them; we want to find out a little more about them. We could use three or four weeks finding out, but we shorten that and say we will try if we can find out more with one or two LSD sessions. We use small doses then. We find that the symptoms are clearer; they are willing to speak more openly to us; we can get a clearer picture of the diagnosis. We have used it in that way to save time.

Psychiatrists talk one language and I talk another. They knew what they wanted but someone had to translate their wishes into architecture. To me there was really no other way. If I were to really understand the fears and problems of the schizophrenic, I would have to look at things the way they did.

First, I would suggest that we be more alert for the early onset of schizophrenia, which is commonly accompanied by strong feelings of unreality and perceptual distortions. Very often the schizophrenic makes early appeals for help, often repeatedly calling his friends or his family, yet he is so blocked that he does not get his message across. Such patients make frequent appeals to the doctor.... I believe that if we can recognize them at this point and somehow reduce the level of anxiety, we can materially impede the perceptual distortions and the rapid disintegration of the ego....

Second, I would like to suggest that our treatment of the acute schizophrenic reaction is all wrong. At a time when the schizophrenic is desperately trying to hold on to some vestige of reality, we do everything in our power to destroy his hold on reality. We take him from his home, to a police station; from there to the emergency hospital, then to the admission ward, and finally either to the treatment ward or to the mental hospital. We cloud his sensorium with soporifics and shock, dealing a blow to his grasp on reality. We isolate him, putting him in a quiet roomas unreal an environment as one could ask for. We change his doctors and nurse; every eight hours a new shift comes on and several new faces appear.... The talking is important, but more important is the presence of another person, whom he can learn to trust and whom he feels is capable of understanding. I think that during an experience when time is meaningless, to have the attendant disappear for prolonged intervals is devastating. As one subject with LSD put it, "Your physical reality disappears, and then your body disappears, and you have only another person and something gets between you and the other person, and you're cut off from the only thing that can save you."

One of the most encouraging things which has happened to me in recent years was the discovery that I could talk to normal people who had had the experience of taking mescaline or Iysergic acid, and they would accept the things I told them about my adventures in mind without asking stupid questions or withdrawing into a safe smug world of disbelief. Schizophrenia is a lonely illness and friends are of great importance. I have needed true friends to help me to believe in myself when I doubted my own mind, to encourage me with their praise, jolt me out of unrealistic ideas with their honesty and teach me by their example how to work and play. The discovery of LSD-25 by those who work in the field of psychiatry has widened my circle of friends.

Footnotes