ay

-“*DIGITALIS*
**PROJ ECT™
of lasting value will,
“anything
once digitized and spread on
fhe world wide web, exist and
be available to aif until the end
of the Technological Era.”
THE DIGITALIS PROJECT:
DIGITIZING THE 20th CENTURY
 LSD

_—
PSYCHOTHERAPY

by STANISLAV GROF, M.D.

Other books by Stanislav Grof M.D.

REALMS OF THE HUMAN UNCONSCIOUS (1976)

THE HUMAN ENCOUNTER WITH DEATH (1977) .

(with Joan Halifax)

 LIST OF CONTENTS

Characteristic patterns of the early stage in a psychedelic session....... veeee 383

Two representations of illusory transformation ACKNOWLEDGMENTS........+--- See c cenceeee et eeneeeenenee Levee cece neeas
l. History or LSD THERAPY .. 0... 00005 Lecce ees Lobe ene ne pete nneeeas 17
under the influence of LSD ..............000
0c cece eee Liteeteeeeseee 84
The ‘psychedelic breakthrough’ in a perinatal experience ................-. 67 The Discovery of LSD and its Psychedelic Effects beeees ence eee ees wees 17
The transition from BPM III to BPMIV................. Cisse ceeeceevess 69 Early Laboratory and Clinical LSD Research ...........0000- Doce eens 20
The final phase of the death-rebirth process. ........ 00.00 ccceceeeeeenceee 70 Therapeutic Experimentation With LSD ............ Secesevaeaenvesees 22
Nausea and sensory deprivation in a perinatal experience .................. 103 Studies of Chemotherapeutic Properties of LSD......--.+.+...5- Leeeeee 24
Transformation of the maternal genitals during the birth process ........ ... 105 LSD-Assisted Psychotherapy ..........00+ 0005s eeeeeees Scene eens ::- 28
Death and rebirth in a perinatal session .............. Lo ceeeueeeanees .... 106 The Need for a Comprehensive Theory of LSD Therapy Loc ee cece eens cans 42
An encounter with the devil........... 000.0. ccc ec eee cee eee eee e tee nees 139
Overwhelming threat and revulsion...............00005 Lecceeaeeceeecess 189 2. CrrricAL VARIABLES IN LSD THERAPY «0.2.00. 0-00 eee eee eres 47
Snake symbolism in the death-rebirth process ..... eee eee eeeeee 141 , Pharmacological Effects of LSD... 06.60.60 ect eene eee ten eee
An ecstatic experience of the divine epiphany following the ego death ..... .. 142 Personality of the Subject......... 60.0520 c eee eee eens 52
‘The Flagellant’: final stages of the death-rebirth process (BPM III) ......... 175 Personality of the Therapist or Guide . . . .6 00.0. e cece eee e eee eens 89
The purifying fire associated with volcanic ecstacy (BPM III) ............-. 176 Set and Setting of the Sessions ....... te tees
0.6... cece nett 108
The last seconds before biological and spiritual birth ........ Lecce eens . 177
Identification with the universe .............. Lede cece eee eues veveeeeeee 178 3. PsyCHOLYTIC AND PsyCHEDELIC THERAPIES WITH LSD:
e eae
Identification with the crucified Christ................ Leen ee ene e ene 211 TowArps AN INTEGRATION OF APPROACHES. 0.0.0.0 0 cee cece eee eens 119
The Search for an Effective Technique of LSD Psychotherapy ............ 119
‘Pega’, a theme on the psychodynamic,
perinatal and transpersonal levels................. Levee e ences Lewes . 212 . Advantages and Drawbacks of the Psycholytic Approach...........--.05. 123
Final stages of the perinatal unfolding (BPM HI) ... ceeeee 214 Pros and Cons of Psychedelic Therapy....... ccc c neste eeeeteueeeeeees 126
Experiencing elements of the collective unconscious . seas. 247
cece eee eee
Embryonal, tissue and cellular consciousness ............0000 247 4. PRINCIPLES OF LSD PSYCHOTHERAPY 1.000.000 ccc cece teen ene e eens 131
Archetypal demonic entities..................0. Leceeeeeuees Lecce eeeeee 250 The Preparation Period ....... 6.60 e cence eee eens 131
‘Through Suffering to the Black Sun’: Psychedelic Sessions ........6000 000 e eee eee Lobe ected eee e eee ennees 148
manifestation of the divine Self ...................4- Levee ee eeeeaues .. 283 Integration of the Drug Experiences............... eee eee 159
The Black Sun as the ultimate source of creative energy ............. weve. 284
The process of creation and the individual and universal Selfs ........ veeee. 285 5. Compiications or LSD PsycHOTHERAPY:
Cosmic creation through volcanic activity ................... Lecce cee eeas 286 OccurRENCE, PREVENTION, AND THERAPEUTIC MEASURES ..... 0.600005 000s 163
Motifs related to the North American tradition ..............c00cceeeeeuee 287 0666-6 ee seer eee ee
Physical and Emotional Contraindications ........... 163
eenbeneens 3920 Critical Situations in LSD Sessions...... eet eee ene
000 cece ee eee ..... 166
Egyptian motifs and the concepts of Kundalini ..... Lecce ees vec
 LIST OF CONTENTS (continued)

Adverse Aftereffects of LSD Psychotherapy ............ceecsencucus Le. 185

Prevention and Management of Complications in LSD Psychotherapy . 195

6. THe Course or LSD PSYCHOTHERAPY .......0.. 0c ccc eccueveeecnceaeees 201 ‘

Changes in the Content of Psychedelic Sessions ...........0.ceceeeeesees 203 ‘
Emotional and Psychosomatic Changes in the Post-Session Intervals . . 218
Long-Term Changes in the Personality Structure, World-View, and
Hierarchy of Basic Values .......... 00. cccveccecceceeceusvucenees 227 ‘ *
7. INDICATIONS FoR LSD PsycHOTHERAPY, THERAPEUTIC PoTENTIAL,
AND CLINICAL RESULTS ...... 00.0 sete cee ee ences eeseseectevevaceeeass 233
Problems in the Evaluation of Clinical Results............0.0.ceeceseee 233 | PREFACE
Depressions, Neuroses and Psychosomatic Symptoms .................... 287 v
Alcoholism, Drug Addiction, Character Disorders and . i
Sexual Deviations .......... 00. c cece cece cee ceseseccncereevee, 240 {
Borderline Psychotic States and Endogenous Psychoses....... seeeee 244 ,
Emotional Distress and Physical Pain of Dying Individuals............... 258 i A book on LSD psychotherapy that is being published at a time when psychedelic
8. Non- THERAPEUTIC USES OF LSD... sec scccccececcccccecceeccccccce.. 957 ‘ research is virtually non-existent requires few words of introduction and justi

Training Sessions of Mental Health Professionals.................

Administration of LSD to Creative Individuals trees
257
od
fication. entre ae nay a an ae
material, accumulated over more than
ee years. The repressive,
twenty-four ethene
Drug-Induced Religious and Mystical Ex eriences ete e nce e eee cee ees 969 legislation in regard to psychedelic drugs has succeeded in terminating almost all
Role of LSD in Personal Growth and Self Actualivatic Preteen sennenenens 268 legitimate scientific research, but has been quite ineffective in curbing
Use of LSD in the Development of Paranormal Abilities , 969 unsupervised self-experimentation. It is nearly impossible for the average
‘ professional to get a license for psychedelic work and a supply of pharmaceutically
J pure substances, but black market samples, frequently of problematic quality, are
. LN enareY mwentionel Therapeutic Me vhoniame reese eee ees oe ' easily available to the teenage generation. Hundreds of thousands—and according
Changes in the D ics of G ing S , Sf to some estimates millions—of young people in the United States alone have
There eutic Potential of th, Death Rebi one eters 277 experimented with psychedelics on their own.
Therapeutic Mechanisms on the Transpersonal Level. Peres sere rece eees ae The information in scientific books and journals is not easily available and
° trees most of it does not have direct practical relevance, while the literature that has
Epttocue: Tue Future or LSD PsycHOTHERAPY 997 had a direct influence on the public has been strongly biased, dichotomized and
Penne eens see eee sees eee e ees contradictory. One part of it, coming from uncritical proselytizers, tended to one-
BIBLIOGRAPHY .......-----.0eece... 300 =. sidedly emphasize the advantages of psychedelic drug use and failed to mention
Ce eens eee ee : the dangers. The rest was a product of official anti-drug propaganda and was for
: wa se on , the most part so distorted and negative that the younger generation did not take it
Appendix I see se of Packet Related to Unsupervised 306 | seriously. Since a similar campaign had been raised in the past against the
Tere ee eee reese rere eee e eens relatively innocent marijuana, it was easy to “throw the baby out with the bath-
Appendix II The Effects of LSD on Chromosomes, Genetic Mutation, | vateinge ws ‘ene not only the demagogic statements, but accurate and realistic

Referens mens and Malignancy ...............s.0e05 ont / Honest and balanced information about the immediate and long-terin
Teeneee ee ee eee nes tenes effects of LSD is of great importance, not only to those who are involved in self-
INDEX ......--.-0-- 005, 348 experimentation, but for the relatives, friends and other persons who may have to
Te ee ee eee er eee eee ea eens deal with various manifestations or consequences of such an undertaking. An
understanding of the psychedelic process is particularly relevant for the parents of
these individuals, teachers, and lawyers who handle cases involving ingestion of
the drug. Moreover, unbiased information is of critical importance for mental
health professionals who are asked for expert help in cases related to psychedelic
drug use. The current practices for handling LSD emergencies and its long-term
8 9
 ll
10 LSD PSYCHOTHERAPY Preface

adverse effects reflect ignorance of the processes involved, and do more damage examples. In this context it should also be emphasized that the new cartography of
than good. Although the material in this book describes the supervised clinical use the mind that has emerged from psychedelic research includes and integrates
of LSD, the information given is directly applicable to crisis intervention and the certain essential elements from various spiritual traditions. This is an important
problems related to unsupervised LSD use are specifically discussed in an appendix step in bridging the colossal gap that has existed in the past between the religious
because of the extreme importance of this issue. Some people, who are not directly systems and various schools of psychology, with the exceptions of the Jungian
or indirectly involved in psychedelic experimentation but had LSD experiences in: orientation and Assagioli’s psychosynthesis.
the past, may find this book a useful source of information which could throw The theoretical importance of the data from psychedelic research extends far
new retrospective light on aspects of their sessions which left them bewildered or beyond the realms of psychiatry and psychology. It is also of immediate or
confused. potential relevance for a broad spectrum of other disciplines, including anthropol-
The failure of the legal and administrative measures of the past to curb LSD ogy, sociology, politics, general medicine, obstetrics, thanatology, religion, philos-
use seems to reflect a lack of awareness of the nature and depth of the problems ophy, mythology and art.
involved. A deeper understanding of the effects of LSD and the transformation By far the most surprising and exciting connections seem to exist between the
processes that it facilitates might provide some interesting and important clues to psychedelic material and modern physics. Some of the challenging observations
legislators. Certain aspects of the material presented in this volume also have from LSD sessions that cannot be accommodated and integrated into the Carte-
direct relevance to the understanding of events around the experiments conducted~ sian-Newtonian model seem to be perfectly compatible with the world-view
by military experts and governmental agencies in various countries in the past and emerging from quantum-relativistic physics. In view of the recent rapid conver-
recently publicized. gence between mysticism, physics and consciousness, the LSD data could contrib-
I hope I will be able to communicate in this book my deep regret that, ute significantly to our understanding of the nature of reality.
because of a complicated set of circumstances, psychology and psychiatry have lost
a very unique research tool and a powerful therapeutic agent. I believe that it is Stanislav Grof
important to clarify the controversies and confusions, whether it is done with Big Sur, California
regard to the possible continuation of LSD research in the future or as a closure of April, 1979
a fascinating chapter in the history of psychiatry. The efficacy and safety of
psychedelic substances has been tested over centuries and even millenia. Many
cultures throughout human history have used them successfully in the context of
shainanic practices, healing ceremonies, and religious rituals. There is a possibility
that we will return to research in this area in the future enriched by the lessons
from the past. However, even if that does not happen, the material that has
already been accumulated is of great theoretical relevance and heuristic value.
Many observations from psychedelic research are of such fundamental im-
portance and are so revolutionary in nature that they should not be ignored by
any serious scientist interested in the human mind. They indicate an urgent need
for drastic revision of some of our theoretical concepts and even the basic scientific
paradigms. Some of the new discoveries and insights concern an expanded model
of the psyche, powerful mechanisms of therapeutic change and _ personality
transformation, strategies and goals of psychotherapy, and the role of spirituality
in human life. The value of this new knowledge is independent of the future of
LSD therapy. It is directly applicable to the experiential psychotherapies which
use various non-drug techniques to reach deep levels of the psyche, such as gestalt
practice, bioenergetics and other neo-Reichian approaches, primal therapy, or
different methods of rebirthing. All these move in essentially the same direction as
psychedelic therapy, but a full utilization of their potential and their further
development are blocked by the straitjacket of the old conceptual frameworks.
The new data are also of great relevance in other areas in which unusual states of
mind are produced by non-chemical means. Creative use of hypnosis, the “mind
*Numbers refer to Bibliography on page 300
games” developed by Robert Masters and Jean Houston, (67)* the new laboratory
techniques for altering consciousness such as biofeedback, sensory isolation and Notes referred to in the text by superior numbers
overload, and the use of kinaesthetic devices can be mentioned here as important are located at the end of each chapter.
 *
ACKNOWLEDGMENTS

Having completed the work on this book, I would like to remember with deep
gratitude some friends who have given me important help at various stages of this
project. Dr. George Roubiéek, former Associate Professor of the Department of
Psychiatry at Charles University School of Medicine, was my first preceptor and
guide for my first LSD session in 1956. This experience was the beginning of my
profound interest in and life-long commitment to the study of unusual states of
consciousness. Dr. Milo’ Vojtéchovsky was the head of an interdisciplinary team
with which I started my research of psychedelic drugs. He introduced me to
several new psychedelic substances and gave me basic training in scientific
research and its methodology.
Much of the work that was of crucial significance for the development of the
ideas presented in this book had been conducted at the Psychiatric Research Insti-
tute’ in Prague, Czechoslovakia. Its director, Dr. Lubomir Hanzliéek, through all
the years of my clinical research with LSD, showed unusual understanding and
support for this unconventional scientific venture. I also feel deep appreciation for
the help of my colleagues at the institute and for the dedication and enthusiasm of
the nursing team.
My initial work in the United States was made possible by a generous grant
from the Foundations’ Fund for Research in Psychiatry from New Haven,
Connecticut. Dr. Joel Elkes, Professor of the Department of Psychiatry and
Behavioral Sciences at Johns Hopkins University School of Medicine in Baltimore,
invited me to the Henry Phipps Clinic, first as a clinical and research fellow and
later as Assistant Professor; he gave me invaluable help and guidance during the
years of my stay there.
The period between 1967 and 1973 that I spent at the Maryland Psychiatric
Research Center in Catonsville, Maryland, was a time of exciting team coopera-
tion with a group of enthusiastic and congenial researchers. I would like to thank
Dr. A. A. Kurland, former director of the center and Assistant Commissioner for
Research of the Maryland State Department of Mental Hygiene, as well as my
colleagues and friends from Spring Grove, for their contributions to my work and
enhancement of my personal life.
The Esalen Institute in Big Sur, California, has played a very important role

13
 LSD PSYCHOTHERAPY
14

in my life. Since my first visit in 1965, it has offered me many opportunities to

conduct seminars and workshops and share my material with open-minded and
sympathetic audiences. In the last five years it has become my home base and a
unique emotional and intellectual resource. In this extraordinary natural labora-
tory of the human potential movement I met many creative people pioneering in
experiential psychotherapies and had the opportunity to relate their work to my_
own. This made it possible for me to integrate the observations from LSD research
into a broader theoretical context. Of particular value have been the experiences
from a series of experimental educational programs for professionals, which my
wife Christina and I have been conducting at Esalen. These events, which
organically combine didactic input, intrapsychic exploration and group work, and
have a guest faculty ranging from Mexican and North-American shamans to
theoretical physicists, have become an invaluable source of inspiration. I would
like to express my deep gratitude to Michael and Dulce Murphy, Richard and
Chris Price, Julian Silverman, Janet Lederman, Beverly Silverman, Gregory and
Lois Bateson, and all our other friends at Esalen, for all their support and under-
standing. Of these, Rick Tarnas has been extremely helpful during the preliminary
work on the manuscript and Kathleen O’Shaughnessy in the typing of the final
version.
Other friends whose interest and support I would like to gratefully acknowl-
edge are Louis and Hazel Valier, Edward Dreesen, and Joseph Chambeau.
My deepest appreciation is reserved for hundreds of patients and LSD sub-
jects who participated in my psychedelic research over the years. Without their
trust, dedication and courage, this book could not have been written.

Stanislav Grof
Big Sur, California
April, 1979
 | HISTORY OF LSD
| THERAPY
The Discovery of LSD and its Psychedelic Effects
Early Laboratory and Clinical LSD Researc
Therapeutic Experimentation With LSD
: Studies of Chemotherapeutic Properties of LSD
~ 4 LSD-Assisted Psychotherapy
The Need for a Comprehensive Theory
of LSD Therapy

THE DISCOVERY OF LSD AND ITS PSYCHEDELIC

aes.
EFFECTS

aig
Albert
. LSD-25 (or diethylamide of d-lysergic acid) was first synthesized in 1938 by

in
Hofmann in the Sandoz chemical -pharmac eutical laboratori es in Basle, Switzer-

le
a sys-
land. As its name indicates, it was the twenty-fifth compound developed in
tematic study of amides of lysergic acid. LSD is a semisynthetic chemical product;
its natural component is lysergic acid, which is the basis of all major ergot alka-
loids, and the diethylamide group is added in the laboratory. According to Stoll,
Hofmann and Troxler(98), it has the following chemical formula:
7 C7Hs

go riesgo ict a
™~
\ / C,H,
Cc CH,

a
HC NCH,

<——_-
CH

oO
CH,

oO
oO
x
GH

NH
 18 HISTORY OF LSD THERAPY The Discovery of LSD and its Psychedelic Effects 19

ah mi
elazpw
Various ergot alkaloids have important uses in medicine, primarily as drugs psychoactive drug known to man. The dose he chose and ingested without any

aorRES
that can induce uterine contractions, stop gynecological bleeding, and relieve special preparation, or any knowledge about psychedelic states, would at present

testeGo ot Ee
migraine headache. The objective in the Sandoz study of ergot derivatives was to be considered a high dose and has been referred to in the LSD literature as a
obtain compounds with the best therapeutic properties and least side effects. After “single overwhelming dose.” If used in clinical praetice it is preceded by many
LSD had been synthesized, it was subjected to pharmacological testing by Profes- hours of preparatory psychotherapy and requires a trained and experienced guide
sor Ernst Rothlin. (88) It showed a marked uterotonic action and caused | to handle all the complications that might occur.
About forty minutes after the ingestion, Hofmann started experiencing
excitation in some of the animals; at the time these effects were not considered of
dizziness and unrest; he had difficulties in concentration, disturbances of visual
sufficient interest to be further explored.
perception, and a strong unmotivated desire to laugh. He found it impossible to
The unique properties of the new substance were brought to the attention of

voregepenen
the researchers by a series of events involving a fortuitous accident. In 1943 Albert keep a written protocol about his experiment as originally planned. The following
Hofmann was reviewing the results of early pharmacological tests on LSD and is an excerpt from his subsequent report written for Professor Stoll: (38)
decided to investigate the stimulating effects on the central nervous system indi-

BR Ter aes om
the laboratory notes are discontinued; the last words
cated in animal experiments. Because of its structural similarity with the circu- “At this point,
were written only with great difficulty. I asked my laboratory assistant to
latory stimulant nikethamide, LSD seemed promising as an analeptic substance.
Feeling that it would be worthwhile to carry out more profound studies with this accompany me home, as I believed that I should have a repetition of the dis-

tee
Albert Hofmann decided to synthesize a new sample. However, even turbance of the previous Friday. While we were cycling home, however, it
compound,
the became clear that the symptoms were much stronger than the first time. I
the most sophisticated experiments in animals would not have detected
be had great difficulty in speaking coherently, my field of vision swayed before
psychedelic effects of LSD, since such specifically human responses cannot
anticipated on the basis of animal data alone. A laboratory accident came to the me, and objects appeared distorted like images in curved mirrors. I had the
an impression of being unable to move from the spot, although my assistant
help of the researchers; by a strange play of destiny Albert Hofmann became
involuntary subject in one of the most exciting and influential experiments in the told me afterwards that we had cycled at a good pace. Once I was at home,
history of science. Working on the synthesis of a new sample of LSD, he acci- the physician was called.
“By the time the doctor arrived, the peak of the crisis had already
dentally intoxicated himself during the purification of the condensation products.
The following is Albert Hofmann’s own description of the perceptual and passed. As far as I remember, the following were the most outstanding
symptoms: vertigo; visual disturbances; the faces of those around me ap-
emotional changes that he experienced as a result: (38)
peared as grotesque, colored masks; marked motoric unrest, alternating
“Last Friday, April 16, 1943, I was forced to stop my work in the labor- with paralysis; an intermittent heavy feeling in the head, limbs, and the en-
atory in the middle of the afternoon and to go home, as I was seized by a tire body, as if they were filled with lead; dry, constricted sensation in the
peculiar restlessness associated with a sensation of mild dizziness. On arriv- throat; feeling of choking; clear recognition of my condition, in which state
ing home, I lay down and sank into a kind of drunkenness, which was not I sometimes observed, in the manner of an independent, neutral observer,
unpleasant and which was characterized by extreme activity of the imagina- that I shouted half-insanely or babbled incoherent words. Occasionally, I
tion. As I lay in a dazed condition with my eyes closed, (I experienced day- felt as if I were out of my body.
light as disagreeably bright) there surged upon me an uninterrupted stream “The doctor found a rather weak pulse, but an otherwise normal circu-
of fantastic images of extraordinary plasticity and vividness, accompanied lation. . . . Six hours after ingestion of the LSD, my condition had already
by an intense kaleidoscope-like play of colors. This condition gradually improved considerably. Only the visual disturbances were still pronounced.
passed off after two hours.” Everything seemed to sway and the proportions were distorted like reflec-
tions in the surface of moving water. Moreover, all the objects appeared in
After he had returned to his usual state of consciousness, Hofmann was able unpleasant, constantly changing colors, the predominant shades being sickly
to make the hypothetical link between his extraordinary experiences and the possi- green and blue. When I closed my eyes, an unending series of colorful, very
bility of accidental intoxication by the drug he was working with. However, he realistic and fantastic images surged in upon me. A remarkable feature was
could not understand how the LSD had found its way into his body in a sufficient the manner in which all acoustic perceptions, (e.g. the noise of a passing
quantity to produce such phenomena. He was also puzzled by the nature of the car), were transformed into optical effects, every sound evoking a cor-
effects, which were quite different from those associated with ergot poisoning. responding colored hallucination constantly changing in shape and color
Three days later he intentionally ingested a known quantity of LSD, to put his like pictures in a kaleidoscope. At about one o'clock, I fell asleep and awoke
suspicions to a solid scientific test. Being a very conservative and cautious person,
the next morning feeling perfectly well.”
he decided to take only 250 micrograms,! which he considered to be a minute dose
judging by the usual dosage level of other related ergot alkaloids. At that time he This was the first planned experiment with LSD, and it proved in a drainatic
had no way of knowing that he was experimenting with the most powerful and convincing way Hofmann’s hypothesis about the mind-altering effects of
 ~a
20 HISTORY OF LSD THERAPY Early Laboratory and Clinical LSD Research 21

en
LSD. Subsequent experiments with volunteers from the Sandoz Research Labora- point of view of the “model psychosis” hypothesis were experiments studying the
tories confirmed the extraordinary influence of this drug on the human mind. antagonism between LSD and various other substances. The possibility of block-
The next important figure in the history of LSD was Walter Stoll, son of ing the LSD state, by premedication with another drug or by its administration at

ee
Hofmann’s superior and psychiatrist at the Psychiatric Clinic in Ziirich. He found the time of fully developed LSD effects, was seen as a promising approach to the
the new psychoactive substance of great interest and conducted the first scientific discovery of new directions in the pharmaco-therapy of psychiatric disorders.
study of LSD in normal volunteers and psychiatric patients. His observations of Several biochemical hypotheses of schizophrenia were formulated at this time, im-
the LSD effects in these two categories of subjects were published in 1947, (97) plicating specific substances or whole metabolic cycles as the primary cause of this
This report became a sensation in the scientific world and stimulated an unusual disease. The serotonin.hypothesis coined by Woolley and Shaw (104) received by
amount of laboratory and clinical research in many countries. far the most attention. According to their model LSD causes abnormal mental

nemee
functioning by interfering with the neurotransmitter substance serotonin
(5-hydroxytryptamine). A similar mechanism was postulated as the biochemical

MMR
EARLY LABORATORY AND CLINICAL LSD RESEARCH cause of schizophrenia.

CE AI
This reductionistic and oversimplified approach to schizophrenia was
Much of the early LSD research was inspired and strongly influenced by the so- repeatedly criticized by psychoanalytically and phenomenologically oriented clini-
called “model psychosis” approach. The incredible potency of LSD and the fact cians and biochemical investigators, and finally abandoned by most researchers. It
that infinitesimally smal! quantities could profoundly alter mental functioning of became increasingly obvious that the LSD-induced state had many specific
otherwise healthy volunteers gave a new impetus to speculations about the characteristics clearly distinguishing it from schizophrenia. In addition, none of
basically biochemical nature of endogenous psychoses, particularly schizophrenia. the biochemical mechanisms postulated for schizophrenia was unequivocally sup-
It was repeatedly observed that microscopic doses of LSD, in the range of 25 to ported by clinical and laboratory data. Although the “model psychosis” approach
100 micrograms, were sufficient to produce changes in perception, emotions, idea- did not resolve the problem of the etiology of schizophrenia or provide a
tion and behavior that resembled those seen in some schizophrenic patients. It was miraculous “test-tube” cure for this mysterious disease, it served as a powerful in-
conceivable that the metabolism of the human body could, under certain circum- spiration for many researchers and contributed in a decisive way to the neuro-
stances, produce such small quantities of an abnormal substance identical with or physiological and psychopharmacological revolution of the fifties and early sixties.
similar to LSD. According to this tempting hypothesis, endogenous psychoses such Another area in which the extraordinary effects of LSD proved extremely
as schizophrenia would not be primarily mental disorders, but manifestations of helpful was self-experimentation by mental health professionals. In the early years
an autointoxication of the organism and the brain caused by a pathological shift in of LSD research, didactic LSD experiences were recommended as an unrivalled
body chemistry. The possibility of simulating schizophrenic symptoms in normal tool for the training of psychiatrists, psychologists, medical students, and psychia-
volunteers and of conducting complex laboratory tests and investigations before, tric nurses. The LSD sessions were advertised as a short, safe and reversible
during, and after this transient “model psychosis” seemed to offer a promising key journey into the world of the schizophrenic. It was repeatedly reported in various
to the understanding of psychiatry’s most enigmatic disease. books and articles on LSD that a single psychedelic experience could considerably
Much research during the years following the discovery of LSD was aimed increase the subject's ability to understand psychotic patients, approach them with
at proving or disproving the “model psychosis” hypothesis. Its power was such sensitivity, and treat them effectively. Even though the concept of the LSD experi-
that for many years LSD sessions conducted for any purpose were referred to as ence as “model schizophrenia” was later discarded by a majority of scientists, it re-
“experimental psychoses,” and LSD and similar substances were called hallucino- mains an unquestionable fact that experiencing the profound psychological
gens, psychotomimetics (psychosis-simulating compounds) or ps chodysleptics changes induced by LSD is a unique and valuable learning experience for all clini-
drugs disrupting the psyche). This situation was not rectified until 1957 when cians and theoreticians studying abnormal mental states.
‘Humphrey Osmond, after mutually stimulating correspondence with Aldous The early experimentation with LSD also brought important new insights
Huxley, coined a much more accurate term, “‘psychedelics” (mind-manifesting or into the nature of the creative process and contributed to a deeper understanding
mind-opening drugs). (74) In these years much effort was directed toward accurate of the psychology and psychopathology of art. For many experimental subjects,
phenomenological description of the LSD experience and assessment of the professional artists as well as laymen, the LSD session represented a profound
similarities and differences between the psychedelic states and schizophrenia. aesthetic experience that gave them a new understanding of modern art move-
These descriptive studies had their counterpart in the research exploring parallels ments and art in general. Painters, sculptors and musicians became favorite LSD
between these two conditions, as reflected in clinical measurements, psychological subjects because they tended to produce most unusual, unconventional and inter-
tests, electro-physiological data, and biochemical findings. The significance at- esting pieces of art under the influence of the drug. Some of them were able to
tributed to this avenue of research found an expression in the number of studies express and convey in their creations the nature and flavor of the psychedelic
contributing basic data about the effects of LSD on various physiological and bio- experience, which defies any adequate verbal description. The day of the LSD
chemical functions as well as on the behavior of experimental animals, on isolated experience often became a dramatic and easily discernible landmark in the
organs and tissue cultures, and on enzymatic systems. Of special interest from the development of individual artists.
 Therapeutic Experimentation With LSD 93
22 HISTORY OF LSD THERAPY

Equally deep was the influence of LSD research on the psychology and LSD could expedite the psychotherapeutic process and shorten the time necessary
psychopathology of religion. Even under the complex and often diffieult cireum- for the treatment of various emotional disorders, which made it a potentially
stances of early LSD experimentation, some subjects had profound religious and valuable tool in the psychiatric armamentarium. In addition, there appeared an
mystical experiences that bore a striking similarity to those described in various increasing number of studies indicating that LSD-assisted psychotherapy could
sacred texts and in the writings of mystics, saints, religious teachers and prophets reach certain categories of psychiatric patients usually considered poor candidates
of all ages. The possibility of inducing such experiences by chemical means started for psychoanalysis or any other type of psychotherapy. Many individual research-
an involved discussion about the authenticity and value of this “instant ers and therapeutic teams reported various degrees of clinical success with
mysticism.” Despite the fact that many leading scientists, theologians and spiritual alcoholics, narcotic-drug addicts, sociopaths, criminal psychopaths, and subjects
teachers have discussed this theme extensively, the controversy about “chemical” with various character disorders and sexual deviations. In the early sixties a new
versus “spontaneous” mysticism remains unresolved until this day. and exciting area was discovered for LSD psychotherapy: the care of patients
Any discussion of the various areas of LSD research and experimentation dying of cancer and other incurable diseases. Studies with dying individuals indi-
would remain incomplete without mentioning certain systematic explorations of cated that LSD psychotherapy could bring not only an alleviation of emotional
its negative potential. For obvious reasons, the results of this research, conducted suffering and relief of the physical pain associated with chronic diseases, it could
by the secret police and armed forces of many countries of the world, have not also dramatically change the concept of death and attitude toward dying.
been systematically reported and most of the information is considered classified. Since the appearance of the early clinical reports on LSD much time and
Some of the areas that have been explored in this context are eliciting of confes- energy has been invested in research of its therapeutic potential, and hundreds of
sions, gaining of access to withheld secrets and information, brainwashing, dis- papers have been published on various types of LSD therapy. Many psychophar-

es gens Sn
abling of foreign diplomats, and “non-violent” warfare. In working with in- macological, psychiatric, and psychotherapeutic meetings had special sections on
dividuals, the destructive techniques try to exploit the chemically induced LSD treatment. In Europe, the initially isolated efforts of individual LSD re-
breakdown of resistances and defense mechanisms, increased suggestibility and searchers resulted in an effort to create a homogeneous organizational structure.
sensitivity to terroristic approaches, and intensification of the transference process. LSD therapists from a number of European countries formed the European
meetings
Medical Society for Psycholytic Therapy, and members held regular

bene psa Ae oR eT NORE RO

In the mass approaches of chemical warfare, the important variables are the
drugs in psychothera py. This organizatio n also
disorganizing effect of LSD on goal-oriented activity, and its uncanny potency. dealing with the use of psychedelic
the specificatio ns and criteria for selection and training of future LSD
The techniques of dispensation suggested for this warfare have been various kinds formulated
therapists. The counterpart of this organization in the United States and Canada
of aerosols and contamination of water supplies. For everybody who is even
remotely familiar with the effects of LSD, this kind of chemical warfare is much was the Association for Psychedelic Therapy. During the decade of most intense
more diabolical than any of the conventional approaches. Calling it non-violent or interest in LSD research several international conferences were organized for the
humane is a gross misrepresentation. exchange of experiences, observations and theoretical concepts in this field
(Princeton, 1959; Goettingen, 1960; London, 1961; Amityville, 1965; Amster-

beg a HIRE tO Te
dam, 1967; and Bad Nauheim, 1968).
THERAPEUTIC EXPERIMENTATION WITH LSD The efforts to use LSD in the therapy of mental disorders now span a period
of almost three decades. It would be beyond the scope of this presentation to
From the point of view of our discussion, the most important area of LSD describe all the specific contributions to this unique chapter of the history of
research has been experimental therapy with this substance. Observations of the psychiatric treatment, as well as give due attention to all the individual scientists
dramatic and profound effects of minute quantities of LSD on the mental pro- who participated in this avenue of research. The history of LSD therapy has been
cesses of experimental subjects led quite naturally to the conclusion that it might a series of trials and errors. Many different techniques of therapeutic use of LSD
that
be fruitful to explore the therapeutic potential of this unusual compound. have been developed and explored during the past thirty years. Approaches
or were not supported by later research were
The possibility of therapeutic use of LSD was first suggested by Condrau did not have the expected effect
(21) in 1949, only two years after Stoll had published the first scientific study of abandoned; those that seenied promising were assimilated by other therapists, or
LSD in Switzerland. In the early fifties several researchers independently recom- developed further and modified. Instead of following this complicated process
mended LSD as an adjunct to psychotherapy, one which could deepen and inten- through all its stages, I will try to outline certain basic trends and the most impor-
sify the therapeutic process. The pioneers of this approach were Busch and tant therapeutic ideas and concepts. Three decades of LSD therapy is a sufficient-
Johnson (17) and Abramson (1,2) in the United States; Sandison, Spencer and ly long period for accumulating clinical observations and verifying research data.
area,
Whitelaw (91) in England; and Frederking (28) in West Germany. We can, therefore, attempt a critical review of the clinical experience in this
tool in
These reports attracted considerable attention among psychiatrists, and summarize the current knowledge about the value of LSD as a therapeutic
stimulated clinicians in various countries of the world to start therapeutic psychiatry, and describe the safest and most effective techniques for its use.
experimentation with LSD in their own practice and research. Many of the Various suggestions concerning the therapeutic use of LSD were based on the
reports published in the following fifteen years confirmed the initial claims that specific aspects of its action. The frequent occurrence of euphoria in LSD sessions
 HISTORY OF LSD THERAPY Studies of Chemotherapeutic Properties of LSD 25
24

with norma 1 volunteers seemed to suggest the possibility that this drug could be patients and expected alleviation of depression and positive changes in mood. Ac-
usefu lin thet reatment of depressive disorders. The profound and often shattering cording to Condrau’s statement, the results were not convincing and the observed
j effect of L SD on psychological as well as physiological functions, amounting to an changes did not exceed the limits of the usual spontaneous variations. He also
emotion alo r vegetative shock, seemed to indicate that it could have a therapeutic noticed that LSD medication usually resulted in deepening of the pre-existing
potent ial si milar to electroshocks, insulin treatrnent, or other forms of convulsive mood rather than consistent euphorization.
if therap is concept was supported by observations of striking and dramatic | Similar results were reported by other authors who used either Condrau’s
changes i the clinical symptomatology and personality structure of some subjects model of daily medication with LSD in depressive patients or isolated administra-
after administ ration of a single dose of LSD. Another aspect of the LSD effect tions of medium dosages of LSD with the intention to dispel depression. Negative
which seemed to be promising from the therapeutic point of view was the unusual or inconclusive clinical experiences have been reported by Becker, (8) Anderson
ability of this drug to facilitate intensive emotional abreactions. The therapeutic and Rawnsley, (3) Roubiéek and Srnec, (89) and others.
Success 0. abreactive techniques such as hypnoanalysis and narcoanalysis in the By and large, the results of this approach to LSID therapy did not justify
re f war neuroses and traumatic emotional neuroses encouraged explora- continuation of research in this direction. Clinical studies clearly indicated that
io is property of LSD. One additional interesting possibility of therapeutic LSD does not per se have any consistent pharmacological effects on depression
use was ased on the activating or “provocational” effect of LSD. The drug can that could be therapeutically exploited, and this approach has been abandoned.
mobilize a nd intensify fixated, chronic and stationary clinical conditions that are
charact teri zed by just a few torpid and refractory symptoms, and it was hypoth- SHOCK-INDUCING PROPERTIES OF LSD AND
that such chemically induced activation might make these so-called oligo- ITS EFFECT ON PERSONALITY STRUCTURE
atic states more amenable to conventional methods of treatment. By far
the most important use of LSD was found in its combination with individual and ‘ In the early period of LSD research, several authors suggested that the profound
group psych otherapies of different orientations. lts effectiveness is based on a very and shattering experience induced by LSD could have a positive effect on some
advantageou s combination of various aspects of its action. LSD psychotherapy patients comparable to the effect of various methods of convulsive treatinent such
seems to intensify all the mechanisms operating in drug-free psychotherapies and as electroshocks, insulin coma therapy, or cardiazole and acetylcholine shocks.
nvolves , addition, some new and powerful mechanisms of psychological Occasionally, unexpected and dramatic clinical improvements were reported in
change as yet unacknowledged and unexplained by mainstream psychiatry. psychiatric patients after a single LSD session. Observations of this kind have been
following sections, I will describe the most important areas of thera- described in papers by Stoll, (97) Becker, (8) Benedetti, (10) Belsanti, (9) and
e exper imentation with LSD, give actual treatment techniques and concepts, Giberti, Gregoretti and Boeri. (30)
n ss their empirical or theoretical bases. Special attention will be paid to In addition, an increasing number of reports seemed to suggest that some-
an evaluat ion of how successfully individual approaches have withstood the test of times a single administration of LSD could have a deep influence on the per-
m sonality structure of the subject, his or her hierarchy of values, basic attitudes, and
entire life style. The changes were so dramatic that they were compared with
psychological conversions.? Many LSD researchers made similar observations and
T ES OF CHEMOTHERAPEUTIC

caer
became aware of the potential therapeutic value of these transformative expe-
PROPER TIES OF LSD riences. The major obstacle to their systematic utilization for therapeutic purposes

Tees
was the fact that they tended to occur in an elemental fashion, without a recog-
The aches that will be discussedin this section are based on different clinical nizable pattern, and frequently to the surprise of both the patient and the thera-
obse s and different theoretical premises; the common denominator is an pist. Since the variables determining such reactions were not understood, thera-
ve emphasis on LSD as a chemotherapeutic agent that has certain beneficial peutic transformations of this kind were not readily replicable. However, it was
effects by virtue of its pharmacological action. The authors of these techniques this category of observations and systematic efforts to induce similar experiences in
were either unaware of the significance of extrapharmacological factors or did not a more predictable and controlled way that finally resulted in the development of
spec ifically utilize them. If psychotherapy was used with these approaches at all, an important treatment modality, the so-called psychedelic therapy. The basic
it was only supportive and of the most superficial kind, without any organic link principles of this therapeutic approach will be discussed later.
to the LSD experience. In summary, LSD can undoubtedly produce a profound emotional and
vegetative shock in a patient or an experimental subject. The shock-effect tends,
EXPLORATI ON OF EUPHORIANT AND however, to be more disorganizing and disruptive than therapeutic, unless it
ANTI DEPR ESSIVE EFFECTS OF LSD occurs within a special framework, in a situation of coinplex psychological sup-
drau (21) proposed the use of LSD for depression on the basis of its port, and after careful preparation. The conversion mechanism is too unpredict-
euphoria effect on some subjects, he followed the model of opium treatment. He able, elemental and capricious to be relied upon as a therapeutic mechanisin per
administere d small and progressively increasing daily doses of LSD to depressive se.
 Studies of Chemotherapeutic Properties of LSD 97
26 HISTORY OF LSD THERAPY

EFFECT OF LSD natural course of psychosis beyond which the disease shows a trend towards spon-
THERAPEUTIC USE OF THE ABREACTIVE
taneous remission. In schizophrenia, these culmination points are usually charac-
Many observations from early LSD research clearly indicated that the drug can terized by hallucinatory experiences of death or destruction, disintegration of the
facilitate reliving of various emotionally relevant episodes from infancy, body, regression and transmutation. These negative sequences are then followed
childhood, or later life. In the case of traumatic memories, this process was pre- by fantasies or experiences of rebirth.
ceded and accompanied by powerful emotional abreaction and catharsis. It The assumption of such a culmination point in the spontaneous course of the
seemed, therefore, only logical to explore the value of LSD as an agent for abreac- illness could explain, according to Jost, some puzzling observations made during
tive therapy in a way similar to the earlier use of ether, short-acting barbiturates, electroshock therapy. As ECT seems to accelerate the spontaneous development of
or amphetamines, in the same indication. the. disease along the intrinsic trajectory, it makes a great deal of difference at
From the historical and theoretical point of view, this mechanism can be which point it is applied. If the electroshock is administered before the psychosis
traced back to the early concepts of Freud and Breuer. (29) According to then, in- reaches the culmination point, it produces dramatic manifestations and intensifies
sufficient emotional and inotor reaction by a patient to an original traumatic event the clinical picture. If it is given after the culmination point has been reached, this
results in “jamming” of the effect: the strangulated emotions (“abgeklemmter results in a rapid sedation of the patient and remission of the symptoms.
Affekt”) later provide energy for neurotic symptoms. Treatment then consists in In their practical approach, Jost and Vicari (42) intended to accelerate the
reliving the traumatizing memory under circumstances that make possible a spontaneous development of the disease by a combination of chemical and electro-
belated redirection of this emotional energy to the periphery and its discharge physiological means to mobilize the autonomous healing forces and processes
through perceptual, emotional, and motor channels. From the practical point of within the organism. They administered LSD and when the clinical condition was
view, the abreactive method was found especially valuable in the treatment of activated by its effect, they applied electroconvulsive therapy. The authors
traumatic emotional neuroses and became popular during the Second World War described substantial shortening of the schizophrenic episode, reduction in the
as a quick and effective remedy for hysterical conversions occurring in various number of electroshocks required to reach clinical improvement, and often a
battle situations. deeper remission.
There is hardly a single LSD therapist who would have doubts about the Sandison and Whitelaw, (92) two British researchers and pioneers in LSD
unique abreactive properties of LSD. It would be, however, a great oversimpli- research, used a similar principle of applying a conventional treatment technique
fication to approach and understand LSD treatment only as abreaction therapy. in patients whose clinical condition was activated by LSD. However, instead of
This was clearly demonstrated in a controlled study by Robinson. (86) Present administering ECT, they used the tranquilizing effect of chlorpromazine (Thora-
opinion is that abreaction is an important component of LSD psychotherapy, but zine). In their study, psychotic patients from various diagnostic groups were given
it represents just one of many therapeutic mechanisms resulting from the complex LSD and two hours later intramuscular injection of the tranquillizer. Although
action of this drug. the results seened promising, the authors themselves later discarded the idea that
the administration of chlorpromazine played a positive role in this procedure.
In general, the idea of provocational therapy with LSD has not found a
USE OF THE ACTIVATING EFFECT OF LSD broader acceptance in clinical practice and has remained limited to the attempts
ON CHRONIC AND FIXATED SYMPTOMS described above. However, Jost’s theoretical speculations contain several inter-
estigg ideas that can prove very fruitful if used in a more dynamic and creative
This approach was inspired by the clinical experience that LSD has an intensify-
way. The basic principle of activating fixated symptoms by LSD can be used in
ing and mobilizing effect on manifest and latent psychopathological symptoms.
the context of intensive psychotherapy; a single LSD session can often help over-
The principle of activation or “provocation” therapy with LSD was theoretically
come stagnation in a long-term psychotherapeutic process. Also, Jost’s concepts of
developed and employed in practice by the Austrian researcher Jost. (41) This con-
an intrinsic trajectory of the psychotic process and the value of its acceleration are
cept was based on clinical observations of an interesting relationship between the
in basic agreement with certain modern approaches to schizophrenia discussed in
nature and course of the psychotic process and prognosis of the disease. It has been
the writings of R. D. Laing, (52) John Perry, (80) Julian Silverman, (94,95) and
a well-known clinical fact that acute schizophrenic episodes with dramatic, rich
Maurice Rappaport. (84) Similarly, the observations regarding Jost’s concept of
and colorful symptoms have a very good prognosis. They frequently result in spon-
the culmination moment of the schizophrenic process and the specific experiences
taneous remission, and therapy of these conditions is usually very successful. Con-
associated with the breaking point make new sense if they are viewed in the con-
versely, schizophrenic states with an inapparent and insidious onset, a few stag-
text of dynamic matrices in the unconscious rather than from the point of view of
nating and torpid symptoms, and a stationary course have the poorest prognosis
Jost’s mechanical model. We will discuss this issue in detail in connection with the
and are very unresponsive to conventional treatments.
perinatal matrices and the therapeutic significance of the ego death and rebirth
After analyzing a great number of trajectories of psychotic episodes, Jost
experience.
came to the conclusion that it is possible to find a certain culmination point in the

|
 THERAPY LSD-Assisted Psychotherapy 29
28 HISTORY OF LSD

LSD-ASSISTED PSYCHOTHERAPY treatment (Levine and Ludwig), and psychosynthesis (Roquet). Individual thera-
pists using LSD psychotherapy have differed considerably in regard to the dosage
As indicated in the above survey of therapeutic experimentation with LSD, the used, frequency and total number of psychedelic sessions, the intensity and type of
efforts to exploit purely pharmacological properties of this drug have failed to the psychotherapeutic work, and certain specificities of set and setting.
bring positive results. The concept of LSD as simply a chemotherapeutic agent has In view of all these differences and variations, any comprehensive discussion
been abandoned by all serious researchers in the field. The use of LSD as an acti- of the history of LSD psychotherapy would involve giving separate descriptions of
vating substance, in Jost and Vicari’s sense, has not found its way into clinical all the individual therapists and therapeutic teams. Yet, it is possible with a degree
practice, at least not in its original mechanical form. The abreactive action of of over-simplification, to distinguish certain basic ways of using LSD in psycho-
therapy. These modalities fall into two major categories, which differ in the
LSD is valued highly, but it is usually considered to be only one of many effective
mechanisins operating in LSD therapy. The shock-effect of LSD cannot in itself be degree of significance attributed to the role of the drug. The first category involves
considered therapeutic; unless it occurs in a specifically structured situation, it can approaches in which the emphasis is on systematic psychotherapeutic work; LSD
have detrimental rather than beneficial consequences. The influence of LSD on is used to enhance the therapeutic process or to overcome resistances, blocks and
the personality structure in the sense of a conversion is a well-established clinical periods of stagnation. The approaches in the second category are characterized by
fact; however, the occurrence of this phenomenon during unstructured adminis- a much greater emphasis on the specific aspects of the drug experience and the
trations of LSD is rare, unpredictable and capricious. Special preparation, a psychotherapy is used to prepare the subjects for the drug sessions, give them sup-
trusting therapeutic relationship, psychological support, and a specifically struc- port during the experiences, and to help them integrate the material.
tured set and setting are necessary to make therapeutic use of this aspect of the
LSD effect. FACILITATION OF THE PSYCHOTHERAPEUTIC PROCESS
There seems to be general agreement at present among LSD therapists that BY LSD ADMINISTRATION

mae
the therapeutic outcome of LSD sessions depends critically on factors of a non-
pharmacological nature (extrapharmacological variables). The drug itself is seen During the years of therapeutic experimentation, there have been several systema-
tic attempts to use small doses of LSD to enhance the dynamics of individual or

yee ae2
as a catalyst that activates the unconscious processes in a rather unspecific way.
Whether the emergence of the unconscious material will be therapeutic or destruc- group psychotherapy. In general, the disadvantages of this approach seem to out-

ae eee la
tive is not determined simply by the biochemical and physiological action of LSD. weigh its potential benefits. The use of small dosages does not save much time,
It is a function of a number of non-drug variables, such as the personality struc- since it does not shorten the duration of the drug action so much as decrease its
ture of the subject, the relationship he or she has with the guide, sitter or persons depth and intensity. Similarly, the risks involved in the use of low doses in
present in the session, the nature and degree of specific psychological help, and the psychiatric patients are not necessarily lower than those related to high-dose ses-
set and setting of the psychedelic experience. For this reason all the approaches sions. It is of greater advantage to interpolate occasional LSD sessions using
that try to utilize LSD simply as another chemotherapeutic agent are, by and medium or high dosages in the course of systematic long-term psychotherapy at
large, bound to fail. This does not mean that it is not possible to benefit froin an times when there is little therapeutic progress. In the following text we will briefly
LSD experience if the drug is taken in an unstructured situation. However, extra- describe each of the above approaches.
pharmacological factors have such a profound influence on the LSD session and its
final outcome that one cannot expect a reasonable degree and consistency of Use of Small Doses of LSD in Intensive Psychotherapy
therapeutic success unless the non-drug variables are sufficiently understood and In this treatment modality the patients participate in a systematic course of long-
controlled. Thus the optimal use of LSD for therapeutic purposes should always term psychotherapy, and in all the sessions they are under the influence of small
involve administration of the drug within the framework of a complex psycho- doses of LSD in the range of 25 to 50 micrograms. The emphasis is clearly on
therapeutic program; this approach offers the most therapeutic possibilities. In psychotherapy and LSD is used to intensify and deepen the usual psychodynamic
this respect, the potential of LSD seems to be quite extraordinary and unique. The processes involved. Under these circumstances, the defense mechanisms are weak-
ability of LSD to deepen, intensify and accelerate the psychotherapeutic process is ened, the psychological resistances tend to decrease, and the recall of repressed
incomparably greater than that of any other drug used as an adjunct to memories is greatly enhanced. LSD also typically intensifies the transference rela-
psychotherapy, with the exception perhaps of some other members of the tionship in all its aspects and makes it easy for the therapist as well as the patient
psychedelic group, such as psilocybin, mescaline, ibogain, MDA, (methylene- to understand clearly the nature of the processes involved. Under the influence of
dioxy-amphetamine), or DPT (dipropyltryptamine). the drug, patients are usually more ready to face repressed material and accept the
In the professional literature, the combination of LSD with various forms of existence of deep instinctual tendencies and conflicts within themselves. All the
psychotherapy has been referred to by many different names: psycholysis (Sandi- situations in these LSD sessions are approached with appropriate modifications of
son), psychedelic therapy (Osmond), symbolysis (van Rhijn), hebesynthesis techniques of dynamic psychotherapy. The content of the drug experience itself is
(Abramson), lyserganalysis (Giberti and Gregoretti), oneiroanalysis (Delay), LSD interpreted and used in much the same way as the manifest content of dreams in
analysis (Martin and McCririck), transintegrative therapy (MacLean), hypnodelic regular non-drug psychotherapy. In the past this approach has been mostly used
30 HISTORY OF LSD THERAPY LSD-Assisted Psychother

in combination with psychoanalytically oriented psychotherapy, although it is ing of repressed biographical events, manifestation of important symbolic
theoretically and practically compatible with many other techniques, such as material, and intensification of the therapeutic relationship that results from a
Jungian analysis, bioenergetics and other neo-Reichian therapies, and Gestalt single LSD session can frequently provide powerful incentives for further psychio-
practice. cf therapy.

Use of Small Doses of LSD in Group Psychotherapy

TECHNIQUES OF LSD THERAPY
In this treatment modality all the participants in a session of group psychotherapy,
with the exception of the leaders, are under the influence of small doses of LSD. Although psychotherapy is a very important component of the approaches in this
The basic idea is that the activation of individual dynamic processes will result in category, the primary emphasis is on the specificities of the drug experience. The
a deeper and more effective group dynamic. The results of this approach have not psychotherapeutic techniques involved are modified and adjusted to the nature of
been very encouraging. Coordinated and integrated group work is usually possible the LSD state to form an integral and organic unit with the psychedelic process.
only with small dosages of LSD which do not have a very profound psychological
impact on the group members. If the dosages are increased, the group dynamic Psycholytic Therapy With LSD
tends to geinicgrate and it becomes increasingly difficult to get the group to do The term psycholytic was coined by the British researcher and pioneer in LSD
organized and coordinated work. Each participant experiences the session in his or therapy, Ronald A. Sandison. Its root, lytic (from the Greek lysis = digsoltition)
her unique way, and most of them find it difficult to sacrifice their individual pro- refers to the process of releasing tensions, dissolving conflicts in the mind. It
cess to the demands of group cohesion. should not be confused with the term psychoanalytic (analyzing the psyche). This
An alternative approach to the psychedelic group experiences which may be treatment method represents in theory as well as in clinical practice an extension
very productive is its ritual use, as practiced by certain aboriginal groups: the and modification of psychoanalytically oriented psychotherapy. It involves
peyote sessions of the Native American Church or Huichol Indians, yagé administration of LSD at one- to two-week intervals, usually in the dosage range
ceremonies of the Amahuaca or Jivaro Indians in South America, ingestion of of from 75 to 300 micrograms. The number of drug sessions in a psycholytic series
sacred mushrooms (Psilocybe mexicana) by the Mazatecs for healing and varies depending on the nature of the clinical problein and the therapeutic goals;
sacramental purposes, or the ibogain rites of some tribes in Gabon and adjacent it oscillates between fifteen and one hundred, the average probably being
parts of the Congo. Here verbal interaction and the cognitive level are typically somewhere around forty. Although there are regular drug-free interviews in the
transcended and group cohesion is achieved by non-verbal means, such as collec- intervals between the sessions, there is a definite emphasis on the events in the
tive rattling, drumming, chanting, or dancing. LSD sessions.
After a few initial attempts to conduct traditional group psychotherapy with The drug sessions take place in a darkened, quiet and tastefully furnished
all the members intoxicated by LSD, this technique was abandoned. However, ex- room that suggests a homelike atmosphere. The therapist is usually present for
posure to a group or contact with co-patients during the termination period of an several hours at the time when the session culminates, giving support and specific
individual LSD session can be a very useful and productive experience. The interpretations when necessary. During the remaining hours the patients are
assistance of an organized group of drug-free peers can be particularly helpful in 2
alone, but they may ring for the therapist or nurse if they feel the need. Some LSD
working through some residual problems from the drug session. A combination of programs use one or more co-patients as sitters for the termination periods of the
the new experiential techniques developed for use in encounter groups can also be sessions, or allow the patient to socialize with the staff and other clients.
of great value in this context. Another useful technique is the combination of indi- All the phenomena that occur in LSD sessions or in connection with LSD
vidually experienced LSD sessions with subsequent analysis and discussion of therapy are approached and interpreted using the basic principles and techniques
the material in drug-free group sessions involving all the subjects participating in of dynamic psychotherapy. Certain specific characteristics of the LSD reaction
the LSD program. however, require some modifications of the usual techniques. These involve a
greater activity on the part of the therapist, elements of assistance and attendance
Occasional Use of LSD Sessions in Intensive Psychotherapy (for example, in case of vomiting, hypersalivation, hypersecretion of phlegm,
This approach involves regular, systematic, long-term psychotherapy, with occa- coughing, or urination), a more direct approach, occasional physical contact and
sional interpolation of an LSD session. The dosages administered in this context support, psychodramatic involvement in the patient's experience, and _ higher
are in the medium or high range, usually between 100 and 300 micrograms. The _tolerance for acting-out behavior. This makes psycholytic procedure similar to the
aim of these psychedelic sessions is to overcome dead points in psychotherapy, in- modified psychoanalytic techniques used for psychotherapy with schizophrenic
tensify and accelerate the therapeutic process, reduce the resistances, and obtain patients. It is necessary to abandon the orthodox analytic situation where the
new material for later analysis. A single LSD session interpolated at a critical time patient reclines on the couch and is expected to share his or her free associations

me ine a poten tee

can contribute considerably to a deeper understanding of the client’s symptoms, while the detached analyst sits in an armchair and occasionally offers interpreta-
the dynamics of his or her personality, and the nature of the transference prob- tions. In psycholytic therapy, patients are also asked to stay in the reclining posi-
lems. The revealing confrontation with one’s unconscious mind, recall and reliv- tion with thelr eyes closed. However, LSD subjects may on occasion remain silent
32 HISTORY OF LSD THERAPY LSD-Assisted Psychotherapy 35

for long periods of time or, conversely, scream and produce inarticulate sounds; the basis of this unexpected observation Hoffer and Osmond, in cooperation with
they might toss and turn, sit up, kneel, put their head in one’s lap, pace around Hubbard, laid the foundations of the psychedelic treatment technique.
the room, or even roll on the floor. Much more personal and intimate involvement The main objective of psychedelic therapy is to create optimal conditions for
is necessary, and the treatment frequently requires genuine human support. the subject to experience the ego death and the subsequent transcendence into the
In psycholytic therapy, all the usual therapeutic mechanisms are intensified so-called psychedelic peak experience. It is an ecstatic state, characterized by the
to a much greater degree than in single LSD sessions. A new and specific elernent loss of boundaries between the subject and the objective world, with ensuing feel-
is the successive, complex and systematic reliving of traumatic experiences from ings of unity with other people, nature, the entire Universe, and God.‘ In most in-
childhood, which is associated with emotional abreaction, rational integration, stances this experience is contentless and is accompanied by visions of brilliant
and valuable insights.’ The therapeutic relationship is usually greatly intensified, white or golden light, rainbow spectra or elaborate designs resembling peacock
and analysis of the transference phenomena becomes an essential part of the treat- feathers. It can, however, be associated with archetypal figurative visions of
ment process. deities or divine personages from various cultural frameworks. LSD subjects give
The toll that psycholytic therapy has had to pay for its theoretical rooting in various descriptions of this condition, based on their educational background and
Freudian psychoanalysis has been confusion and conflict about the spiritual and-~ intellectual orientation. They speak about cosmic unity, unio mystica, mysterium
mystical dimensions of LSD therapy. Those psycholytic therapists who firmly tremendum, cosniic consciousness, union with God, Atman-Brahman union,
adhere to the Freudian conceptual framework tend to discourage their patients Samadhi, satori, moksha, or the harmony of the spheres.
from entering the realms of transcendental experiences, either by interpreting Various modifications of psychedelic therapy use different combinations of
them as an escape from relevant psychodynamic material or by referring to then elernents to increase the probability of psychedelic peak experiences occurring in
as schizophrenic. Others have identified the psychoanalytic framework as in- LSD sessions. Before the actual session there is typically a period of drug-free
complete and restricting and become more open to an extended model of the preparation conducted with the aim of facilitating the peak experience. During
human mind. The conflict concerning the interpretation of transpersonal ex- this time, the therapist explores the patients’ life history, helps them to understand
periences in LSD therapy and the attitude toward them is not only a matter of their symptoms, and spccifically focuses on personality factors that could represent
academic interest. Major therapeutic changes can occur in connection with serious obstacles to achieving the psychedelic peak experience. An important part
transcendental states, and so facilitation or obstruction of these experiences can of the preparation is the therapist's explicit and implicit emphasis of the growth
have very concrete practical consequences. potential of the patients, and an encouragement to reach the positive resources of
Typical representatives of the psycholytic approach have been Sandison, their personalities. Unlike conventional psychotherapy, which usually goes into
Spencer and Whitelaw, Buckman, Ling, and Blair in England; Arendsen-Hein detailed exploration of psychopathology, psychedelic therapy tries to discourage

Dahon crane pape

and van Rhijn in Holland; Johnsen in Norway; and Hausner, Tauterman, the patient's preoccupation with pathological phenomena, be they clinical symp-
Dytrych and Sobotkiewiczova in Czechoslovakia. This approach was developed in toms or maladjustive interpersonal patterns. In general, there is much more con-
Europe and is more characteristic of European LSD therapists. The only therapist 4 cern about transcending psychopathology tlan interest in its analysis.
using psycholytic therapy in the United States at this time is Kenneth Godfrey of Occasionally, patients even receive direct advice and guidance as to how
the Veterans Administration Hospital in Topeka, Kansas. In the past it was prac- Ahey could function more effectively. This approach is very different from the un-
ticed by Eisner and Cohen, Chandler and Hartman, Dahlberg and others. disciplined and random advising in life situations against which psychoanalytical-
ly oriented therapists so emphatically warn. It docs not involve specific suggestions
Psychedelic Therapy with LSD for solving important problems of everyday life, such as marriage or divorce, ex-
This therapeutic approach differs from the preceding one in many important tramarital affairs, induced abortions, having or not having children, and taking
aspects. It was developed on the basis of dramatic clinical improvements and pro- or leaving a job. Psychedelic counseling operates on the very general level of a
found personality changes observed in LSD subjects whose sessions had a very basic strategy of existence, life philosophy, and hierarchy of values. Some of the
definite religious or mystical emphasis. Historically, it is related to the develop- issues that might be discussed in this context are, for example, the relative
ment of a unique LSD treatment program for alcoholics; conducted in the early significance of the past, present, and future; the wisdoin of drawing one’s satisfac-
fifties by Hoffer and Osmond in Saskatchewan, Canada. These authors were in- tion from ordinary things that are always available iu life; or the absurdity of ex-
spired by the alleged similarity between the LSD state and delirium tremens, aggerated ambitions and needs to prove something to oneself or to others. From
reported by Ditman and Whittlesey (23) in the United States. Hoffer and Osmond the practical point of view, the general directions in psychedelic counseling are
combined this observation with the clinical experience that many chronic alco- based on observations of specific changes in individuals who have been successful-
holics give up drinking after the shattering experience of delirium tremens. In ly treated with LSD psychotherapy. They involve au orientation and approach
their program, they initially gave LSD to alcoholic patients with the intention of toward life that seem to be associated with the absence of clinical symptoms and
deterring them from further drinking by the horrors of a simulated delirium with a general feeling of well-being, joy and affirmation of the life process.
tremens. Paradoxically, however, it seemed to be the profound positive ex- Although the psychedelic philosophy and life strategy were developed quite in-
periences in LSD sessions that were correlated with good therapeutic results. On dependently from the work of Abrahani Maslow, (64) some of the principles of
this approach are closely related to his description of a self-realizing person and his
 138! HISTORY OF LSD THERAPY LSD-Assisted Psychotherapy 39 \
Se Npeqeawad

neuroses, major therapeutic changes usually cannot be achieved without syste- of “fusion” have been described in all their psychological and spiritual ramifica-
matically working through various levels of problems in serial LSD sessions. tions as fulfillment of the deepest needs of human nature, and as extremely healing
experiences. Some patients described this technique as offering the possibility of a
retroactive intervention in their deprived childhood. When the original traumatic
Anaclitic Therapy With LSD (LSD Analysts) situations from childhood become reenacted in all their relevance and complexity
The term anaclitic (from the Greek anaklinein—to lean upon) refers to various with the help of the “psychedelic time-machine,” the therapist's affection and lov-
early infantile needs and tendencies directed toward a pregenital love object. This ing care can fill the vacuum caused by deprivation and frustration.
method was developed by two London psychoanalysts, Joyce Martin (62) and ‘The dosages used in this treatment technique ranged between 100 and 200
Pauline McCririck. (68) It is based on clinical observations of deep age regression micrograms of LSD, sometimes with the addition of Ritalin in later hours of the
occurring in LSD sessions of psychiatric patients. During these periods many of sessions. Martin and McCririck described good and relatively rapidly achieved
them relive episodes of early infantile frustration and emotional deprivation. This results in patients with deep neuroses or borderline psychotic disorders who had
is typically associated with agonizing cravings for love, physical contact, and experienced severe emotional deprivation in childhood. Their papers, presen-
other instinctual needs experienced on a very primitive level. tations at scientific meetings, and a film documenting the anaclitic technique
The technique of LSD therapy practiced by Martin and McCririck was stirred up an enormous amount of interest among LSD therapists and generated a
based on psychoanalytic understanding and interpretation of all the situations and great deal of fierce controversy. The reactions of colleagues to this treatment
experiences occurring in drug sessions and in this sense is very close to psycholytic modality ranged from admiration and enthusiasm to total condemnation. Since
approaches. The critical difference distinguishing this therapy from any other was most of the criticism from the psychoanalytically oriented therapists revolved
the element of direct satisfaction of anaclitic needs of the patients. In contrast to around the violation of the psychoanalytic taboo against touching and the possible
the traditional detached attitude characteristic of psychoanalysis and psycholytic detrimental consequences of the fusion technique for transference-countertrans-
treatment, Martin and McCririck assumed an active mothering role and entered ference problems, it is interesting to describe the authors’ response to this serious
into close physical contact with their patients to help them to satisfy primitive objection.
infantile needs reactivated by the drug. Both Martin and McCririck seemed to concur that they had experienced’
More superficial aspects of this approach involve holding the patients and much more difficulty with transference relationships before they started using the
feeding them warm milk from a bottle, caressing and offering reassuring touches, fusion technique. According to them, it, is the lack of fulfillment in the conven-
holding their heads in one’s lap, or hugging and rocking. The extreme of psycho- tional therapeutic relationship that foments and perpetuates transference. The
dramatic involvement of the therapist is the so-called “fusion technique,” which. original traumatic situations are continuously reenacted in the therapeutic rela-
consists of full body contact with the client. The patient lies on the couch covered tionship and the patient essentially experiences repetitions of the old painful rejec-
with a blanket and the therapist lies beside his or her body, in close embrace, tions. When the anaclitic needs are satisfied in the state of deep regression induced
usually simulating the gentle comforting movements of a mother caressing her by the drug, the patients are capable of detaching themselves emotionally from
baby. the therapist and look for more appropriate objects in their real life.
The subjective reports of patients about these periods of “fusion” with the " This situation has a parallel in the early developmental history of the indi-
therapist are quite remarkable. They describe authentic feelings of symbiotic vidual. Those children whose infantile emotional needs were adequately met and
union with the nourishing mother image, experienced simultaneously on the level satisfied by their parents find it relatively easy to give up the affective ties to their
of the “good breast” and “good womb.” In this state, patients can experience family and develop independent existence. By comparison, those individuals who
themselves as infants receiving love and nourishment at the breast of the nursing experienced emotional deprivation and frustration in childhood tend to get
mother and at the same time feel totally identified with a fetus in the oceanic trapped during their adult life in symbiotic patterns of interaction, destructive
: paradise of the womb. This state can simultaneously involve archetypal dimen- and self-destructive clinging behavior, and life-long problems with dependence-
sions and elements of mystical rapture, and the above situations be experienced as independence. According to Martin and McCririck, the critical issue in anaclitic
contact with the Great Mother or Mother Nature. It is not uncommon that the therapy is to use the fusion technique only during periods of deep regression, and
deepest form of this experience involves feelings of oneness with the entire cosmos keep the experience strictly on the pregenital level. 1t should not be used in the ter-
and the ultimate creative principle, or God. mination periods of the sessions when the anaclitic elements could get easily con-
The fusion technique seems to provide an important channel between the Tused with adult sexual patterns.
psychodynamic, biographical level of the LSD experience and the transcendental The anaclitic technique never achieved wide acceptance; its use seemed to be
states of consciousness. Patients in anaclitic therapy relate that during their nour- closely related to unique personality characteristics in its authors. Most other
ishing exchange with the mother image, the milk seemed to be “coming directly therapists, particularly males, found it emotionally difficult and uncomfortable to
from the Milky Way.” In the imaginary re-enactment of the placentary circula- enter into the intimate situation of fusion with their clients. However, the impor-
tion the life-giving blood can be experienced as sacramental communion, not only tance of physical contact in LSD psychotherapy is unquestionable and many
with the material organism, but with the divine source. Repeatedly, the situations therapists have routinely used various less-intense forms of body contact.
 4]
40 HISTORY OF LSD THERAPY LSD-Assisted Psychotherapy

Hypnodelic Therapy therapeutic team. Despite the fact that they share the same room, patients
The name of this treatment technique is a composite derived from the words “‘hyp- essentially experience their sessions individually with only occasional, unstruc-
nosis” and “psychedelic.” The concept of hypnodelic therapy was developed by tured encounters and interactions of an elemental nature. A standard program of
Levine and Ludwig (58) in an effort to combine the uncovering effect of LSD into stereophonic music is usually offered to the entire group, or several alternative
an organic whole with the power of hypnotic suggestion. In their approach the channels might be made available on different headphone circuits. Sometimes the
hypnotic technique was used to guide the subject through the drug experiences projection of slides of emotionally relevant and provocative material or
and modulate the content and course of the LSD session. aesthetically stimulating pictures and mandalas can form an integral part of the
The relationship between hypnosis and the LSD reaction is very interesting program for the session day. The therapist and his helpers provide collective
and deserves a brief mention here. Fogel and Hoffer (27) reported that they were supervision; individual attention is given only if absolutely necessary. On the day
able to counteract the effects of LSD by hypnotic suggestion and, conversely, at a following the drug session or later on, the individual experiences of the par-
later date evoke typical LSD phenomena in a subject who had not ingested the ticipants are usually shared with other group members.
drug that day. Tart (100) conducted a fascinating experiment of “mutual hyp- This approach has its advantages and disadvantages. The possibility of
nosis,” in which two persons trained both as hypnotists and hypnotic subjects con- treating a number of patients simultaneously is an important factor from the
tinued to hypnotize each other into an increasingly deep trance. From a certain economic point of view, and could in the future represent the answer to the un-
point on they became unresponsive to Tart’s suggestions and shared a complicated favorable ratio between mental health professionals and psychiatric patients. On
innér journey that bore many similarities to psychedelic states. the other hand, the lack of sensitive individualized support might make this treat-
In Levine and Ludwig's hypnodelic treatment, the first interview focused on ment less effective and less conducive to working through some especially difficult
the exploration of the patient’s clinical symptoms, present life situation, and past and demanding areas of personal problems. There is also, in such a collective situ-
history. Subsequently, the patient was trained as a hypnotic subject; high fixation ation, a danger of psychological contagion; panic reactions, aggressive behavior
of the eyes was used as the principle method of trance induction. Ten days later and loud abreactions of individual patients can negatively influence the ex-
the psychiatrist conducted a psychedelic session using 125 to 200 micrograms of periences of their peers. If the group approach is sensitively combined with in-
LSD. During the latency period, which usually lasts thirty to forty minutes when dividual work when necessary, however, its advantages can outweigh its
.
the drug is administered orally, the patient was exposed to hypnotic induction so drawbacks.
The best-known treatment program of this kind was a multidimen sional ap-
that at the time of onset of the LSD effect, he or she was typically in a state of
trance. Because of a basic similarity between LSD experiences and the phenomena proach to psychedelic psychotherapy developed by Salvador Roquet, (87) a Mexi-
of hypnosis the transition from hypnotic trance to the LSD state tends to be can psychiatrist and founder of the Albert Schweitzer Association in Mexico City.
relatively smooth. During the culmination period of the LSD ‘session, the Although his therapeutic program utilized other psychedelic drugs and substances
psychiatrists tried to use the effect of the drug for therapeutic work while also of plant origin in addition to LSD, it deserves more detailed discussion in this con-
utilizing their hypnotic rapport with the patients. They helped them to work text. Roquet combined his training as a psychoanalyst with his knowledge of the
through important areas of problems, encouraged them to overcome resistances indigenous healing practices and ceremonies of various Mexican Indian groups
and psychological defenses, guided them to relevant childhood memories, and and created a new approach to therapy with psychedelic drugs that he called
facilitated catharsis and abreaction. Toward the end of the session, the patients psychosynthesis. This should not be confused with the theory and practice of the
were given posthypnotic suggestions to remember all the details of the session and original psychotherapeutic system also called psychosynthesis developed in Italy
to continue thinking about the problems that emerged during the session. A by Roberto Assagioli. The latter approach is strictly a non-drug procedure,
special isolated room was provided for them for the rest of the session day. although it shares with psychedelic therapy a strong transpersonal emphasis. In
Levine and Ludwig explored the efficacy of the hypnodelic technique in Roquet’s approach, therapy was conducted with groups of ten to twenty-eight
narcotic-drug addicts and alcoholics. According to their original report, the com- patients of differing ages and sexes. The members of each group were carefully
bination of LSD administration and hypnosis proved to be more effective than selected to make the group as heterogeneous as possible with respect to age, sex,
either of the components used separately. clinical problems, the psychedelic drug received, and length of time already spent
in treatment. Each group included novices just beginning therapeutic work, indi-
Aggregate LSD Psychotherapy viduals who were in the main course of treatment, and patients about to ter-
In this form of LSD therapy en masse, patients experience their LSD sessions, minate therapy. An important goal of the selection process was to offer a broad
usually with medium or high dosages, in the company of several co-patients par- spectrum of suitable figures for projections and imaginary roles. Various members
ticipating in the same psychedelic treatment program. The basic difference be- of such a heterogeneous group could then represent authority figures, maternal
tween this therapeutic approach and the LSD-assisted group psychotherapy and paternal images, sibling substitutes, or objects of sexual interest.
described earlier is the absence of any effort at coordinated work with the group Following the example of Indian rituals, the drug sessions took place at
as a whole during the time of the drug action. The most important reason for giv- night. All the participants met in a large room for a leaderless group discussion
ing the drug simultaneously to a large number of individuals is to save time for the that lasted about two hours. These meetings allowed the patients to meet new
 The Need for a Comprehensive Theory of LSD Therapy 43
42 HISTORY OF LSD THERAPY

sent the most important insights and findings in a simple and comprehensive form.
members and discuss their fears, hopes and expectations; they also gave the par-
Such an effort seems justified whether this study becomes an epitaph to the LSD
ticipants ample opportunity for projections and transferences that had an impor-
era or a manifesto for future psychedelic researchers. If we are witnessing the
tant catalyzing influence on their drug sessions and frequently provided valuable
“swan song” of psychedelic research, it would be interesting in retrospect to be
learning experiences. The treatment room was large and decorated with paintings
able to throw more light on the controversies and lack of theoretical under-
and posters with evocative themes. A wide spectrum of psychedelic substances
standing concerning the nature of the LSD effect. If LSD research continues into
were administered in these meetings, including LSD, peyote, a variety of
the future, clarification of the present confusion and disagreements would be of
psilocybin-containing mushrooms, morning glory seeds, Datura ceratocaulum,
great practical importance. Additional controlled studies on a large scale are
and ketamine.
needed to assess the efficacy of LSD as an adjunct to psychotherapy with a satis-
The patients spent most of the time in a reclining position on mattresses
factory degree of scientific accuracy. However, unless the critical reasons for past
arranged along the walls, though they were allowed to move around freely if they
controversies can be clearly identified and taken into consideration in future
wanted. Two stereo systems were used and a wide variety of music and sounds
research, the new studies will probably perpetuate old errors and yield cor-
was available to influence the depth and intensity of the group’s reactions. An im-
respondingly inconclusive results.
portant part of the psychedelic sessions was a sensory overload show using slides,
As indicated above, individual authors and research teams used LSD start-
movies, stereo effects, and intermittent flashes of colored floodlights. Several
ing from very different premises. They followed different therapeutic objectives,
themes considered to be of crucial relevance were interwoven in the otherwise
adhered to different theoretical systems, employed differing technical approaches,
erratic and confused barrage of unrelated images and sounds; these included
religion, and childhood. The sensory overload and administered the drug in the most disparate frameworks and settings. It is my
: birth, death, violence, sexuality,
belief that the main reason for the controversies about LSD therapy is a lack of
portion of the drug sessions lasted about six hours and was followed by a reflective
understanding regarding the nature of the LSD effect, and the absence of a plausi-
phase that lasted until sunrise. Following this, the therapists and all participants
ble and generally acceptable conceptual framework that would reduce the vast
rested for an hour.
amounts of observed data to certain common denominators. Such a theoretical
The integrative session involved group discussions and sharing of experi-
system would have to provide understanding of the content and course of separate
ences, The main objective of this phase was to facilitate integration of the material
sessions as well as of repeated exposures to LSD in a therapeutic series. And it
uncovered in the drug session and to apply the insights to the problems of everyday
should be able to explain the paramount importance of extrapharmacological fac-
living. Depending on the nature of the interactions this process took from four to
tors—the personalities of the subject and the guide, their mutual relationship, and
twelve hours. The course of therapy consisted of ten to twenty drug sessions,
the elements of the set and setting—in the development of LSD sessions.
depending on the nature and seriousness of the clinical problems involved. The
Other important problems that should be accounted for within a compre-
patient population consisted mostly of neurotic out-patients, although Roquet also
hensive theoretical framework are the occasional prolonged reactions and even
described various degrees of success with some antisocial personalities and selected
psychotic breakdowns that occur after some of the sessions, or the later recur-
schizophrenics.
rences of the LSD-like states (“flashbacks”). The general understanding of these
phenomena is at present very incomplete and unsatisfactory, a situation that has
THE NEED FOR A COMPREHENSIVE THEORY serious practical consequences. One result of it is that the approach of mental
OF LSD THERAPY health professionals to complications of the non-inedical use of psychedelics is
generally ineffective and often harmful.
A comprehensive theory of LSD psychotherapy should also be able to bridge
Therapeutic experimentation with LSD, and psychedelic research in general, has
been very negatively influenced by the existence of the black market, unsupervised the gap at present existing between psycholytic and psychedelic therapy, the two
most relevant and vital approaches to LSD treatment, and some other therapeutic
self-experimentation, sensational journalism, and irrational legislative measures.
modifications such as anaclitic and hypnodelic therapy. It should be possible to
Despite the fact that LSD now has been known for almost three decades, the
find important common denominators and explanatory principles for these various
literature describing its effects and therapeutic potential is controversial and
approaches and understand their indications and contraindications, as well as suc-
inconclusive. Further developments in this field would require that independent
cesses and failures. A conceptual frainework correctly reflecting the most impor-
teams in different countries interact and cooperate in collecting experimental data
tant aspects of the LSD effect should be able to provide practical directives con-
and exchanging information. However, the number of places studying LSD has
cerning the optimal conditions for the use of this substance in psychotherapy. This
been cut down considerably and continues to decrease. Although the present pros-
would involve general treatinent strategy, as well as details concerning dosages,
pects for extensive psychedelic research are rather grim, there are indications that
effective approaches to various special situations, use of auxiliary techniques, and
systematic exploration will be resumed after the general confusion has been clari-
the specific elements of set and setting. Finally, a useful, comprehensive theory
fied and rationality reintroduced into the study of the problems involved.
should provide a number of partial working hypotheses of a practical and
Whatever becomes of LSD research in the future, there are good reasons to
theoretical nature that could be tested with the use of scientific methodology.
analyze the observations and results of past psychedelic experimentation and pre-
 44 HISTORY OF LSD THERAPY The Need for a Comprehensive Theory of LSD Therapy 45

eae
In view of the complex and multileveled nature of the problems involved, it tional experience. The most spectacular illustration of political conversion and
is extremely difficult to formulate at present a conceptual framework that would later reconversion was described by Arthur Koestler in his Arrow in the Blue
(47) and The God That Failed. (46) Biblical examples of moral and sexual con-
fully satisfy all the above criteria. For the time being, even a tentative and ap-
versions of a religious nature are the stories of Barabas and Mary Magdalene.
proximate theoretical structure, organizing most of the important data and 3. The significance of traumatic memories from childhood for the dynamics of
} providing guidelines for therapeutic practice, would represent distinct progress. In psycholytic therapy has been systematically studied and described by Hanscarl
the following chapters an attempt will be made to present a tentative framework ' Leuner. (57) See also the discussion of psychodynamic experiences in the first
for the theory and practice of LSD psychotherapy. It is iny belief that a concep- volume of this series, Stanislav Grof, Realms of the Human Unconscious:
tual system that could account for at least the major observations of LSD therapy Observations from LSD Research. (32) Subsequent references to this book will
requires not just a new understanding of the effects of LSD, but a new and ex- be indicated by a shortened title, thus: Realms of the Human Unconsctous.
panded model of the human mind and the nature of human beings. The re- 4, Walter Pahnke (76) summarized the basic characteristics of spontaneous and
searches on which my speculations are based were a series of exploratory clinical psychedelic peak experiences in his nine mystical categories. According to him,
studies, each of which represented an exciting venture into new territories of the
‘ the essential features of these states are: (1) feelings of unity, (2) transcendence
of time and space, (3) strong positive affect, (4) sense of reality and objectivity
mind as yet uncharted by Western science. It would be unrealistic to expect that
of the experience, (5) sacredness, (6) ineffability, (7) paradoxicality, (8) tran-
they would be more than first sketchy maps for future explorers. I am well aware siency, and (9) subsequent positive changes in attitudes and behavior. The
of the fact that, following the example of old geographers, many areas of my car- Psychedelic Experience Questionnaire (PEQ) developed by Pahnke and Richards
tography would deserve to be designated by the famous inscription: Hic sunt makes it possible to assess whether or not the psychedelic peak experience
leones.® occurred in an LSD session, and allows for its gross quantification.
The proposed theoretical and prdctical framework should be considered as 5. Hic sunt leones literally means ‘Here are lions”; this expression was used by
an attempt to organize and categorize innumerable new and puzzling observations early geographers in the old charts to denote insufficiently explored territories,
from several thousand LSD sessions and present them in a logical and compre- possibly abounding in savages, wild animals, and other dangers.
hensive way. Even in its present rough form, this conceptual framework has
proved useful in understanding the events in psychedelic sessions run in a clinical
setting, as well as LSD states experienced in the context of non-medical experi-
mentation; following its basic principles has made it possible to conduct LSD
therapy with maximum benefit and minimum risk. I believe that it also offers im-
portant guidelines for more effective crisis intervention related to psychedelic drug
use and more successful treatment of various complications following unsuper-
vised self-experimentation.

NOTES

1. One microgram or gama is one millionth of a gram, about thirty-five

billionths of an ounce.
2. Conversions are sudden, very dramatic personality changes occurring unex-
pectedly in psychologically predisposed individuals in certain specific situations.
The direction of these profound transformations is usually contrary to the sub-
ject’s previous beliefs, emotional reactions, life values, attitudes and behavior
patterns. According to the area which they primarily influence, we can
distinguish religious, political, moral, sexual, and other conversions. Religious
conversions of atheists to true believers or even religious fanatics have been
observed in gatherings of ecstatic sects and during sermons of famous charis-
,matic preachers, such as John Wesley. Maya Deren gave in her Divine
Horsemen (22) a unique description of her conversion to Haitian voodoo, which
occurred during her study of aboriginal dances. Victor Hugo’s example of
the moral conversion of Jean Valjean in Les Misérables (39) found its way into
psychiatric handbooks and gave its name to a special kind of corrective emo-
 CRITICAL VARIABLES IN
LSD THERAPY

ee
ne
Pharmacological Effects of LSD
Personality of the Subject
Personality of the Therapist or Guide
Set and Setting of the Sessions

A deep understanding of the nature and course of the LSD experience and the
dynamics of LSD psychotherapy is impossible without full awareness of all the
factors involved in the LSD reaction. The early simplistic and reductionistic
models of the LSD experience as being either “model schizophrenia” or a “toxic
psychosis”—basically a result of the drug’s interference with the normal
physiological and biochemical processes in the brain—have been abandoned a
long time ago by all serious researchers. The LSD literature abounds in observa-
tions indicating the utmost importance of non-drug factors as determinants of
psychedelic experiences and the critical role they play in the therapeutic process.
In order to understand the nature of the LSD reaction in all its complexity, we
have to discuss not only the actual pharmacological effect of the drug, but also the
most important extrapharmacological factors—the role of the personality of the
subject, his or her emotional condition and current life situation, the personality
of the guide or therapist, the nature of the relationship between the subject and
the guide, and an entire complex of additional factors usually referred to as set
and setting.

PHARMACOLOGICAL EFFECTS OF LSD

Since administration of LSD is the conditio sine qua non, or the absolutely
necessary condition for the LSD reaction, it would seem only logical to consider
the drug itself as the factor of fundamental importance. Careful analysis of
clinical observations from LSD psychotherapy, however, shows this issue to be
much more complicated. The phenomena that can occur in the course of LSD ses-
sions cover a very wide range; there are hardly any perceptual, emotional, or
psychosomatic manifestations that have not been observed and described as part
47
48 CRITICAL VARIABLES IN LSD THERAPY Pharmacological Effects of LSD 49

of the LSD spectrum. If different subjects take the same dosage of the drug under
relatively standard circumstances, each will have a distinctly different experience.
The extreme multiformity and interindividual variability of the LSD state is com-
plemented by its equally striking intraindividual variability. [f the same person
takes LSD repeatedly, each consecutive session is usually quite different from the
others as to its general character, specific content, and course. This variability cer-
tainly is a serious objection to the concept that the LSD reaction has simple
biochemical and physiological determinauts.
The question whether there exist invariant, repeatable and standard effects
of LSD that are purely pharmacological in nature is very interesting and impor-
tant from both the theoretical and practical point of view. Such effects would
have to be unrelated to the personality structure and independent of external
circumstances; they would have to occur without exception in every subject who
took a sufficient dose of LSD. Conversely, the questions of the extent to which
various extrapharmacological factors participate in the LSD experience, and the
nature and mechanism of their effect, are equally interesting and theoretically as
well as practically relevant. Theyssearch for typical and mandatory pharmaco-
logical effects of LSD was an important aspect of my analytical work on the LSD
data. The result of this quest was rather surprising: after analyzing almost five
thousand records from LSD sessions, I did not find a single symptom that was an
absolutely constant component in all of them and could thus be considered truly
invariant.
Changes in optical perception are usually described as typical manifestations
of the LSD state and are thus serious candidates for being pharmacological in-
variants. Although reports of various abnormal visual phenomena occurred fre-
quently in my records, I have observed a number of high-dose sessions where there
were no alterations in optical perception. Some of these LSD reactions where
visual changes were absent had the form of intense sexual experiences; others were
characterized by massive somatization with feelings of general malaise and

We
physical illness, or experiences of excruciating pain in various parts of the body.

eh
Special examples of sessions without optical perceptual changes were observed in
advanced stages of psycholytic treatment and in some psychedelic sessions. They
involved either a brutal and primitive experieutial complex described by various
subjects as reliving of their own birth, or transcendental experiences of cosmic uni-
ty and the Supracosinie Void which had the paradoxical quality of being “con-
tentless yet all-containing.”
Physical manifestations of the LSD state deserve special notice in this con-
text since, in the early reports, they were seen as simple pharmacological effects of

a
the drug and attributed to direct chemical stimulation of the vegetative centers in
the brain. Careful observation of a large number of sessions and analysis of the
records does not support this explanation. The physical concomitants of the LSD
reaction vary considerably from session to session. The spectrum of so-called
“vegetative symptoms” is very broad and excceds that of any other drug known,
with the exception of sone other psychedelics. Strangely enough, these symptoms
include both sympatlictic and parasympathetic phenomena, and they appear in
clusters involving various combinations thereof. They occur with the same fre-
quency and intensity in low- and high-dose sessions and there is no demonstrable
dose-effect relationship. In many high-dose LSD sessions, physical manifestations An experience of nausea, one of the most frequent physical symptoms in LSD sessions.

ter
 VARIABLES IN LSD THERAPY Pharmacological Effects of LSD 51
50 CRITICAL

ite
are entirely absent, or they occur intermittently in close connection with difficult instruction and reassurance of the subjects, lack of their full agreement and coop-
eration, or absence of basic trust in the therapeutic relationship. In this case, the

inh ope
and strongly defended unconscious material. Conversely, some low-dose sessions
are characterized by massive vegetative symptoms during the entire course of the LSD reaction sometimes does not take its full course until the motives for resis-
drug reaction. It is not uncommon that after administration of an additional dose tance are analyzed and understood. Similar factors seein to be responsible for the
of LSD a subject suffering from severe physical symptoms surrenders to the expe- inability of many persons to surrender to the effect of the drug under the circum-
rience, works through the underlying problem, and gets rid of the somatic distress. stances of unsupervised self-cxperimentation in the presence of strangers and in
Another aspect of these syinptoins that is particularly relevant to our discussion is unfamiliar environments. Such sessions are conducive to incomplete resolution
their unusual sensitivity to various psychological factors; they can often be and integration, adverse after-effects, and later recurrences (“flashbacks”). Instant
modified or even terminated by specific external influences and psychotherapeutic sobering, which can occur at any period of the session and on any dosage level,
interventions. The factors that can dramatically affect “vegetative” and other typically indicates a sudden mobilization of defenses against the impending
physical manifestations in LSD sessions range from relevant interpretations or emergence of unpleasant traumatic material.
Among psychiatric patients, severe obsessive-compulsive neurotics are par-
arrival of a specific person to the use of physical contact and various bioenergetic
exercises. ticularly resistant to the effect of LSD. It has been a common observation in my
One of the physical manifestations of the LSD reaction that deserves special research that such patients can frequently resist dosages of more than 500 micro-
mention is the dilation of the pupils (mydriasis). It is so common that its presence grams of LSD and show only slight signs of physical or psychological distress. In
has been used by many experimenters and therapists as a relatively reliable indica- extreme cases it can take several dozen high-dose LSD sessions before the psycho-
tion that a person is still under the influence of the drug. For a long time, logical resistances of these individuals are reduced to a level where they start hav-
mydriasis seemed to be a serious candidate in my investigations for being the ing episodes of regression to childhood and become aware of the unconscious
invariant manifestation of the LSD effect. Later, I witnessed several LSD sessions, material that has to be worked through. After observing several situations in
some of them very dramatic, in which the pupils of the subjects appeared con- which even a drastic increase of dosage—in one instance to 15000 micrograms given
stricted or in which they oscillated rapidly between extreme dilation and con- intramuscularly—did not result in a fully developed LSD experience, it became
striction. obvious that high psychological resistance to LSD cannot be overcoine just by an
A similar situation exists in the area of gross physical manifestations such as increase in, dosage; it has to be gradually reduced in a series of sessions. There
psychomotor excitement or inhibition, muscular tension, tremors, twitches, seems to be a saturation point of LSD somewhere between 400 and 500 micro-
seizure-like activities, and various twisting movements. None of these symptoins is grams; if the subject does not respond adequately to this dosage, additional LSD
standard and predictable enough to be considered a specific pharmacological will not change anything in the situation.
There is some evidence, of an anecdotal rather than experimental nature,
effect of LSD. This does not mean that LSD does not have any specific
physiological effects per se; these can be clearly demonstrated in animal ex- suggesting that a lowered response to LSD can occur in spiritually highly-
periments using incomparably higher dosages. However, my experience indi- ‘developed individuals who have extensive experience of unusual states of mind or
cates that within the dosage range commonly used in human experiments or in live in such a state most of the time. The most famous example of this is Ram Dass’
psychotherapeutic practice, physical manifestations do not result from direct account, according to which his Indian guru did not respond on two occasions to
pharmacological stimulation of the nervous system. They seem to reflect chemical extremely high dosages of LSD (900 and 1200 micrograms respectively). (83) This
activation of dynamic matrices in the unconscious and have a structure similar to would indicate the possibility that lack of reaction to the drug can be associated
hysterical conversions, organ-neurotic phenomena, or symptoms of psychosomatic paradoxically with two opposite conditions, namely excessive rigidity and a strong
disorders. psychological defense systein or extreme openness and a lack of separating
As unpredictable as the content of the LSD reaction is its intensity, and indi- barriers.
vidual responses to the same dosage level vary considerably. The degree of sensi- Having reviewed various kinds of evidence suggesting the absence of any
tivity or resistance to LSD seems to depend on complicated psychological factors clear, specific and invariant pharmacological effects of LSD at the dosage level
rather than on variables of a constitutional, biological, or metabolic nature. Sub- commonly used in experimental and clinical work with human subjects, we can
jects who in everyday life manifest a strong need to maintain full self-control, and try to outline what the effects of LSD actually are. According to my experience,
they are very unspecific and can be described only in the most general terms. Ina

wena
have difficulties in relaxing and “letting go,” can sometimes resist relatively high
dosages of LSD (300-500 micrograms) and show no detectable change. Occa- great majority of sessions there is an overall tendency toward perceptual changes
sionally, individuals can resist considerable doses of LSD if they have set this as a in various sensory areas. Consciousness is usually qualitatively changed and has a
personal task for themselves. They may do it to defy the therapist and compete dream-like character. The access to unconscious material is typically facilitated
with him or her, to prove or demonstrate their psychological “strength,” to endure and psychological defenses are lowered. Emotional reactivity is almost always

to
more than their fellow patients, to impress their friends, or for many other greatly enhanced and affective factors play an important role as determinants of
reasons. However, it is obvious that deeper and more relevant unconscious the LSD reaction. A rather striking aspect of the LSD effect is a marked inten-
motives should be looked for behind such superficial rationalizations. Additional sification of mental processes and neural processes in general; this involves

a ee
causes of high resistance to the effect of the drug may be insufficient preparation, phenomena of differing nature and origin.
52 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 53

Pre-existing and recent psychogenic symptoms, as well as those the indi- sonality variables and later move on to the deeper underlying structures that func-
vidual had suffered from in childhood or at some later period of life, may be tion as determinants of the LSD experience.
amplified and exteriorized. While experiencing them in an exaggerated form the Some interesting personality variables can already be observed in the pre-
individual frequently develops insights into the network of unconscious processes drug phase of LSD treatment—during the initial interview and the preparatory
that underlies them, discovering their specific psychodynamic, perinatal and trans- period. There is a very typical group of individuals who approach the LSD ses-
personal roots. Traumatic or positive memories connected with a strong emotional sions with multiple anxieties and great apprehension. They raise a number of
charge are activated, brought forth from the unconscious, and relived, and the questions and doubts concerning the effect of the drug and value of the thera-
content of various dynamic matrices from different levels of the individual and peutic procedure, dwell on the horror stories they have read in the newspapers or
collective unconscious may emerge into consciousness and be experienced in a heard on the radio and TV, and show a tendency to procrastinate and delay the
complex way. Occasionally, phenomena of a neurological nature can be amplified actual session as long as possible. It is not uncommon that these subjects have
and manifested in the sessions; this is true for pains associated with arthritis, serious disturbances of sleep or terrible nightmares as a result of the approaching
dislocation of vertebral discs, inflaminatory processes, or post-operative and post- prospect of taking the drug. Such persons usually require much reassurance of a
traumatic changes. Reliving sensations related to past injuries and operations is general and specific nature before they agree to have a drug session.
particularly common. What is interesting from a theoretical point of view is that There seems to exist a typical cluster of conflicts and problems that many of
LSD subjects even seem to be able to relive pains and other sensations related to these individuals share. In their everyday life they are constantly concerned about
past operations conducted under deep general anesthesia. The propensity of LSD maintaining perfect control over their feelings and behavior. They are afraid of
and other psychedelics to activate and amplify various neurological processes is so temporary or permanent unleashing of instinctual energies, especially those of a
striking that it has been used by several Czech neurologists as a diagnostic tool for sexual and aggressive nature, and of involuntary emotional outbursts. There is fre-
the exteriorization of latent paralyses and other subtle organic damage of the cen- quent preoccupation with the issue of loss of control and fear of social embar-
tral nervous system. (24) The negative side of this interesting property of LSD is rassment, blunder and public scandal resulting from the ensuing behavior. The
the fact that it can activate seizures in patients suffering from inanifest epilepsy, or struggle with forces that threaten to emerge from the unconscious can take much
those who have a latent disposition to this disease. A rapid sequence of epileptic time and energy in the life of these persons, and is often associated with feelings of
seizures that might be difficult to control, the so-called status epilepticus, inferiority, a sense of guilt, and self-reproach in regard to the instinctual drives. In
represents one of the few serious physical risks of LSD therapy. the extreine, the above concerns can take the form of fear of insanity or death.
By and large, I have not been able to discover during my analyses of the These persons typically dislike and fear all situations such as fatigue, diseases with
data any distinct pharmacological effects that are constant and. invariant and can fever, sleep deprivation, and the hypnagogic period which threaten to reduce the
therefore be considered drug-specific. At present, I see LSD as a powerful degree of conscious control over the unconscious impulses. In some instances the
unspecific amplifier or catalyst of the biochemical and neurophysiological pro- fear of the transition between waking consciousness and sleep is so intense that
cesses in the brain. It seems to create a situation of general undifferentiated acti- these patients take long, fatiguing walks before going to sleep or keep themselves
vation that facilitates the emergence of unconscious material from various levels of busy until late hours to shorten the hypnagogic period and expedite the process of
the personality. The richness, as well as the unusual inter- and intra-individual falling asleep.
variability, can be explained by the participation and determining influence of ex- Since full sexual orgasm requires a temporary suspension of voluntary con-
trapharmacological factors. trol, such problems usually find their most salient expression in the sexual life of
In the following sections we will discuss in detail all the major non-drug these persons. Their problems in this area range from impotence, frigidity or in-
variables that seem to have a decisive influence on the process of LSD complete and superficial orgasms to a tendency to avoid sexual situations alto-
psychotherapy. They include the personality structure and current life situation of gether. Discussions about their experience of sexual intercourse may reveal a fear
the subject, the personality of the guide, the nature of their mutual relationship, of unleashing aggressive impulses in themselves or their partners, and a frighten-
and the set and setting of the sessions. ing sense that the situation might get “out of control.” On a deeper level the asso-
ciated fantasies can take the form of intense unconscious fears of devouring the
partners or being devoured by them. People with such problems usually instinc-
PERSONALITY OF THE SUBJECT tively sense or deduce from the reports of others that LSD has a disinhibiting ef-
fect, and that its administration can result in loss of control and a powerful up-
When we discuss the significance of the subject’s personality for the nature, con- surge of unconscious material. The prospect of having an LSD session thus feeds
tent and course of the LSD experience, it is necessary to distinguish between the directly into the central fears of these individuals. The problems related to sexual
role of personality factors in individual sessions using low and medium dosages on intercourse and orgasin that are described here also betray the manifestation of
the one hand, and in consecutive sessions of a therapeutic series or high-dose perinatal energies in these persons. (See a detailed discussion of these problems on
psychedelic sessions on the other. We will first cover the more superficial per- p 71 ff.)
/ 54 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 55

Another problem related to the negative attitude toward LSD therapy and do not lose trust in the value of the process. The major exception to this rule are
unwillingness to have a drug session is associated with a lack of trust in oneself, patients with severe obsessive-compulsive neuroses, who can maintain a generally
other people, human society, and the world in general. If these feelings are within pessimistic attitude all through the procedure. Their pessimism is frequently rein-
the neurotic range it is necessary to spend extra time with the patient to develop a forced and confirmed by uneventful sessions and an apparent lack of therapeutic
sufficient degree of trust before administration of the drug. Openly paranoid at- benefit.
titudes about the procedure, especially when the patient tends to include the Special mention should be made of subjects with superior intelligence and
therapist among the suspected persecutors, should be considered a contraindica- strong intellectual interests in human culture, psychology, art, philosophy, and
tion for LSD therapy. religion. Such subjects tend to discover very quickly that the process of serial LSD
An enthusiastic approach to LSD treatment, vivid interest in the drug, and sessions transcends the framework of traditional depth-psychological analysis and
an eagerness to have psychedelic sessions has been observed in certain types of offers unique. possibilities for a serious philosophical and spiritual quest. As a result
intellectuals who are dissatisfied with the dullness and monotony of their everyday of this insight, they pursue psychedelic self-exploration with great interest and
life and are looking for unusual, exotic and stimulating experiences. In this group, emotional involvement. In this context, LSD sessions can be seen as an oppor-
the possibility of exploring hidden recesses of the mind is also frequently seen as a tunity to confront the mysteries of the universe and the riddle of human existence.
unique learning opportunity, and adds to the special appeal of the experience. Pa- They thus assume a function comparable to the spiritual practices of ancient and
tients with a strong positive component in the transference relationship sometimes Oriental cultures, or to rites of passage, temple mysteries, and various esoteric
see the major attraction of the psychedelic session as the prospect of having the full procedures of the mystical tradition.
and undivided attention of the therapist for an entire day. Some of the patients, We have also observed interesting connections between the clinical diagnosis
unconsciously or with various degrees of conscious awareness, use the framework or symptomatology of some patients and the nature of their LSD sessions. These
of the drug session as an opportunity to experience, express and act out some of are most striking in the case of persons suffering from severe obsessive-compulsive
their otherwise unacceptable tendencies. : neuroses. These patients usually belong to the group of those who are afraid of the
On occasion, a potentially dangerous eagerness and strong motivation to drug session before they have experienced it; they tend to voice a number of con-
have a psychedelic session is observed in certain desperate patients with few alter- cerns and questions, and typically delay the onset of treatment. Their resistance to
natives left in life. They find themselves in a subjectively unbearable situation of the effect of LSD is extremely high and even sessions with excessive dosages are
intense conflict associated with great emotional distress and tension. Typical char- frequently uneventful. The phenomenology of their LSD sessions is usually limited
acteristics include serious questioning of the meaning of life, toying with suicidal to a determined fight against the effect of the drug and an extreme effort to main-
fantasies, and a careless and risky approach to various life-situations in general. tain reality-testing and full self-control. There are practically no disturbances of
Unable to tolerate the intensity of the conflicting psychological forces, and tired of optical perception and the only manifestations of the LSD effect are typically
making painful compromises, they crave instant termination of this agonizing massive somatizations. If they experience any unusual feelings at all, these patients
state. In their fantasy LSD becomes the magic tool that will give them instant re- usually present multiple complaints about unpleasant physical symptoms, such as
lief, either by mediating a miraculous cure or by precipitating self-destruction. If headaches, weakness, fatigue, general malaise, a tendency to collapse or swoon,
the psychedelic sessions with these individuals do not result in elements of ego death nausea, profuse sweating, chills and hot flashes. They might be alarmed by their
and transcendence, they can activate the existing self-destructive tendencies. It is sense of losing touch with reality, concerned about intensification of their sexual
quite important to detect such attitudes in advance, analyze the underlying motives, and aggressive drives, or preoccupied with conflicts regarding self-esteem and
and discuss the situation with the subject before the administration of the drug. ethical issues. Their sessions are characterized by intense inner struggle and are
All the factors discussed above are of primary importance before the first usually followed by excessive feelings of fatigue. For patients with obsessive-
LSD session. When the drug has been repeatedly administered in the context of a compulsive neuroses of extreme intensity, it can take a considerable number of
therapeutic series, most patients realize the possibilities that psychedelic experi- LSD sessions before their resistances are reduced and the sessions start having a
ences can offer in terms of deep self-exploration, finding the roots of one’s emo- more concrete content.
tional symptoms, and solving life problems. Even those patients who were initially In individuals with a hysterical personality structure and symptomatology,
concerned about loss of control usually discover its therapeutic value. Their the nature, content and course of the LSD sessions is usually substantially dif-
previous concept of control, that once lost it cannot be regained, is replaced by the ferent; as a matter of fact, they seem to be at the opposite end of the spectrum
insight that suspension of defenses is a liberating experience. They discover a new from the obsessive-compulsives. Excitement, and intense curiosity about the pro-
way of being in the world in which one can exert control without any effort cedure is quite typical of these patients and their attitude toward the drug experi-
because the urgent forces that required constant anxious attention have been ence is generally much more positive. They are extremely sensitive to the effects of
discharged. LSD and frequently display a rather dramatic reaction after a relatively small
By and large, all patients treated with serial LSD sessions tend to develop a dose. In this group, the various perceptual changes are extraordinarily rich, with a
positive atittude toward the treatment. Although after particularly difficult ses- definite predominance of visual elements and intense body sensations. In agree-
sions some individuals might show fear and a reluctance to continue, they usually ment with observations from classical psychoanalysis, perceptions of an erotic
‘
IN LSD THERAPY Personality of the Subject 57
56 CRITICAL VARIABLES

nature and rich sexual symbolism seem to dominate the experiential world of these diagnosis established by psychiatric interviews and conventional diagnostic tech-
patients. Their images tend to have a flowing scenic character; they are usually niques. The relationship between the original diagnostic category of the patient
dramatic, vivid and colorful with visualization of various glamorous daydreams and his or her psychedelic experiences becomes even looser and less predictable in
and other wishful elements of fantasy life. This smooth scenic course can be serial LSD sessions. As we will discuss later, repeated exposures to the drug are
disturbed when patients approach traumatic and pathogenic memory constella- associated with major dynamic shifts in the personality structure and frequent
tions. Like everyone else, hysterical patients are not immune to difficult and pain- changes of symptoms.
ful experiences in psychedelic sessions. However, they seem to have high tolerance of The limited value of LSD as an auxiliary to conventional clinical diagnosis
suffering and can appreciate periods of inhuman horror and torture as much as contrasts sharply with its potential for dynamic diagnosis. It is an unrivalled tool
episodes of ecstatic rapture. During LSD psychotherapy, as in systematic drug- for the exploration of the forces constituting the basic personality, and for study of
free therapy, these patients might present special challenges and problems in the deep dynamic structures underlying clinical symptoms. In sessions with lower
regard to transference and countertransference. and medium dosages of LSD, and in the termination periods of high-dose sessions,
Observations from LSD psychotherapy seem to confirm Freud’s findings of a one can often observe a marked intensification of pre-existing personality
close relationship between homosexuality and paranoid behavior. It was repeated- characteristics and behavior patterns. This is typically accompanied by accentua-
ly observed that patients with serious latent or manifest problems concerning tion of current clinical symptoms or recurrence of emotional and psychosomatic
homosexuality had a greater disposition toward panic reactions, paranoid percep- effects that the patient suffered from at some point in the past. Sometimes this
tion, use of projection in regard to their LSD experiences, and delusional inter- reenactment involves relatively recent history, at other times very early periods of
pretation of the situation and the session in general. These difficulties usually childhood or even infancy.
occurred or were particularly accentuated when a preoccupation with their Occasionally, completely new symptoms may emerge during a session which
homosexual problems was the central focus of their experience. the patient does not remember ever having experienced before. This offers a
We have not been able to detect any fixed and specific correlations between unique opportunity for the researcher to study the psychogenesis and physiogenesis
symptoms of clinical depression and the nature of the psychedelic experiences. of clinical symptoms in the process of their origination, in statu nascendi, The
Although deepening of pre-existing depression and intensification of suicidal idea- general dynamic structure of these newly fornied symptoms seems to be identical
tion can often be observed in LSD sessions, the clinical condition of depressed per- with that of the usual neurotic manifestations; it represeuts a compromise forma-
sons frequently appears quite labile and prone to dramatic changes and break- tion between powerful unconscious drives or tendencies and the inechanisnis of
throughs. In neurotic depressions, heightened affective lability sometimes results defense. Phenomena of this kind seem to be reflected in activation and exterioriza-
in a peculiar condition in which depressive affect and crying occurs simul- tion of latent matrices of the unconscious which exist in the dynamic structure of
taneously with euphoria and forceful laughing, or alternates with them in a rapid the personality. The reason why they have not manifested earlier in life is that
succession. In general, it is not uncommon that a depressed patient experiences they have not been activated by biochemical or psychological forces to a sufficient
most of the session in a thoroughly euphoric or even ecstatic way and that a degree to influence the patient’s ego. The so-called “vegetative” symptoms fre-
marked and sometimes lasting improvement can be noted after the session. Several quently seem to fall into this category.
accidental observations have suggested that a single LSD session can cause a com- The individual characteristics that are amplified in the low-dose range
plete remission of a serious periodic depression with a very stubborn pattern with- represent more superficial but practically important aspects of the personality. In
out, of course, changing the underlying personality structure or preventing recur- everyday life some of these elements are so inapparent that they are not readily
rence of future depressions at the usual tire periods. detected and identified, or the subjects use various techniques to counteract and
Repeated observations of LSD sessions in depressed patients suggest that the hide them. LSD can enhance these subtle features to such a degree that they reach
drug can be useful in making a differential diagnosis between exogenous and the point of a caricature. Under the magnifying effect of the drug they become so
endogenous depressions. Patients whose depression is basically of exogenous origin obvious that they cannot possibly escape the attention of either the therapist or the
usually deal in their sessions with rich biographical material which is thematically subject. The broad spectrum of phenomena belonging to this group can be divided
.
and dynamically related to their disease. In patients with endogenous depressions, into several typical categories.
the content of the sessions is usually much more limited and frequently consists of The first category includes manifestations reflecting emotional reactivity
accentuation of the deep and primordial feelings constituting the depression. In and general feeling tone. The subjects can get deeply in touch with their present
these patients there is a definite risk that their clinical symptoms might be tem- emotional condition and explore the experiential dimensions and characteristics of
porarily intensified after some LSD sessions. This observation is in agreement with the various affective states that it entails. Probably the most valuable insights
the experiences of Arendsen-Hcin (5), a Dutch psychiatrist and pioneer in LSD available in this context are into positive and negative feelings towards certain
psychotherapy. i” persons and situations, especially in the form of ambivaleuce and conflicting atti-
In general, it can be concluded that the relationship between the diagnostic tudes. Similarly, many patients may fully experience and express their anxieties
group and the nature of the LSD experience is not sufficiently distinct and con- and various specific fears, depression and despair, states of aggressive tension, irri-
stant to be of great clinical value, except in the few extreme cases mentioned tability and impulsivity, or emotional lability with alternating depressive and
above. In this sense, LSD certainly cannot contribute much to the clinical euphoric moods. An experience that characteristically occurs in neurotic patients
 58 » CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 59

is an agonizing feeling of loneliness and isolation with a sense of uselessness. The The third important category of phenomena related to personality charac-
feeling of being superfluous in the world and the inability to see the meaning of teristics involves accentuation of typical patterns in the subject’s social reactivity.
one’s existence are frequently associated with the need to be needed and sought Some individuals show a marked enhancement of sociability, with incessant
after. Individuals who experienced marked emotional deprivation and rejection in search for human contact, non-stop talking, and a tendency towards clowning,
childhood frequently show at this point an intense need for love. Such cravings joking, and entertaining others. Sometimes there is an enormous need for atten-
usually have strong infantile features and involve anaclitical elements. On occa- tion and imagincd or actual neglect is experienced as very painful. This may be
sion, experiences of this kind can result in valuable insights into the basically associated with various attention-getting maneuvers, typically those also used to
childlike nature of various dependency needs, and lead to an understanding of some degree in everyday life. They can range from noisy and theatrical per-
how this confusion creates conflicts in everyday life. formances to affectionate behavior and seeking gentle pliysical contact. Sometimes
The second category involves problems related to self-image and self-esteem. the erotic component can come to the foreground; this results in coquetry, seduc-
The most frequent phenomena in this area are agonizing inferiority feelings expe- tiveness, minor sexual aggression, or verbalizations full of sexual undertones or
rienced in regard to different dimensions of one’s existence. Thus patients quite overt obscenities.
often express dissatisfaction, unhappiness, or even despair about their physical Conversely, one may observe a marked accentuation of withdrawal
appearance. They complain about being ugly, misshapen or repulsive, point to mechanisms which the subject uses habitually in everyday life. Psychological
imagined or insignificant physical defects, and greatly exaggerate the relevance of withdrawal and an unwillingness to interact with people in an LSD session can be
some existing handicaps. This preoccupation with self-esteem is as often related to an expression of a lack of interest in socialization and preference for aesthetically
intellectual abilities. Subjects describe themselves as stupid, dull, unimaginative, or intellectually more attractive introspection. However, in some instances it can
incapable, primitive and uneducated, often directly contradicting their real be a manifestation of complicated interpersonal problems and inner conflicts.
qualities and social achievements. It is typical of the neurotic group to compare Avoidance of human contact may reflect the patient’s fear of people and his or her
their own abilities unfavorably with those of significant others, such as parents, low self-esteem. Sometiines this comes from an underlying feeling of being unim-
siblings, peers, and co-patients. This is frequently projected onto the therapist, portant, uninteresting, unpleasant, or disgusting; in others, it may be associated
who is highly idealized and seen as far superior in every respect. As a result, with a strong fear of rejection. Tendencies to withdraw can also reflect conflicts
patients may spend much time and emotional energy ruminating obsessively that and problems related to aggression: the presence of other people, their,expressions
they do not deserve the attention being offered to them, and that some other and behavior are experienced as irritating and trigger hostile impulses which are
patients could make better use of the therapist’s time. unacceptable and frightening. In this case, withdrawal is used in the service of
An especially striking manifestation in a great number of subjects is low self-control. A typical problem that an LSD session can amplify is the conflict be-
moral self-evaluation and conflicts between instinctual impulses and ethical or tween the need for the company of others and the tendency to be alone. The
aesthetic principles. They feel that they are bad, evil, disgusting and worthless patient is afraid to be alone but at the same time cannot stand the company of
1b Seanfie be

human beings and see their lives as utterly immoral or sinful. It suddenly appears others; he or she has an intense craving for human contact but is also afraid of it.
to them that by their actions in everyday life they are exploiting other pcople, Another frequent occurrence is intensification of social and interpersonal
betraying them, offending or bothering them, imposing upon them, or hurting patterns related to dominance and submission. This can be reflected in strong ten-
them. This can reach such proportions that some subjects talk about sensing dirty, dencies to manipulate, control, criticize, or mentor others. The subject may make
perverted, bestial, or even criminal elements in their own personality. In most in- determined efforts to create situations involving competition and testing of
stances these objectionable traits involve tendencies and activities that are quite powers, or the derogation, humiliation and ridicule of others. Similarly, sub-
trivial, or represent ubiquitous and common human characteristics. Another missive manifestations and deferential behavior patterns can be accentuated to the
variation of low self-esteem is the feeling of emotional inferiority. Some subjects point of caricature. Some subjects keep apologizing for various trivial or imag-
complain that while others treat them with love and warmth, they are unable to inary things and require reassurance that they are not interfering with anything or
reciprocate these emotions. They feel incapable of experiencing genuine affection anyone. Others keep asking if they are offending or hurting anybody, or want to
and human concern toward their children, marital partners, lovers, parents, or make sure that nobody is angry with them. Irresolution, anxious clinging and
siblings. Other common manifestations in this area are agonizing guilt feelings, passive-dependent maneuvers may also reach extreme dimensions and border on
sa

qualins of conscience, and self-accusation. anaclitic behavior.

OR erm

Less frequently, one may see an activation of self-aggrandizing tendencies, A remarkable and frequently observed manifestation is the desperate and
such as unnatural bragging and boasting, condescending and pseudoauthoritative determined fight for maintenance of full self-control. As already described above,
attitudes, exaggerated demonstrations of power, indulgence in caustic attacks and this typically occurs in subjects who have various problems with self-control even
hypercritical comments, or a tendency to cynicism and ridicule. The amplified in their everyday life. Conversely, individuals with a rich inner world to which
caricature-like quality of these manifestations makes it easy to recognize them as they can turn as a protective shelter against traumatizing reality, often complain
compensatory maneuvers covering up underlying feelings of basic inferiority and in an LSD session about their inability to relate fully to either the external world
inadequacy. These dynamics quite regularly reflect important pre-existing prob- or their inner experience.
lems in the subject. While lower dosages of LSD activate and accentuate superficial layers of the
 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 61
60

eae
interac- Various aspects of the personality structure discussed above—the superficial
subject’s personality structure which play an important role in everyday
dynamic forces and tendencie s. After the LSD facade, the deep dynamic forces that underly it, and the interplay between the
tion, higher doses exteriorize deep
critical limit, which varies considerably from one person to two—can be expressed in LSD sessions in many different ways. These elements
dose reaches a certain
At this point, may be experienced in the form of emotional feelings, physical sensations, specific
another, a striking psychological reversal can often be observed.
thought-processes, behavior patterns. However, they are more typically
various powerful tendencies which are contrary to the above superficial elements
subject. associated with a variety of perceptual changes in all the sensory areas. These can
tend to surface and dominate the experiential world and behavior of the
dynamic undercurrents that are counteracted and con- result in systematic distortions of the body image, intricate autosymbolic transfor-
These represent important
the mation, and experiences of complex symbolic scenes, in which not only self-
trolled under normal circumstances by various defense mechanisms. While
lead to a better descripti ve knowledg e of various perception but the perception of the human and even the physical environment is
phenomena discussed earlier
e of these drastically changed.
more-or-less manifest aspects of the subject’s personality the emergenc
nding of the dynamics Instead of attempting to describe the entire spectrum of phenomena that can
deep tendencies can contribute significantly to an understa
occur in this context, we will briefly review the animal symbolism that is par-
of the personality structure.
ticularly frequent. During characterological self-exploration, many LSD subjects
This reversal is most frequently observed in extremely submissive and
identify experientially with various animals that traditionally represent certain
anxious persons who in their everyday existence are timid, shy and overly polite,
human personalities, attitudes and behaviors. Thus an autosymbolic experiential
and meticulously avoid any interpersonal conflict. After losing the struggle for
stylization into a predator such as a tiger, lion, jaguar or black panther can be
self-control, these individuals exhibit marked aggressivity with hostile and destruc-
used as an expression of the subject’s intense aggressive feelings. Identification’
tive tendencies. A temporary conversion of a similar kind is quite common in sub-
an ex- with a monkey can reflect polymorphously perverted tendencies and uninhibited;
jects who normally have strong sexual inhibitions, Victorian prejudices,
to shame, and tendencies toward asceticism, puritanism and indulgence in genital as well as pregenital, pleasures. A strong sexual drive can be
cessive proneness
fre- represented by a transformation into a stallion or a bull; if it has a strong compa-
prudishness. In the LSD sessions of such persons, overt sexual manifestations
towards coquetry, frivolous nent of lust and indiscriminate promiscuity it might be symbolized by a dirty wild
quently dominate the experience. These subjects tend
boar. A streak of masculine vanity and sexually tainted exhibitionism can be
or seductive behavior, and social exhibitionism with a sexual undertone. They
ridiculed by an autosymbolic representation of the subject as a noisy cock om a
may indulge in obscenities, show signs of sexual aggression, or attempt to mastur-
dunghill. A donkey or an ox may symbolize stupidity, a mule can indicate stub-
bate in the presence of the sitters.
bornness, and a hog usually represents self-neglect, sloppiness, and moral flaws.
Sudden, dramatic changes can take place in persons who normally suffer
In sessions where the subject's eyes are open, the intrapsychic events can get '
from intense feelings of inadequacy and inferiority. They tend to become gran-
projected onto other persons or even on the physical environment. Therapists,
diose and overtly self-confident, manifest various dictatorial and domineering
nurses, co-patients, friends or relatives can be illusively transformed into represen-
tendencies, and express megalomanic ideas and fantasies. Conversely, in markedly
tatives of the subject’s instinctual tendencies. They can be perceived as sadists,
authoritarian persons who are excessively autocratic in their normal life and osten-
lechers, perverts, criminals, murderers, or demonic characters. Conversely, they
tatiously demonstrate their personal strength and power, this phase of LSD
can represent embodiments of the critical attitudes of the Superego and be seen as
therapy frequently brings out the compensatory and defensive character of their
parental figures, judges, members of a jury, policemen, jailers, or executioners. In
stances. Under the influence of LSD, the underlying feelings of abysmal inse-
the extreme, the entire human and pliysical situation may be systematically
curity, low self-esteem, and childlike helplessness surface and dominate the ex-
sexual orgy, medieval
periential field. Many male patients who in their everyday life demonstrate
transformed into a complex scene of a bordello, harem,
dungeon, concentration camp, courtroom, or death row.
elements of masculine pride and macho behavior with an emphasis on body-
Detailed analysis of the form and content of all these phenomena, using the
building, who accentuate male supremacy and superiority, and treat women with
method of free account or free association to all their elements, can become the
disrespect and irony, discover in these sessions that they have serious doubts about
source of additional specific and relevant information about the personality of the
their masculinity and harbor intense homosexual fears. Similarly, hypersensitivity,
subject. If LSD therapy is combined with non-drug experiential approaches, any
emotional frailty and excessive vulnerability frequently appear in sessions of peo-
of these images can be used later for further therapeutic work; for instance, the
ple with a manifestly cynical attitude toward the world, who are otherwise overt-
complex scenes mentioned above are particularly suitable for the gestalt tech-
ly caustic and derisive of human feelings and positive values in life.
niques developed by Fritz Perls for dream analysis. (79) Thus it is clearly
It is also quite common that church-oriented persons, who have been
demonstrated that LSD experiences are highly specific for the personality of the
brought up in families dominated by religious fanaticism and hypocritical bigoted
or subject; they represent in a condensed and symbolic way his or her most important
attitudes, often manifest strong antireligious tendencies and make heretical
y, extremely rational and logical persons, emotional problems, and are closely related to various relevant situations from
blasphemous comments. Conversel
past history and the present life situation. A detailed study of the individual ele-
whose adherence to pragmatic values and reason has a defensive character, often
ments of the LSD experience on this level, using Freudian technique or the new
show on a deeper level intense tendencies towards metaphysical fears, irrational
experiential approaches, reveals far-reaching similarities between their dynamic
ideation, superstition, and magical thinking.
 Personality of the Subject 63
62 CRITICAL VARIABLES IN LSD THERAPY

Symbols of a patient's general feelings about his life. The ship of his existence is precariously
A patient expresses how, during a psychedelic session, he saw the situation in his marriage.
balanced on the top of a dangerous wave while a shark-like monster waits in the depths
His wife appears as a monstrous predator; he as a helpless mouse hanging from her mouth. ready to devour the ship-wrecked victim.
This experience was strongly colored by the underlying perinatal elements.

The significance of personality factors for the nature, content, and course of
structure and the structure of dreams. Freud once ealled dreams the “via regia” or
the LSD experience becomes even more evident when the drug is administered
“royal road” to the unconscious, and this is even more applicable to LSD experi-
repeatedly in the framework of an entire therapeutic series. Under these cir-
ences. Association to all the elements of the experiential content of an LSD session
cumstances the subject is usually able to trace various emotional and
that appear on the psychodynamic level leads very directly to important emotional
psychosomatic symptoms, interpersonal attitudes and behavior patterns to their
problems of the subjects.
deep sources in the unconscious. This occurs quite spontaneously in most in-
The tendency of LSD to selectively activate unconscious material that has
stances, without the use of free association or much interpretive help from the
the strongest emotional charge makes this drug a unique tool for psychodynamic
therapist. Sequential LSD sessions can be understood as a process of progressive
diagnostics. Even one LSD exposure can frequently identify the areas of most
activation and unfolding of the content of dynamic matrices in the unconscious.
significant conflict, reveal the deep dynamic structure of clinical symptoms, and
The nature of the LSD experience depends on the level of the unconscious
help differentiate between relevant and irrelevant problems. All LSD experiences
that gets activated and becomes the focus of conscious awareness. Although the
of a psychodynamic nature are generally multiply overdetermined, and express in
nature of the unconscious, and thus the nature of LSD phenomena, is
the cryptic shorthand of their symbolic language the key problems of the
holographic, multileveled and multidimensional, it is useful for theoretical and
personality!
64 CRITICAL VARIABLES IN LSD TUERAPY Personality of the Subject 65

practical purposes to distinguish certain major experiential realms. Each of them

has a distinct content, is governed by specific dynamic systems, and has a
characteristic significance for mental functioning. The following three categories
of LSD phenomena seem to be sufficiently distinct and well-defined to be de-
scribed as separate types:
a. Psychodynaniie experiences
b. Perinatal experiences
c. Transpersonal experiences
We will omit in this context the abstract or aesthetic level of the LSD experience
which seenis to reflect chemical stimulation of sensory organs and is not relevant
from the point of view of a deeper understanding of the personality structure.”

PSYCHODYNAMIC EXPERIENCES
The experiences belonging to this category are associated with and derived from
biographical material from the subject’s life, particularly from emotionally
highly-relevant events, situations, and circumstances. They are related to impor-
tant memories, problems, and unresolved conflicts from various periods of the in-
dividual’s life since early childhood. Psychodynamic experiences originate in areas
of the human personality that are generally accessible in normal states of con-
sciousness, or in the individual unconscious which contains repressed biographical
material. The least complicated psychodynamic phenomena have the form of ac-
tually reliving events from the past and vivid reenactments of traumatic or
unusually pleasant memories from infancy, childhood or later periods of life.
More complicated experiences involve creative combinations of various memory
elements, pictorial concretizations of fantasies, dramatizations of wishful day-
dreams, screen inemories, and other complex mixtures of fantasy and reality: In
addition, the psychodynamic level involves a variety of experiences that contain
important unconscious material in the form of symbolic disguises, cryptic defen-
sive distortions, and metaphorical allusions.
The experiences in psychodynamic LSD sessions can be understood to a great
extent in terms of baste psychoanalytic concepts. If psychodynamic episodes were
the only type of LSD experience, the observations from LSD psychotherapy could
be considered laboratory proof of the Freudian theoretical framework. Psycho-
sexual dynamics and the basic conflicts described by Freud are manifested with
unusual clarity and vividness even in the sessions of naive subjects. Under the in-
fluence of LSD, such persons experience regression to childhood and early infancy,
relive various psychosexual traumas and confront conflicts related to activities in
different libidinal zones. They have to face and work througl some of the basic
psychological problems described by psychoanalysis, such as the Oedipus and
Electra complex, early cannibalistic feelings, conflicts about toilet training,
castration anxiety, and penis envy.
: However, for a more complete understanding of these sessions and of the
Fear of threat unknown. The patient was reliving early childhood memories of being left
consequences that they have for the clinical condition of psychiatric patients and
alone at home.
their personality structure, a new principle has to be introduced into psycho-
analytic thinking. Many LSD phenomena on this level can be comprehended and
some of them even predicted if one thinks in terms of specific memory constella-
tions, for which I use the name COEX systems (systems of condensed experience).*
 Personality of the Subject 7]
66 CRITICAL VARIABLES IN LSD THERAPY

during a particular session or sequence of sessions, undergoing a parallel process of

This concept emerged from my analysis of the phenomenology of therapeutic LSD
abreaction and integration.
sessions conducted in the early phase of my psychedelic research in Prague. It has
A very interesting interdependence and interplay can be demonstrated be-
proved unusually helpful for understanding the dynamics of the initial stages of
tween the dynamics of COEX systems and events in the external world. It has
psycholytic therapy with psychiatric patients.
already been mentioned that an activated COEX system determines the subject's
ed A COEX system can be defined as a specific constellation of memories (and .
perception of the environment and his or her reaction to it. Conversely, certain
associated fantasies) from different life periods of the individual. The memories
elements of the setting or specific events during the session can activate a COEX
belonging to a particular COEX system have a similar basic theme or contain
systein which has associated features; we will discuss this mechanism again in con-
similar elements, and are accompanied by a strong cmotional charge of the same
nection with the significance of the set and setting of LSD sessions. The governing
quality. The decpest layers of this system are represented by vivid and colorful
function of an activated COEX system may not be limited to the period of phar-
memories of experiences from the period of infancy and early childhood. More
macological action of LSD; it can continue for days, weeks, or months following
superficial layers involve memories from a later time, leading up to the present life
the session. The principles of COEX dynamics described above are thus important
situation. The excessive emotional charge which is attached to COEX systems (as
for understanding the therapeutic effect of psychodynamic LSD sessions, as well
indicated by the powerful abreaction often accompanying the unfolding of these
as their complications. (See chapters 5 and 6 on Complications of LSD
systems in LSD sessions) seems to represent a summation of the emotions belong-
Psychotherapy and the Course of LSD Psychotherapy.)
ing to all the constituent memories of a particular kind.
Before concluding this discussion of the psychodynamic and biographical
Individual COEX systems involve special defense mechanisms, and are con-
aspects of LSD sessions, it is important to mention a category of experiences that
nected with specific clinical symptoms. The detailed interrelations between con-
systems are in most instances in basic agreement with
represent a transitional form between the psychodynamic area and the following
stitutent parts of the COEX
perinatal level, which focuses on the phenomena of birth and death, or death and
Freudian thinking; the new element from the theoretical point of view is the con-
rebirth. This transitional group involves the reliving of traumatic memories from
cept of the organizing dynamic system. The personality structure of psychiatric
the life of an individual that are of a physical rather than a purely psychological
patients usually involves several major COEX systems. Their specific forms, total
nature. Such ineinories typically deal with situations from the past that repre-
number, extensity and intensity vary considerably from one individual to another.
sented a threat to survival or body integrity. They cover a wide range, from
The psychodynamic level of the unconscious, and thus the role of COEX systems,
serious operations, painful and dangerous injuries, severe diseases and instances of
is much less significant in individuals whose childhood was not particularly
near drowning to episodes of cruel psychological and physical abuse. Memories of
traumatic.
According to the basic quality of the emotional charge we can differentiate incarceration in concentration camps, exposures to the brainwashing and inter-
rogation techniques of Nazis or Communists, and maltreatment in childhood
negative COEX systems (condensing unpleasant emotional experiences) from
could be mentioned as special examples of the latter group.
positive COEX systems (condensing pleasant emotional experiences and positive
These memories are clearly biographical in nature, yet thematically they are
aspects of the individual's past). Although there are certain interdependencies and
closely related to perinatal experiences. Not infrequently, the reliving of various
overlaps, individual COEX systems function relatively autonomously. In a com-
physical traumas from one’s life occurs simultaneously with the experience of the
plicated interaction with the environment they can selectively influence the sub-
birth agony as a more superficial apposition. Memories of somatic traumatization
ject’s perception of himself or herself and of the world, his or her feelings and
processes. are a frequent source of very painful and frighteninz experiences in LSD sessions.
thoughts, and even somatic
They also seem to play a significant role in the psychogenesis of various emotional
The phenomena observed in LSD sessions that are predominantly
disorders that is as yet unrecognized and unacknowledged by the schools of
psychodynamic in nature can be understood in terms of the successive exterioriza-
dynamic psychotherapy. This is particularly true in the case of depressions,
tion, abreaction, and integration of various levels of negative COEX systems in
suicidal behavior, sadomasochism, hypochondriasis, and psychosomatic disorders.
the subject, and an opening of pathways for the influence of positive ones. When a
negative COEX system approaches the experiential field, a specific change takes
place in the content and course of the LSD sessions. The system assumes a govern-
PERINATAL EXPERIENCES
ing influence on all the aspects of the psychedelic experience. It determines the
direction in which the physical and interpersonal environment is illusively
The most important common denominator and focus of the experiences orig-
transformed, dictates the way the subject sees and experiences himself or herself,
inating in this area of the unconscious is a group of problems related to biological
and dominates the emotional reactions, thought-processes, and certain physical
birth, physical pain and agony, discasc, aging, decrepitude, dying and death. It is
manifestations. In general, the COEX system plays this governing role until the
important to emphasize that the encounter with these critical aspects of human
oldest memory, or core experience, of the system is completely relived and in-
ex- life typically takes the form of a profound first-hand experience, rather than just
tegrated. After this happens, another system takes over and dominates the
, several COEX systems alternate in the leading role symbolic confrontation. Specific eschatological ideation, and visions of wars,
periential field. Frequently
revolutions, concentration camps, accidents, decaying cadavers, coffins,
 CRITICAL VARIABLES IN LSD THERAPY 73
72 Personality of the Subject

cemeteries and funeral corteges occur as characteristic illustrations and con- In addition to the seizure-like motor discharges and other conditions described °
comitants of perinatal experiences. However, their very essence is an extremely above, there may be cardiac distress and irregularities, and hypersecretion of
realistic and authentic sense of the ultimate biological crisis which subjects fre- mucus and saliva. Such subjects also assume various fetal postures and move
quently confuse with real dying. It is not uncommon for patients in this situation in sequences that bear a similarity to those of a child during the stages of bio-
to lose critical insight and develop a delusional conviction that actual physical , logical delivery. In addition, they frequently report visions of or identification,

we
deinise is imininent. with fetuses and newborn children. Equally common are several authentic neo-
The shattering confrontation with these alarming aspects of existence and natal feelings, postures and behavior, as well as visions of female genitals and
deep realization of the vulnerability and imperinanence of humans as biological breasts,
creatures lias two important consequences. The first of these is a profound emo-
Most of the rich and complex content of the LSD sessions reflecting this level
tional and philosophical crisis that forces individuals to question seriously the of the unconscious seems to fall into four typical clusters or experiential patterns.
meaning of existence and their values in life. They come to realize through these Searching for a simple, logical and natural conceptualization of this observation, I
experiences, not intellectually but on a deep, almost cellular level, that no matter was struck by the astonishing parallels between these patterns and the clinical
what they do, they cannot escape the inevitable. They will have to leave this stages of delivery. It proved very useful for didactic purposes, theoretical con-
world, bereft of everything that they have achieved and accumulated. This pro- siderations, and the practice of LSD psychotherapy, to relate these four categories
cess of ontological crisis is usually associated with a definite crystallization of basic of phenomena to the four consecutive stages of the biological birth process and to
values. Worldly ambitions, competitive drives, and cravings for status, power, the experiences of the child in the perinatal period. For the sake of brevity I refer
fame, prestige and possessions tend to fade away when viewed against the back- to the functional structures in the unconscious which manifest in these four major
ground of the mandatory ending of each human drama in biological annihilation. experiential patterns as Basic Perinatal Matrices (BPM I-IV). I see them as hypo-

eee
The other important consequence of this shocking encounter with the phe- thetical dynamic governing systems that have a similar function on the perinatal
nomenon of death is the opening of areas of religious and spiritual experience that level of the unconscious as tle COEX systems have on the psychodynamic level.
seem to be an intrinsic part of the human personality and are independent of the Basic perinatal matrices have specific content of their own: concrete,
individual's cultural and religious background and programming. The only way realistic aud authentic experiences related to individual stages of the biological
to resolve the existentialist dilemma described above is through transcendence. birth process and their symbolic and spiritual counterparts (exemplified by ,the
The individual has to find reference points that are beyond the narrow boundaries elements of cosmic unity, universal engulfment, no-exit, death-rebirth struggle,
of his or her perishable physical shrine and the limitations of the individual life and death-rebirth experience). In addition to manifesting specific coutent, basic
span. It would appear that everybody who experiences these levels develops con- perinatal matrices also function as organizing principles for the material from
vincing insights into the utmost relevance of the spiritual dimension in the univer- other levels of the unconscious. Perinatal experiences can thus occur in psychedelic
sal scheme of things. Even positivistically oriented scientists, hard-core sessions in association with specific psychodynamic material related to various
materialists, sceptics and cynics, uncompromising atheists and antireligious COEX systems, and also in association with certain types of transpersonal ex-
crusaders such as Marxist philosophers and politicians, suddenly become interested periences, Particularly frequent concomitants of the birth experience are
in the spiritual quest after they confront these levels in themselves. memories of diseases, operations and accidents from the individual's life, arche-
The sequences of dying and being born (or reborn) that are characteristic of typal phenomena (especially images of the Terrible Mother and the Great
the process of perinatal unfolding are frequently very dramatic and have many Mother), elements of group consciousness, ancestral and phylogenetic experiences,
biological concomitants, apparent even to the outside observer. Subjects may and past-incarnation meniories.
spend hours in agonizing pain, with facial contortions, gasping for breath and dis- Individual perinatal matrices also have fixed associations with activities in
charging enormous amounts of muscular tension in tremors, twitches, violent the Freudian erotogenic zones and with specific categories of psychiatric disorders.
shaking and complex twisting movements. The face may turn dark purple or dead All these complex interrelations are shown in the synoptic paradigin on pages
pale, and the pulse show considerable acceleration. The body temperature usually 75-78. They provide clues to the understanding of many otherwise puzzling
dscillates in a wide range, sweating may be profuse, and nausea with projectile aspects of LSD experiences, and also have far-reaching implications for
vomiting is a frequent occurrence. psychiatric theory. This paradigm demonstrates, among other things, the close
It is not quite clear at the present stage of research how the above experi- parallels between the stages of biological delivery and the pattern of sexual
ences are related to the circumstances of the individual’s actual biological birth. } orgasm. The similarity between these two biological patterns is a fact of funda-
Some LSD subjects refer to them as reliving of their birth trauma, others do not inental theoretical iniportance. It makes it possible to shift the etiological em-
make this explicit link and conceptualize their encounter with death and rebirth in phasis in the psychogenesis of emotional disorders from sexual dynamics to peri-
purely symbolic, philosophical, and spiritual terms. However, even in this latter natal matrices, without denying or negating the significance and validity of the
group perinatal experiences are quite regularly accompanied by a complex of basic Freudian principles for understanding the psychodynamic phenomena and
physical symptoms that can best be interpreted as a derivative of biological birth. their mutual interrelations.
 74 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 75

In the following text, Basic Perinatal Matrices will be discussed in the BPM I
sequence in which the corresponding phases of biological delivery follow during
childbirth. In serial LSD sessions this chronological order is not maintained, and
Related Psychopathological Syndromes
elements of individual matrices can occur in most variegated sequential patterns.
© The death-rebirth process does not consist of one single experience of dying and schizophrenic psychoses (paranoid symptomatology, feelings of mystical union,
being reborn, no matter how profound and complete this experience might feel. encounter with metaphysical evil forces, karmic experiences); hypochondriasis
As a rule it takes a great number of death-rebirth sequences and an entire series of (based on strange and bizarre physical sensations); hysterical hallucinosis and
high-dose LSD sessions to work through the material on the perinatal level, with confusing daydreams with reality
all its biological, emotional, philosophical and spiritual manifestations.
In this. process the individual, has.to.face the deepest, roots_of existential Corresponding Activities in Freudian Erotogenic Zones
despair, metaphysical anxiety and loneliness, murderous aggression, abyst I guilt
~and inferiority feelings, as well as excruciating physical discomfort and the agony libidinal satisfaction in all erogenic zones; libidinal feelings during rocking and
of total annihilation. These experiences open up access to the opposite end of the bathing; partial approximation to this condition after oral, anal, urethral, or
spectrum—orgiastic feelings of cosmic proportions, spiritual liberation and en- genital satisfaction and after delivery of a child
lightenment, a sense of ecstatic connection with all of creation, and mystical union
with the creative principle in the universe. Psychedelic therapy involving ex- Postnatal Life
Associated Memories from
periences on the perinatal level thus seems to represent a twentieth-century version
of a process that has been practiced through millenia in various temple mysteries, situations from later life where important needs are satisfied, such as happy
rites of passage, secret initiations, and religious meetings of ecstatic sects. moments from infancy and childhood (good mothering, play with peers, har-
monious periods in the family, etc.), fulfilling love, romances; trips or vaca-
tions in beautiful natural settings; exposure to artistic creations of high aesthetic
value; swimming in the ocean and clear lakes, etc.

Phenomenology in LSD Sessions

undisturbed intrauterine life: realistic recollections of “good womb” experiences;
“oceanic” type of ectasy; experience of cosmic unity; visions of Paradise;
disturbances of intrauterine life: realistic recollections of “bad womb
experiences” (fetal crises, diseases and emotional upheavals of the mother, twin
situation, attempted abortions), cosmic engulfment; paranoid ideation;
unpleasant physical sensations (“hangover,” chills and fine spasms, unpleasant
tastes, disgust, feelings of being poisoned); association with various
transpersonal experiences (archetypal elements, racial and evolutionary
memories, encounter with metaphysical forces, past-incarnation experiences, etc.)
 77
CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject
76
i
1 BPM III
BPM Il

Related Psychopathological Syndromes

Related Psychopathological Syndromes
automutila-
schizophrenic psychoses (sadomasochistic and scatological elements,
schizophrenic psychoses (elements of hellish tortures, experience of meaningless l sexual behavior) ; agitated depressio n, sexual deviation s (sado-
tion, abnorma
“cardboard” wortd); severe, inhibited “endogenous” depressions; irrational eating of feces); obsessive -
masochism, male homosexuality, drinking of urine,
inferiority and guilt feelings; hypochondriasis (based on painful physical sensa- psychogenic asthma, tics, stammering; conversion and
compulsive neuroses;
tions); alcoholism and drug addiction organ
anxiety hysteria; frigidity and impotence; neurasthenia; traumatic neuroses;
is; psoriasis; peptic ulcer
neuroses; migraine headache; enuresis and encopress
Corresponding Activities in Freudian Erotogenic Zones
oral frustration (thirst, hunger, painful stimuli): retention of feces and/or urine; Corresponding Activities in Freudian Erotogenic Zones
sexual frustration; experiences of cold, pain and other unpleasant sensations
chewing and swallowing of food; oral aggression and destruction of an object;
process of defecation and urination; anal and urethral aggression; sexual
Associated Memories from Postnatal Life orgasm; phallic aggression; delivering of a child, statoacoustic eroticism
(jolting, gymnastics, fancy diving, parachuting)
situations endangering survival and bodily integrity (war experiences, accidents,
injuries, operations, painful diseases, near-drowning, episodes of suffocation,
imprisonment, brainwashing and illegal interrogation, physical abuse, etc.); Associated Memories from Postnatal Life
severe psychological traumatizations (emotional deprivation, rejection, threaten-
. t

and revolu-
ing situations, oppressing family atmosphere, ridicule and humiliation, etc.) struggles, fights and adventurous activities (active attacks in battles
service, rough airplane flights, cruises on stormy
tions, experiences in military
s car-drivi ng, boxing); highly sensual memories (carnival s, ,
oceans, hazardou
orgies, etc.); childhoo d
Phenomenology in LSD Sessions amusement parks and nightclubs, wild parties, sexual
activities; experiences of seduction and rape; in
observations of adult sexual
immense physical and psychological suffering; unbearable and inescapable
situation that will never end; various images of hell; feelings of entrapment and females, delivery of their own children
encagement (no exit); agonizing guilt and inferiority feelings; apocalyptic view
of the world (horrors of wars and concentration camps, terror of the Inqui- Phenomenology in LSD Sessions
sition; dangerous epidemics; diseases; decrepitude and death, etc.); meaningless- between pain and
intensification of suffering to cosmic dimensions; borderline
ness and absurdity of human existence; “cardboard world” or the atmosphere of brilliant colors; explosion s and fireworks;
pleasure; “volcani c” type of ecstasy;
artificiality and gadgets: ominous dark colors and unpleasant physical symptoms ent in
(feelings of oppression and compression, cardiac distress, flushes and chills, sadomasochistic orgies; murders and bloody sacrifice, active engagem
and dangerou s explorati ons;
sweating, difficult breathing) fierce battles; atmosphere of wild adventure

a
and scenes of harems and carnivals ; experiences
intense sexual orgiastic feelings
of dying and being reborn; religions
involving bloody sacrifice (Aztecs, Christ’s
suffering and death on the cross, Dionysus,
etc.); intense physical manifestations
(pressures and pains, suffoeation,
muscular tension and discharge in tremors
and twitches, nausea and vomiting,
hot flushes and chills, sweating, cardiac
distress, problemis of sphincter control,
ringing in the ears)
 VARIABLES iN LSD THERAPY Personality of the Subject 79
78 CRITICAL

BPM IV Perinatal Matrix I (Primal Union With Mother)

The first perinatal matrix (BPM I) is related to primal union with the mother, to
the original state of intrauterine existence during which the maternal organism
Related Psychopathological Syndromes and the child form a symbiotic unity. When no noxious stimuli intercede, the
schizophrenic psychoses (death-rebirth experiences, messianic delusions, conditions for the fetus are close to being ideal, involving protection, security and
elements of destruction and recreation of the world, salvation and redemption, continuous satisfaction of all needs. However, a variety of adverse circumstances
identification with Christ); manic symptomatology; female homosexuality; can interfere with this condition. These involve diseases and difficult emotional
exhibitionism states of the mother as well as disturbing influences from the outside world, such
as toxic factors, loud noises, and mechanical concussions or vibrations. The first
perinatal matrix has therefore its positive and negative aspects; subjects frequently
Corresponding Activities in Freudian Erotogenic Zones refer to them as the “good womb” and the “bad womb” experience.
satiation of thirst and hunger; pleasure of sucking; libidinal feelings after defe- The elements of undisturbed intrauterine existence can be experienced in
cation, urination, sexual orgasm, or delivery of a child LSD sessions in a concrete biological form or in the form of its spiritual counter-
part, the experience of cosmic unity. Although the “oceanic feelings” of the em-
bryonal state are not identical with the experience of cosmic unity, there appears
Associated Memories from Postnatal Life
to be a deep association and overlap between these two conditions. The experience
fortuitous escape from dangerous situations (end of war or revolution, survival of cosmic unity is characterized by transcendence of the usual subject-object
of an accident or operation); overcoming of severe obstacles by active effort; dichotomy. The individual in this state becomes deeply aware of his or her unity
episodes of strain and hard struggle resulting in a marked success; natural with other people, nature, and the entire universe, and with the ultimate creative
scenes (beginning of spring, end of an ocean storm, sunrise, etc.) principle, or God. This is accompanied by an overwhelming positive affect that
can range from peace, serenity and bliss to an ecstatic rapture. In this state the
categories of space and time are transcended and subjects can perceive themselves
Phenomenology in LSD Sessions as existing outside of the usual space-time continuuin, In the extreme, they may
enormous decompression, expansion of space, visions of gigantic halls; radiant experience eternity and infinity within a period lasting seconds or minutes of
light and beautiful colors (heavenly blue, golden, rainbow, peacock feathers); actual clocktime. Other typical characteristics of this state are a sense of
feelings of rebirth and redemption; appreciation of simple way of life; sensory sacredness and of ultimate insight into the true and real nature of existence. Ac-
enhancement; brotherly feelings; humanitarian and charitable tendencies; occa- counts or descriptions of this revelatory experience are usually full of paradoxes
sional manic activity and grandiose feeling; transition to elements of BPM I; and appear to violate the basic laws of Aristotelian logic. This state of mind is
pleasant feelings may be interrupted by umbilical crisis: sharp pain in the referred to as “contentless yet all-containing,” “formless but pregnant with form,”
navel; loss of breath, fear of death and castration, shifts in the body, but no one of “cosmic grandeur yet utmost humility,” or one characterized by loss of ego
external pressures while at the same time the ego has expanded and become the whole universe. Dif-
ferent subjects experience and describe this event within different symbolic frame-
works. Most frequent references are to Paradise, The Garden of Eden, Heaven,
Elysian Fields, unio mystica, the Tao, Atman-Brahman union, or Tat tvam asi
(Thou art That). |
With the eyes closed, the phenomenon of cosmic unity is experienced as an
independent complex experiential pattern of oceanic ecstasy. With the eyes open,
it results in an experience of merging with the environment and a sense of unity
with perceived objects. It is basically this experience that is defined by Walter
Pahnke’s (76) mystical categories and that Abraham Maslow (63) calls a “peak
experience.” In LSD sessions, feelings of cosmic unity seem to be closely related to
“good womb” experiences, “good breast” experiences, and happy childhood mem-
ories. They also appear to represent an important gateway to a variety of
transpersonal experiences, such as ancestral memories, elements of the racial and
collective unconscious, karmic phenomena, evolutionary memories, and various
archetypal constellations. The disturbances of intrauterine existence can likewise
be experienced in concrete biological form or symbolically as encounters with
various demonic appearances, metaphysical evil forces, or malefic astrological in-
fluences.
 Personality of the Subject 81
80 CRITICAL VARIABLES IN LSD THERAPY

experienced separately, simultaneously, or in an alternating fashion. The deepest

As far as the relation to memory mechanisms is concerned, the positive
level is related to various concepts of hell—a situation of unbearable suffering that
aspects of BPM I are related to positive COEX sytems. The positive facet of BPM 1
will never end—as it has been depicted by many religions of the world. In a more
seems to represent the basis for the recording of all later life situations in which the
superficial version of the same experiential pattern, the subject is confronted with
individual is relaxed, relatively free from needs, and not disturbed by any un-
images of our planet and sees the whole world as an apocalyptic place full of
pleasant stimuli. Negative aspects of BPM I have'similar links to certain negative
bloody terror, senseless suffering, genocidal wars, racial hatred, dangerous epi-
COEX sytems.
In regard to the Freudian erotogenic zones, the positive aspects of BPM I demics, and natural catastrophes. Existence in this world appears to be completely
meaningless, nonsensical and absurd, and the search for any meaning in human
coincide with the biological and psychological condition in which there are no
life futile. While under the influence of this matrix the individual perceives the
tensions in any of these zones and all the partial drives are satisfied. Conversely,
world and human existence as if through a negatively biased stencil; he or she
satisfaction of needs in these zones (satiation of hunger, release of tension by urin-
ation, defecation, sexual orgasm, or delivery of a child) results in a superficial and appears to be blinded to any positive aspects of life. In the most superficial form of
partial approximation to the tension-free ecstatic experience described above. the experience, the subject sees his or her own concrete life situation in terins of
circular patterns and as completely desperate, unbearable, and full of insoluble
Perinatal Matrix I] (Antagonism With Mother) problems. Agonizing feelings of metaphysical loneliness, alienation, helplessness,
LSD subjects confronted with this experiential pattern frequently relate it to the hopelessness, inferiority and guilt are a standard part of this matrix.
The symbolism that most frequently accompanies this experiential pattern
very onset of the biological delivery and to its first clinical stage. In this situation
involves various images of hell, Christ’s humiliation and suffering, and the theme
the original equilibrium of the intrauterine existence is disturbed, first by alarm-
of eternal damnation as exemplified by Ahasverus, the Flying Dutchman,
ing chemical signals and later by muscular spasms. Later, the fetus is periodically
Sisyphus, Ixion, Tantalus or Prometheus. The most important characteristic that
constricted by uterine contractions; the cervix is closed and the way out is not yet
differentiates this pattern from the following one is the unique emphasis on the
open,
role of the victim and the fact that the situation is unbearable, inescapable and
As in the previous matrix, the corresponding biologieal situations can be
eternal—there appears to be no way out either in space or in time.
relived in a rather realistic way. The symbolic concomitant of the onset of delivery
BPM II seems to represent the basis for recording all extremely unpleasant
is the experience of cosmic engulfment. It involves overwhelming feelings of
future situations, in which the passive and helpless individual is victimized and en-
increasing anxiety and awareness of an imminent vital threat. The source of this
dangered by an overwhelming and destructive external force. In regard to
approaching danger cannot be clearly identified and the subject has a tendency to
interpret his or her immediate environment or the entire world in paranoid terms. Freudian erotogenic zones, this matrix seems to be related to a condition of un-
pleasant tension in all of them. On the oral level, it is hunger, thirst, nausea, and
Not infrequently do individuals in this state report experiences of evil influences
painful stimuli; on the anal level, retention of feces; and on the urethral level,
coming from members of secret organizations, inhabitants of other planets,
malevolent hypnotists, black magicians, or diabolic gadgets emanating noxious retention of urine. The corresponding phenomena on the genital level are sexual
radiation or toxic gases. Further intensification of anxiety typically results in an frustration and excessive tension, as well as pains experienced by the delivering
experience involving a monstrous, gigantic whirlpool, a Maelstrom sucking the female in the first clinical stage of labor.
subject and his or her world relentlessly toward its center. A frequent variation of
this universal engulfment is an experience of being swallowed by a terrifying Perinatal Matrix III (Synergism With Mother)
monster, such as a giant dragon, octopus, python, crocodile, whale, or spider. A Many aspects of this complex experiential matrix can be understood from its asso-
less dramatic form seems to be the theme of descent into the underworld and ciation with the second clinical stage of biological delivery. In this stage, the
uterine contractions continue, but the cervix stands wide open and makes possible
encounter with various dangerous creatures and entities.
The symbolic counterpart of a fully developed first clinical stage of delivery gradual and difficult propulsion through the birth canal. There is an enormous
is the experience of no exit. An important characteristic of this experiential pattern struggle for survival, crushing mechanical pressures, and often a high degree of
anoxia and suffocation. In the terminal phases of delivery the fetus may experi-
is the darkness of the visual field and the ominous and sinister colors of all the
ence immediate contact with a variety of biological materials, such as blood,
images that accompany it. Subjects feel encaged or trapped in a monstrous claus-
mucus, fetal liquid, urine and even feces.
trophobic situation and experience incredible psychological and physical tortures.
From the experiential point of view, this pattern is rather ramified and com-
The situation is typically absolutely unbearable and appears to be endless and
plicated; beside actual realistic reliving of various aspects of the struggle through
hopeless. While under the influence of this matrix the individual cannot see the
the birth canal it almost always involves a variety of phenomena that can be
possibility of any end to his or her torments nor any form of escape from thein.
arranged in typical sequences. Its most iniportant facets are an atinosphere of
Death-wishes and suicidal craving can be combined with feelings of futility and
: titanic fight, sadomasochistic orgies, intense sexual sensations, scatological in-
with a conviction that not even physical death would terminate this hellish state
volvement, and the element of purifying fire (pyrocatharsis) occurring in various
and bring relief.
This experiential pattern can be manifested on several levels, which may be . corhbinations. The above elements constitute the death-rebirth struggle.
§2 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 83

The subject experiences in this state powerful currents of energy streaming

through his or her entire body and increasing to a level of concentration and con-
densation that seems to transcend all imaginable limits. This is followed by epi-
sodes of explosive discharge and feelings of ecstatic release. Visions typically
accompanying these experiences involve titanic battles of universal proportions,
archetypal feats of super-heroes, explosions of atomic bombs, thermonuclear reac-
tions, launchings of missiles and spaceships, power plants, hydroelectric stations,
high-voltage power lines, dramatic scenes of destruction in modern wars, gigantic
conflagrations, exploding volcanoes, earthquakes, tornadoes and other natural
catastrophes. A mitigated form of this experiential pattern is associated with
visions of medieval battles, bloody revolutions, dangerous hunts for wild animals,
or discoveries and conquests of new continents.
Another important aspect of this experiential matrix is excessive activation
of sadomasochistic elements in the personality of the subject. Enormous amounts
of aggressive energy are being discharged and consumed in destructive and self-
destructive fantasies, images, and vivid experiences. The individual indulges in
rapes, various sexual perversions involving pain, bestial murders, tortures and
cruelties of all kinds, executions, mutilations, bloody sacrifices, and self-sacrifices.
This can be accompanied by suicidal ideation, fantasies, or even tendencies in-
volving brutal and mutilating self-destruction.
Sexual arousal can reach an unusually high degree and be expressed in com-
plex scenes of unbridled orgies, pornographic sequences, visions of Middle-Eastern
harems, endless Oriental nuances of the art of loving, lascivious carnivals, and
rhythmic sensual dances. In this context, many LSD subjects discover a close
experiential link between agony and sexual ecstasy; they realize that intense
orgiastic arousal can border on suffering and mitigated agony can be experienced
as sexual pleasure.
The scatological facet of the death-rebirth process can be very complete and
have not only visual and tactile, but also olfactory and gustatory dimensions. The
subject can experience himself or herself as wallowing in excrement, drowning in
cesspools, crawling in offal or sewage systems, eating feces, swallowing phlegm,
drinking blood or urine, and sucking on putrefying wounds. This is often followed
by an experience of passing through a purifying and rejuvenating fire; its over-
powering flames seem to destroy whatever is corrupted and rotten in the indi-
vidual and prepare him or her for the experience of spiritual rebirth.
The religious and mythological symbolism of this matrix is most frequently
derived from religions that glorify bloody sacrifice or use it as part of their cere-
monies. Quite common are allusions to the Old Testament; images of Christ’s suf-
fering and death on the cross; scenes of worshipping Moloch, Astarté or Kali; and
visions of rituals from various Pre-Columbian cultures using sacrifice and self-
sacrifice, as they were practiced in the Aztec, Mixtec, Olmec, and Mayan reli-
gions. Another group of images is related to religious rituals and ceremonies in-
volving sex and wild rhythmic dances: fertility rites, phallic worship, or various
tribal religions of the aborigines. A frequent symbol associated with the purifying COR LTV).
fire is the image of the legendary bird the Phoenix. A very appropriate symboliza-
“re o4 of he,
‘

tion of the scatological aspect of the death-rebirth struggle is Hercules cleaning the (Above) Insight into the connection between birth and crucifixion—the crucified fetus.
stables of King Augeas, or the Aztec goddess Tlacolteutl, Devourer of Filth, a (Below) The connection between intrauterine existence and transcendental feelings of
deity of child-birth and carnal lust. peace—a fetus inside a pyramid.
84 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 85
F

mechanism of sexual orgasm, and the feelings of the delivering woman in the
second stage of labor.

Perinatal Matrix IV (Separation From Mother)

This perinatal matrix seems to be meaningfully related to the third clinical stage
of delivery. In this final phase, the agonizing process of the intense struggle
culminates; the propulsion through the birth canal is completed and the extreme
intensification of tension and suffering is followed by a sudden relief and relaxa-
tion. After the umbilical cord is cut blood ceases to flow through its vessels, and
the child has to develop its own systein of respiration, digestion and elimination.
The physical separation from the mother has been completed and the neonate
starts its existence as an anatomically independent individual.
As in the case of the preceding matrices, some of the experiences belonging
here seem to represent a realistic reenactment of the actual biological events dur-
ing this phase, as well as specific obstetric interventions. The symbolic counterpart
of this final stage of delivery is the death-rebirth experience; it represents the ter-
mination and resolution of the death-rebirth struggle. Physical and emotional
agony culminates in a feeling of utter and total annihilation on all imaginable
levels. It involves an abysmal sense of physical destruction, emotional catastrophe,
intellectual defeat, ultimate moral failure, and absolute damnation of transcen-
dental proportions. This experience is usually described as “ego death”; it seems to
entail an instantaneous and merciless destruction of all the previous reference
points in the life of the individual. .
wa After the subject has experienced the limits of total annihilation and “hit the
cosmic bottom,” he or she is struck by visions of blinding white or golden light.
A seatological experience showing the subject drowning in a gigantic cesspool.
The claustrophobic and compressed world of the birth struggle suddenly opens up
and expands into infinity. The general atmosphere is one of liberation, salvation,
redemption, love, and forgiveness. The subject feels unburdened, cleansed and
Several important characteristics of this experiential pattern distinguish it purged, and talks about having disposed of an incredible amount of personal “gar-
from the previously described no-exit constellation. The situation here does not bage,” guilt, aggression, and anxiety. This is typically associated with brotherly
seem hopeless and the subject is not helpless. He or she is actively involved and has feelings for all fellowmen and appreciation of warm human relationships, friend-
the feeling that the suffering has a definite direction and goal. In religious terms, ship and love. Irrational and exaggerated ambitions, as well as cravings for
this situation would be closer to the concept of purgatory than to that of hell. In money, status, fame, prestige and power, appear in this state as childish, irrele-
addition, the subject does not exclusively play the role of a helpless victim. He is vant and absurd. There is often a strong tendency to shiare and engage in service
an observer and can at the same time identify with both sides, to the point that it and charitable activities. The universe is perceived as indescribably beautiful and
might be difficult to distinguish whether he is the aggressor or the victim. While radiant. All sensory pathways seem to be wide open and the sensitivity to and
the no-exit situation involves sheer suffering, the experience of the death-rebirth appreciation of external stimuli is greatly enhanced. The individual tuned into this
struggle represents the borderline between agony and ecstasy and the fusion of experiential area usually discovers within himself or herself genuinely positive
both. It seems appropriate to refer to this type of experience as “volcanic ecstasy” values, such as a sense of justice, appreciation of beauty, feelings of love, and self-
in contrast to the “oceanic ecstasy” of the cosmic union. respect as well as respect for others. These values, as well as the motivations to
As a memory matrix, BPM III is related to all experiences of the individual pursue them and live in accordance with them, appear on this level to be intrinsic
involving intense sensual and sexual elements, to wild, hazardous and exciting to human nature.‘ They cannot be satisfactorily explained in terms of compensa-
adventures, as well as scatological exposures. Memories of sexual abuse, orgies, tion, reaction-formation, or sublimation of primitive instinctual drives. The indi-
and violent rapes are also recorded in this context. In regard to the Freudian vidual experiences them as genuine and integral parts of the universal order.
erotogenic zones, this matrix is related to those activities which bring sudden relief The symbolism associated with the experience of death and rebirth can be
and relaxation after a prolonged period of tension. On the oral level it is the act of drawn from many different cultural frameworks. The element of ego death can be
chewing and swallowing of food (or conversely, of vomiting); on the anal and associated with visions of various destructive deities, such as Moloch, Shiva the
urethral level, the process of defecation and urination; on the genital level, the Destroyer, Huitzilopochtli, and the terrible goddesses Kali and Coatlicue, or expe-
86 CRITICAL VARIABLES IN LSD THERAPY Personality of the Subject 87

rienced in full identification with the death of Christ, Osiris, Adonis, or Dionysus. can also find its expression in shaping the perception of the world. BPM IV gives
Typical symbolism of the moment of rebirth involves fantastic visions of radiant the world a touch of freshness, novelty, cleanliness and joy, associated with a sense
sources of liglit experienced as divine, heavenly blue cosmic spaces, magnificent of triumph.
rainbow spectra, or stylized peacock designs. Rather frequent are non-figurative The above descriptions reflect only the most general characteristics of the
images of God, as exemplified by the Tao, Atmman-Brahinan, Allah, or the Cosmic perinatal matrices in their function as governing systems; the individual ex-
Sun. On occasion subjects may see personified images and traditional representa- periences that occur within this context represent manifestations of their specific
tions of God and the various deities of specific religions. Thus God can appear in content as described earlier (see paradigm on pages 75-78). Like the COEX
the Christian form as an archetypal wise, old man sitting on a throne surrounded systems, perinatal matrices show a complicated two-sided interaction with the
by cherubim and seraphim in radiant splendor. Also quite common in this context elements of the environment. After a poorly-resolved LSD session, the dynamic in-
is the experience of union with the Great Mother, such as the Divine Isis of the fluence of the activated negative matrix can continue in the subject's everyday life
Egyptians, Cybele, or the Virgin Mary. Joining the Greek gods on Mount Olym- for indefinite periods of time. After a well-integrated session of a perinatal nature,
pus in drinking nectar and eating ambrosia, admission to the Germanic Valhalla, he subject can be under the continuing influence of the positive matrix that
or advent to the Elysian fields are some additional symbolic alternatives for the ominated the experiential field at the time when the effect of the drug was wear-
rebirth experience. Other visions involve gigantic halls with richly decorated ing off. Conversely, external influences involving elements characteristic of the
columns, marble statues and crystal chandeliers, or beautiful natural scenery individual perinatal matrices can facilitate specific corresponding experiences
—the star-filled sky, majestic mountains, luscious valleys, flourishing meadows, or related to the death-rebirth process.
clear lakes and oceans.
In regard to memory, BPM IV represents a matrix for the recording of all TRANSPERSONAL EXPERIENCES
later situations involving major personal success and termination of conditions of
prolonged serious danger, such as ends of wars or revolutions, survival of acci- The common denominator of this otherwise rich and raimified group of phe-
dents, or recoveries from severe diseases. As far as Freudian erotogenic zones are nomena is the subject’s feeling that his or her conscoiusness has expanded beyond
concerned, BPM IV is associated on all the levels of libidinal development with the usual ego boundaries and has transcended the limitations of time and space. In
the condition of satisfaction immediately following an activity that reduced or the “normal” or usual state of consciousness, we experience ourselves as existing
discharged tension (swallowing of food, relieving vomiting, defecation, urination, within the boundaries of the physical body (the body image) and our perception of
sexual orgasm and delivery of a child). the environment is restricted by the physically determined range of exteroceptors.
The Basic Perinatal Matrices have a function on the perinatal level which is Both our internal perception (interoception) and the perception of the external
comparable to the one that COEX systems play in the psychodynamic realm. The world (exteroception) are confined by the usual spatial and temporal boundaries.
phenomena occurring in psychedelic sessions of a predominantly perinatal nature Under ordinary circumstances we vividly experience only our present situation
can be understood as the result of successive exteriorization, abreaction, and inte- and our iinmediate environment; we recall past events and anticipate the future
gration of the content of negative perinatal matrices, (BPM II and III) and con- or fantasize about it.
necting with the positive ones (BPM I and IV). When a perinatal matrix domi- In transpersonal experiences, as they occur in psychedelic sessions or in
nates the experiential field its content determines not only the subject’s emotional various non-drug frameworks, one or several of the above limitations appear to be
reactions, thought-processes and physical manifestations, but also his or her per- transcended. Many experiences belonging to this category are interpreted by the
ception of the physical and interpersonal environment. The hegemony of BPM I subjects as regressions in historical time and explorations of their biological or
provides a totally positive stencil which makes the subject see the world as radiant, spiritual past. It is not unusual in psychedelic sessions to experience quite concrete
incredibly beautiful, safe, nourishing, and essentially a manifestation of the and realistic episodes identified as fetal and embryonic memories. Many subjects
divine. Transition from BPM I to BPM II (cosmic engulfment) introduces the ele- report vivid sequences on the level of cellular consciousness which seem to reflect
ment of insidious, but very basic, threat. The world and all its components seem their existence in the form of a sperm or ovum at the moinent of conception.
to be closing in on the subject and seem to represent a serious danger to his or her Sometimes the regression appears to go even further and the individual has a con-
security, sanity, and life. The subject tends to fear entrapment and inight make an vinced feeling of reliving memories from the lives of his or her ancestors, or even
attempt to escape from the treatment room, not recognizing that the trap is inside. drawing on the racial and collective unconscious. On occasion, LSD subjects
Feelings of panic and paranoia are typical concomitants of this state. In terms of report experierices in which they identify with various animal ancestors in the
an experiential stencil, BPM II is the exact opposite of BPM I. The world is seen as evolutionary pedigree or have a distinct feeling of reliving episodes from their exis-
a hopeless place of diabolic, absurd and meaningless suffering. It can also have an tence in a previous incarnation.
empty cardboard-like quality or the bizarre and grotesque character of a circus Some other transpersonal phenomena involve transcendence of spatial
sideshow. The influence of BPM III typically gives the world the quality of a rather than temporal barriers. Here belong the experiences of merging with
dangerous battlefield, where one has to be on guard and struggle hard to defend another person into a state of dual unity or completely identifying with him or
one’s life. The sexual, sadomasochistic and scatological component of this matrix her, tuning into the consciousness of an entire group of persons or expanding one’s
 Personality of the Therapist or Guide 8&9
88 CHITICAL VARIABLES IN LSD THERAPY

organization is much looser and does not allow one to speak of dynamic governing
consciousness to the extent that it seems to encompass all of mankind. In a similar
systems and matrices as in the case of psychodynamic and perinatal material. In
way, one can transcend the limits of the specifically human experience and tune in
the process of transpersonal unfolding the very principles that would allow for
to what appears to be the consciousness of animals, plants, or even inanimate
organization and classification, such as the concepts of linear time, three-dimen-
objects. In the extreme, it is possible to experience the consciousness of all crea-
sional space, matter, causality, and ultimately form itself, are progressively ques-
tion, of our planet, of the entire material universe. Another phenomenon related -
tioned, undermined and transcended.
to the transcendence of normal spatial limitations is consciousness of certain parts '
Emerging transpersonal experiences tend to influence the perception of one-
of the body such as various organs, tissues, or individual cells. An important cate-
self, of the persons present in the room, and of the physical environment. All these
gory of transpersonal experiences involving transcendence of time and/or space are
elements can appear systematically transformed in a certain direction to fit the
the various ESP phenomena, such as out-of-body experiences, telepathy, precogni-
and space aud time travel.
content of the emerging theme, whether it is an ancestral or phylogenetic
tion, clairvoyance and clairaudience,
memory, elements of the racial and collective unconscious, archetypal structures,
In a large group of transpersonal experiences, the extension of consciousness
or a karmic pattern. A powerful transpersonal experience that has not been com-
seems to go beyond the phenomenal world and the time-space continuum as we
pleted in a psychedelic session, such as manifestation of an important archetype or

Puree
perceive it in our everyday life. Quite common examples are the experiences of an
reliving of a past-incarnation memory, can continue to influence the subject for an
encounter with spirits of deceased human beings or supra-human spiritual entities.
indefinite period of time after the drug experience has worn off.
LSD subjects also report numerous visions of archetypal forms, individual deities
and demons, and complex mythological sequences. An intuitive understanding of
universal symbols, or the arousal of the Kundalini and activation of various
chakras are additional examples of this category. In the extreme form the indi-
PERSONALITY OF THE THERAPIST OR GUIDE
vidual consciousness seems to encompass the totality of existence and identify with
Numerous observations made during clinical research with LSD strongly suggest
the Universal Mind. The ultimate of all experiences appears to be the Supracosmic
that the personalities of the therapist, the co-therapist, the sitters, or any persons
and Metacosmic Void, the mysterious primordial emptiness and nothingness that
present are factors of paramount significance in structuring the content, course,
is conscious of itself and contains all existence in a germinal forin.
and outcome of psychedelic sessions. Probably the single most important element
Although we have discussed transpersonal experiences in the context of
determining the nature of an LSD experience is the feeling of safety and trust on
extrapharmacological variables related to the personality of the subject, such an
the part of the experient. This is, of course, critically dependent on the presence or
approach presents serious difficulties. On the one hand, transpersonal phenomena
absence of the guide, his or her personal characteristics, and the nature of the rela-
occur on the same continuum as psychodynamic and perinatal experiences in the
tionship between the subject and this person. It is absolutely essential for the
process of the subject’s deep self-exploration and probing of his or her unconscious.
successful course and outcome of an LSD session that the subject lets go of his or
On the other hand, from the point of view of present conceptual frameworks,
her usual defenses and surrenders to the psychedelic process. This usually requires
their sources frequently appear to be outside the conventionally defined context of
future, remote locations, or other dimensions of
the possibility of relegating the reality testing and all the decisions on practical
the individual—in pre-history,
matters to a trusted sitter.
existence. The psychodynamic level draws from the individual’s history and is
A person taking a psychedelic drug alone cannot really fully abandon con-
clearly biographical in origin and nature. Perinatal experiences seem to represent
as is reflected by their
trol at the crucial moments of the experience, because a part of him or her has to
a frontier between the personal and the transindividual,
continue playing the role of the reality-oriented judge and sitter. However, total
deep association with biological birth and death. The transpersonal realm, then,
surrender is absolutely essential for completing the experience of ego death, one of
reflects the connections between the individual and cosmos mediated through
the crucial steps in the LSD process. Certain important problems that originated
channels which seem at the present to be beyond our comprehension. All we can
in interpersonal situations, such as difficulties with basic trust, can also not be suc-
say in this respect is that somewhere in the process of perinatal unfolding a
cessfully resolved and overcome without the human element providing a correc-
qualitative leap seems to occur in which this process of in-depth exploration of the
tive emotional experience. 1 have repeatedly seen in the early stages of our
individual unconscious turns into an adventure in the universe-at-large and
therapeutic work with LSD,5 when the role of the sitter was not sufficiently
involves what can best be described as the superconscious mind.
understood, that patients were not able to overcome certain recurrent impasses in
Intimate knowledge of the transpersonal realms is absolutely essential not
their LSD sessions until the therapist promised to stay with them through the en-
only for the understanding of the psychedelic process, but for any serious ap-
tire experience and never leave the room.
proach to such phenomena as shamanism, religion, mysticism, rites of passage,
_mythology, parapsychology, and schizophrenia. Transpersonal experiences in If psychedelic sessions are conducted for therapeutic purposes, the emotional
significance of the therapist for the patient has two distinct components. The first
LSD sessions as well as in non-drug states tend to occur in thematic clusters. Thus,
one is based on the reality of the patient’s actual life-situation at the time of
for example, embryonal experiences are typically associated with evolutionary
therapy and reflects the fact that the therapist is a person who is supposed to pro-
(phylogenetic) memories and with images of blissful or wrathful archetypal
vide help with crippling emotional symptoms and the difficulties of living. The
deities, depending on the nature of the intrauterine experience. However, their
 CRITICAL VARIABLES IN LSD THERAPY Personality of the Therapist or Guide v1

nvestment of time and energy, as well as the financial commitment necessary for nature of the maladjustive interpersonal patterns of the patient. If the situation
treatment, further accentuate the intensity of the patient’s emotional involvement. between the therapist and the patient is clear and open, this becomes a great
The second component of the therapeutic relationship is its transference aspect. In opportunity for therapeutic progress. However, if there are overt or covert mis-
LSD therapy this element is generally much more powerful than in conventional understandings, conflicts and distortions in the therapeutic relationship before the
psychotherapy, and tends to inereasc with the number of LSD sessions until the session, they can be exaggerated by the drug-cffect to such a degree that they
time it is resolved. It is based on the fact that the patients, in the course of become a serious impasse and eventually endanger the treatinent process. It is im-
long-term psychotherapeutic interaction in the sessions and outside of them, pro- portant therefore that the guide be aware during the sessions of his or her own
ject on the therapist a variety of strong emotional attitudes derived from impor- intrapsychic and interpersonal patterns, so that they do not interfere with the
tant figures of their past and present life, especially close family members. psychedelic process.
Although there exist techniques which can minimize the transference problems All the phenomena in LSD sessions that involve the subject, the sitters, and
during the free intervals between psychedelic sessions, this element plays an im- . their mutual relationships, are the result of a complicated interaction between the
portant role at the time of the drug effect. It is not unusual for the actions of the specific personality characteristics of each of them. The proportion of the indi-
therapist to have a far-reaching influence on the content and course of the ses- vidual contributions varies from situation to situation and session to session. How-
sions. At certain periods of the psychedelic experience, LSD subjects can show. ever, since the mental processes of LSD subjects are powerfully activated by the
unusually strong reactions to the therapists’ leaving or entering the room, offering drug, they usually play a more important role in determining the content and
or withdrawing physical contact, or to seemingly indifferent gestures and com- nature of such interactions unless some very serious countertransference problems
ents. Occasionally, even such phenomena as the colors of optical illusions and are involved on the part of the sitters.
visions, or intense physical symptoms such as severe nausea and vomiting, suffoca- The degree of the transference distortion seems to be related to the dosage
on, agonizing pain and cardiac distress, can change dramatically as a result of and to the nature of the unconscious material that is emerging in the session. In
the therapist's behavior, intervention, or interpretations. periods in which the subject is under the influence of the drug but is not dealing
The importance of the therapist as a powerful determinant of the session in- with any difficult emotional material, he or she can show unusual depth and clar-
creases considerably if LSD is administered after a long period of systematic inten- ity of perception. The ability for intuitive and empathic understanding of others
sive psychotherapy or if the drug is given repeatedly within the framework of a can be sharpened and deepened to a startling degree. In some instances, LSD
psycholytic series. In that case, it is not uncommon for the transference phe- subjects can make amazingly accurate readings of the sitters even at a time When
nomena to play a dominant role in the manifest content of an entire session.® they are struggling with emotional problems of various kinds. This happens when
The degree of human and professional interest of the therapist, his or her the nature of the problems they are facing is similar to or identical with problema-
clinical experience and therapeutic skill, personal security, freedom from anxiety, tic areas in the sitters. A deep exploration of certain unconscious structures within
and current physical and mental condition are very important factors in successful oneself can thus mediate an instant intuitive understanding of corresponding
LSD therapy. It is absolutely essential that, prior to the administration of LSD, elements in others.
e therapist examine his or her own motivation and attitudes toward the subject, In these situations, the personalities of the sitters, their thought-processes,
try to establish a good working relationship, and clarify the transference-counter- emotional reactions, attitudes and behavior patterns become especially important.
transference situation. The therapist should never offer LSD as an impressive and We have repeatedly observed that LSD subjects were able to tune into the inner
“magical” procedure to a patient who is stagnating in psychotherapy, just because feelings of the sitters with great accuracy. They were able to tell when the thera-
he or she can not tolerate the atmosphere of failure, insecurity, or helplessness. pist was fully concentrated, dedicated to the session, and pleased with its course
Another objectionable approach is to administer the drug to a patient who has or, conversely, distracted by other professional or personal problems, bored, tired,
been neglected for a long time because of personal or objective reasons, in order to dissatisfied with the course of the session, or worried about its unfavorable
compensate for these circurnstances and create a feeling that something important development. This is quite understandable in those cases where the LSD subject
is going on. Perhaps the most dangerous motivation for using LSD is the need to can see the sitters’ facial expressions. It is conceivable that the effect of the drug
demonstrate power and authority to a troublesome patient who is shattering the can sensitize an individual to various minor or even subliminal clues to the point
erapist’s sense of security. All these and similar problems, if not properly ana- where these would provide adequate information and sufficient feedback for ac-
lyzed, can easily contaminate the LSD session, especially if they happen to repli- curate reading. This could happen even in those cases where the phenomena in-
cate traumatic experiences in the patient’s past. volved were so subtle that under the conditions of conventional psychotherapy
Clarity in the relationship between the therapist and the subject is a they would escape the patient’s conscious attention. However, in some instances
necessary prerequisite for a successful course of therapy. As we mentioned earlier, where this happened the subjects had their eyes closed or covered by eyeshades; in
LSD can.best be described as an amplifier of mental processes. By activating the others, their eyes were open but they were not facing the therapist.
intrapsychic elements in the subject, it also amplifies the interpersonal situation It is also important to add that the subject's and the therapist's concepts of
between him or herself and other people present in the session. This makes it possi- what constitutes a “good” and productive session do not necessarily coincide,
ble to see the transference aspects of the relationship clearly and thus view also the especially at the time it is still underway. Therefore it is not possible for the LSD
{
 93
92 CRITICAL VARIABLES IN LSD THERAPY Personality of the Therapist or Guide

Quite
subject to guess the therapist’s feelings about the session automatically from his or variety of feelings and attitudes that the subject transfers onto the therapist.
her own evaluation. In some instances, the ability of the subjects to “read” the frequently, the projections take a much more elaborate and intricate form; in the
therapist correctly was truly striking and seemed to border on genuine extra- extreme, this can result in complex illusive transform ations of the therapist’s face,
sensory perception, Some patients correctly guessed not only the therapist's body image, and attire. Sometimes the symbolic meaning of such changes is im-
emotional tones, but also the specific content of his thought-proeesses, or they felt mediately clear and obvious; at other times their full understanding requires
connected with his memory system and accurately described certain concrete systematic and focused analytical work.
circumstances and recent or remote events from his life. There are several typical categories of problems reflected in these symbolic
Elements of accurate perception are more common in low-dose sessions, in transformations. The most common are those images that represent projections of

em
which the amount of LSD is not sufficient to activate important emotional the subject’s instinctual tendencies of an aggressive or sexual nature. Thus the
material. In high-dose sessions they occur by and large, at the beginning, before therapist can be illusively transformed into various figures representing violence,
s such
the subject’s experiential field is occupied by the emerging unconscious contents, cruelty and sadism. Here belong, for example, representatives of profession
historical
or later, after the difficult aspects of the experience have been worked through as a butcher, boxer, executioner, mercenary, or inquisitor; infamous
Caesar Nero, Voivod Dracula, Hitler, or Stalin; and an
and resolved. However, this is not an absolute rule and there exist significant figures like Genghis Khan,
guns, robbers, SS and Gestapo members, red
exceptions; episodes of unusual clarity occasionally occur at any dosage level and entire gallery of murderers , hired
characters from horror
at any time during the session. They seem to be associated with the nature of the commissars, head-hunting savages, and others. Famous
The
experience or a particular state of mind, rather than a specific time of the drug movies also occur frequently in this context, exemplified by Frankenstein,
reaction or its intensity. When LSD subjects are deeply engaged in their problem Creature from the Black Lagoon, Dracula, King Kong, and Godzilla. Another
of the
areas, most of their perceptions, thoughts, feelings and anticipations concerning manifestation of the subject's aggression is the symbolic transformation
the sitters have very little substantiation in reality. They are projections, reflecting therapist into a bloodthirsty predator—eagle, lion, tiger, black panther, jaguar,
the subject’s inner experiences—his or her emotions, instinctual tendencies, and shark, or tyrannosaurus. A similar meaning can be associated with the therapist
gladiator,
superego functions. changing into one of the traditional adversaries of such animals—a
In high-dose LSD sessions a good therapeutic relationship is an element of wild beasts. Archetypa l images symbolizi ng aggression are
hunter, or tamer of
critical importance. It is necessary to emphasize that even an ideal interpersonal they range froin evil magicians , malicious witches, and vam-
equally common;
aggressive
situation cannot completely prevent the occurrence of significant distortions under pires to devils, demons, and devouring deities. A subject tuned into
treatment room transform ed
the influence of the drug. However, if there is a clear and solid relationship be- themes in his or her own unconscious may see the
torture chamber, barrack in a con-
tween the experient and the sitters outside of the session context, the drug-induced into the cabinet of Dr. Caligari, a dungeon,
as
distortions become an important opportunity for learning and for corrective emo- centration camp, or a death cell. Innocent objects in the therapist's hand, such
tional experiences, rather than a danger to the psychedelic process. A good fountain pen, or a piece of paper, change into daggers, hatchets, saws,
a pencil,
therapeutic relationship helps the patient to let go of psychological defenses, sur- guns, and other murderous tools.
render to the experience, and cudure the difficult periods of sessions characterized In the sanie way, sexual tendencies can be manifested in the form of sym-
by intense physical and emotional suffering or confusion. The quality of the bolic projections. The therapist is perceived as an Oriental harem owner, a lewd
therapeutic relationship is essential for working through one of the most crucial lecher, prostitute, suburban pimp, metropolitan swinger, or a frivolous and pro-
situations in psychedelic therapy, the crisis of basic trust. miscuous bohemian painter. Don Juan, Rasputin, Poppea, Casanova, and Hugh
As long as the guide does not significantly contribute to the interpersonal Hefner were some other sexual symbols observed in this context. Images that ex-
configuration on a reality basis, in terms of strong countertransference, the sub- press sexual attraction without a pejorative undertone range from famous film
ject’s LSD experiences concerning the therapeutic situation reflect the nature of stars and legendary romantic lovers to archetypal gods of love.In advanced LSD
the emerging unconscious material. There exist many different forms and degrees sessions deified personifications of the male and female principles such as the
of projective distortion in the therapeutic relationship. The most superficial and Apollo-Aphrodite or Shiva-Shakti dyad occur frequently, and images of priests or
in-
simple manifestation of this kind is fantasizing or visualizing the therapist as priestesses in various love cults, fertility rites, phallic worship, or tribal rituals
assuming certain specific opinions and attitudes. If this occurs at a time when the volving sexuality are also quite common. On several occasions, transform ation of
subject has eye contact with the therapist, it can take the form of actual illusive the therapist's visage into the; “leonine face” of a leper or the deformed face of a
transformations of the facial expression. Thus the patient may see the therapist as syphilitic could be deciphered as a projection of sexual wishes combined with the
chuckling, smiling and laughing, or expressing condescension, irony and ridicule. threat of punishment.
He or she might find clear indications of sexual interest or even arousal in the Another typical category of illusive transformations involves projections of
therapist’s face and signs of seductiveness in his gestures. The therapist can appear the subject's Superego. The therapist is frequently perceived as various specific
to be critical, angry, hateful and aggressive, or emanate compassion, under- personages who evaluate, judge, or criticize the experient. These can be parental
standing and love. His face may appear to betray uncertainty, concern, fear, or teachers and other critical authorities from the subject’s life, priests,
figures,
guilt feelings. The nature of fantasies and transformations of this kind reflects the judges and jury members, various archetypal personifications of Justice, and even
94 CRITICAL VARIABLES IN LSD THERAPY Personality of the Therapist or Guide 95

Three representations of illusory

transformation of the therapist.
Ile appears as an Arabian mer-
chant dealing with dangerous in-
toxicating drugs (above left): a
wild and primitive African native
(left); and as an Indian sage radi-
ating perennial wisdom (above
right). Each image reflected the
nature and content of the patient's
psychedelic experience at that
particular time,

Illusory transformation of the therapist. [ere he becomes a sadistic monster who enjoys in-
flicting suffering on the patient. The angelic figure on the left represents the patient's aware-
ness that the tortures will ultimately lead to a spiritual opening. The castle on the right
reflects his vague awareness of a medieval scene of torture which he felt as a karmic
memory. The experience occurred during a session characterized by the transition from
BPM III to BPM IV.
 96 CRITICAL VARIABLES IN LSD THERAPY Personality of the Therapist or Guide 97

God or the Devil. Some other visions seem to reflect the part of the subject’s
Superego that represents the ego ideal. The therapist is then perceived as being an
absolutely perfect human, a person endowed with all imaginable virtues, possess-
ing and having achieved all that the patient always wanted—physical beauty,
moral integrity, superior intelligence, emotional stability, and a balanced life
situation.
A typical category of transformations reflects the subject's strong need for
unconditional love and undivided attention, as well as irritation at not having ex-
clusive possession and control of the therapist. This is most characteristic of
psychodynamic sessions that involve deep regression to early infancy and intense
anaclitic necds. Many patients find it difficult to accept the fact that they have to
share the therapist with other patients, that the therapist has a private life of his or
her own, or that the therapeutic framework sets certain clear limits on intimacy.
Whether the objective reality justifies it or not, many patients feel they are being
treated with professional coolness and scientific objectivity, or as experimental
guinea pigs. Even if physical contact is used in the sessions, a client sensitive in this
area may experience it as a therapeutic technique or a professional ploy rather
than a genuine expression of human affection.
The therapist’s curiosity concerning the patient's history or the dynamics of
his or her problems can in this context be ridiculed by an illusive change of the
therapist into Sherlock Holmes, Hercule Poirot, Leon Clifton, or just a caricature
of a detective with a large pipe, spectacles, and a magnifying glass. [is profes-
sional, objective and “scientific” approach to the patient can be caricatured in an
illusive transformation into a funny-looking, learned owl, sitting on a pile of
cobweb-covered volumes. The irritating lack of adequate emotional response and
professional “coolness” can be refleeted in a visual illusion showing him in the
thick protective suit of a medieval armored knight, astronaut, fireman, or scuba-
diver. The recording of the session may irritate the patient, even if he or she not
only agreed to it before the session, but specifically requested it. It can be ridi-
culed by a satirical vision of the therapist as a philistine bureaucrat, ambitious and
diligent schoolboy, or provincial clerk. The white coat, a common symbol of the
physician, can play an important part in this context; the medical role of the
therapist can be attacked by changing him into representatives of other professions
who also use white coats, such as grocers, barbers, or butchers. Transformations
of the therapist into Doctor Faust, observed in the past, were deciphered as allu-
sions to his. sophistication and title, the unconventional nature of his scientific Mlusory transformation of the therapist into a nosy detective with a large pipe (“Sherlock
Holmes”). The patient is depicting his irritation with the therapist's inquisitiveness and
quest, and the magical properties of the drug he uses; in some instances they also
objectivity.
reflected the wish that he follow Faust’s example and exchange science for mun-
dane pleasure.’

A very interesting, cartoon-like illustration of some of these problems that were in different stages of hatching. Since the experience of birth is an
occurred in one of the early sessions of Agnes, who was undergoing psycho- important therapeutic step in LSD therapy, hatching symbolized in this
lytic treatment for a severe chronic neurosis. In the phase of therapy when context the successful end of treatment and the cure of neurosis. The
she desperately wanted the therapist for herself and was jealous of all the patient-eggs were competing with each other, trying to expedite the hatch-
other patients, she experienced in her LSD session symbolic sequences from ing process, but also to win the affection of the therapist. The latter was
a chicken hatchery, which represented a satire on her LSD treatment. The represented by a system of electric bulbs providing scientifically ineasured
hatchery symbolized the Psychiatric Research Institute where she was in amounts of light and warmth. The patient herself was a dissatisfied little
therapy and her co-patients appeared as eggs with various flaws and defects chicken embryo who passionately competed for the artificial heat, since that
:
 THERAPY Personality of the Therapist or Guide 99
98 CRITICAL VARIABLES IN LSD

was all that was available. In reality, she wanted to be the single offspring
of a real mother hen and could not put up with the electric surrogate.

As indicated by this example, the transformation of the therapist does not

have to occur as an isolated phenomenon, but can be accompanied by simul-
taneous autosymbolic transformation of the patient and/or illusive change of the
entire environment.
Like most LSD phenomena, the illusive transformation of the guide and the
environment usually has a multi-level and overdetermined structure. Although
one specific incaning or connection may be in the center of awareness, one can
usually find a number of additional functions for the same image. As in the case of
dreams, there frequently exist several interpretations for the same phenomenon.
They involve material from different levels of the unconscious and, quite typical-
ly, opposing tendencies and emotions can find joint representation in a single con-
densed symbolic image. Although we have thus far been discussing visual
manifestations, which are the most striking, projective distortions can involve
other senses, such as hearing, smell, taste, and touch.
The concrete content of the illusive transformations reflects the type of the
LSD experience and the level of the unconscious that is activated. The most super-
ficial changes are of an abstract nature and do not seem to have any deeper sym-
bolic significance. The therapist’s face can appear undulating, distorted, or in
changing colors. On occasion, his or her skin is covered with mosaics and intricate A Sphinx moth seen in the therapist's eye.
geometrical designs that look like tattoos or aboriginal decorations. These changes
resemble the disturbances on the screen of a television set that is out of tune and
seem to reflect chemical stimulation of the sensory apparatus.
On the psychodynamic level, the illusive transformations reflect the basic skull on its back and is usually associated in folklore with death. This
themes of individual COEX systems colored by the specific content of the layer reflects a theme which was very important for Renata and formed the basis
that is at that time in the center of the experiential field. The therapist can be per- of her cancerophobia. As a result of certain childhood experiences, particu-
ceived as a parental figure, sibling, close relative, nanny, neighbor, or any signifi- larly sexual abuse by her stepfather at the age of eight, sex and death were
cant person who was instrumental in important childhood experiences. Doctors intimately connected in her unconscious. Summer nights and heavy sweet
and nurses who conducted painful medical interventions, acquaintances who fragrance suggest the atmosphere of romance and love-making; the Sphinx
played the roles of surrogate parents, adults who physically or sexually abused the flying around is a portent of death.
subject, and protagonists in various frightful episodes are typical representatives of Some additional associations showed the complicated, overdetermined,
this category. Occasionally, the therapist may assume the form of favorite and ingenious structure underlying this transformation. Renata read some-
animals, such as the family dog, pet rabbit or hen, or even an emotionally impor- where that the Sphinx caterpillars live on Atropa Belladonna or the deadly
.
tant children’s toy which was the subject’s surrogate companion. nightshade, which is known for its psychoactive properties and was used in
Sometimes the projective transformations do not directly reflect the medieval potions and ointments for the Witches’ Sabbath. Small doses of
biographical events recorded in a COEX system, but variations on its central Belladonna are hallucinogenic and larger doses extremely toxic. The
theme. The following example from an LSD session of Renata,® a patient who suf- hallucinogenic properties of Belladonna represent a link to the LSD process.
fered from severe cancerophobia, shows how even a seemingly insignificant par- Its relation to the orgies of the Witches’ Sabbath alludes to dangerous
tial transforination of the therapist can condense relevant material from different aspects of sex. Its connection with death, beside reemphasizing the closeness
levels. between sex and death, also points back to the LSD process which has the
death experience as an important element. Renata also remembered reading
When Renata looked at the therapist, the light reflection in his eye took somewhere that the Sphinx caterpillars sleep in an erect position. She found
the form of a large Sphinx moth. Free associations which Renata volun- a direct link from here to the traumatic situation of seduction by her step-
teered the next day brought out the following material: father during which she was confronted with his penis.
The Sphinx is a night moth that visits flowers with intoxicating fra- On the deepest level the name of the Sphinx moth pointed to the Egyp-
grance and sucks the nectar from them. It has a distinct mark of a human tian Sphinx. This image of the destructive female—a creature with a human
 101
Personality of the Therapist or Guide
100 CRITICAL VARIABLES IN LSD THERAPY

of boundaries and a feeling of fundamental oneness with the therapist, associated

head and animal body, which strangles its victims—occurs frequently in
with a sense of absolute safety and total nourishment.
LSD sessions dealing with the agony of birth and transcendence. It was on
Quite frequently during the death-rebirth process, the therapist assumes for
the perinatal level, in the process of biological birth, that Renata found the
the subject the role of the delivering mother and may actually be experienced as
deepest unconscious roots of the fusion and confusion in her between sex and
such; this can occur with both male and female sitters without regard to the actual
death,
sex identity. Under these circumstauces the transference relationship can assume a
symbiotic quality; it is characterized by a deep biologically rooted ambivalence,
The transformations of the therapist in sessions with strong perinatal em-
and its relevance is so basic that it appears to be a matter of life and death. The
phasis have a very different quality. The general direction of the projective change
therapist can become for the patient a magical and powerful figure of cosmic pro-
depends on the stage of the death-rebirth process, or the basic perinatal matrix
portions. The patient can have either a sense of participating in this power or of
which is activated at that time.
being in a totally passive, dependent and vulnerable position. A critical factor in
The basic elements and attributes associated with each of the matrices are
this situation seems to be the patient's ability to trust the world and human beings,
characteristic and quite distinct. For BPM I it is transcendental beauty, uncondi-
sense of
which essentially reflects his or her early history. The nature of the childhood ex-
tional love, merging of boundaries, an atmosphere of numinosity, and a
* perience determines whether a totally dependent role can be enjoyed or whether it
t
nourishment and protection. The very beginning of BPM II involves deep meta-
{ becomes a source of vital threat and paranoid ideation.
physical fear, feelings of threat and paranoia, and a sense of losing autonomy. A
Frequently the patient has to go through a profound crisis of basic trust to
fully developed BPM II is characterized by an atmosphere of irreversible entrap-
be able to reconnect with the nourishing aspects of the mother-child relationship.
ment, hopeless victimization, experience of endless, diabolical tortures and loss of
When the early symbiotic situation of the perinatal period is projected on the
one’s soul. BPM III imparts the elements of a titanic and bloody fight with
III to
therapist, LSD patients often lose the ability to differentiate clearly between the
sadomasochistic, sexual, and scatological features. The transition from BPM
therapist and themselves. Their perceptions, emotions and thoughts seem to merge
BPM IV is experienced as an overwhelming pressure to surrender completely and
with those of the therapist. This can result in a feeling of being magically influ-
unconditionally, abysmal fear of annihilation, and expectations of catastrophe.
enced or controlled by suggestion, hypnosis, telepathy, or even psychokinesis. The
BPM IV then has the unmistakable quality of spiritual liberation, deliverance
therapist appears to read their minds and know all their thoughts; the opposite is
from darkness, salvation, and illumination.
also common, namely, the sense of having access to the therapist's mind and shar-
If the subject is under the influence of one of the negative perinatal fre-
ing his feelings or thought-processes. Under these circumstances patients
matrices, the therapist can appear as a representative of elements and movements experiences verbally. They feel
quently find it unnecessary to communicate their
that threaten not only individuals but the entire world: the chief of a dangerous
either that the therapist automatically shares and knows the experience in all its
underground organization, a representative of an extraterrestrial civilization try-
details, or that he has prearranged it and controls it, so that everything is happen-
ing to enslave mankind, an important Nazi or Communist leader, a misguided
ing according to his plan. In critical stages of the death-rebirth process the
religious fanatic, a mad-genius scientist, or the Devil himself. Confronted with
therapist can become the murderous or life-giving womb, and can also be experi-
these images, the subject can lose the critical insight that he or she is involved in a
enced as the delivering obstetrician or midwife. This is especially frequent if the
symbolic process and experience a full-blown paranoid reaction. In more
treatment technique involves actual physical contact and support.
superficial and less convincing experiences, a number of specific elements of
The problems in the transference relationship on the perinatal level culmi-
perinatal symbolism can be projected onto the therapist; he can change into a
nate when the patient is approaching the moment of ego death, which coincides
mythological monster threatening to devour the subject, the Great Inquisitor, the
,4 with reliving the moment of biological birth. This involves totally letting go of all
commandant of a concentration camp, or a diabolic sadist. He or she can change
it defenses, all effective control, and all reference points, and is typically associated
into various historical figures known for their cruelty, sexual perverts, copro-
' with a profound crisis of basic trust. In this state of ultimate vulnerability the
philiacs, warriors, severely sick or wounded persons, conquistadors, Pre-
patient questions the character and motives of the therapist in an attempt to assess
Columbian priests, carnival figures, or crucified Christ. The specific form of these
the degree of danger in total surrender. Important negative aspects of the patient’s
transformations depends on the stage of the death-rebirth process, the level on
history emerge in an amplified form and are projected onto the therapist in
which! it is experienced, and the passive or active role of the subject.
various symbolic manifestations. In addition, the real flaws in the therapist's per-
When the positive matrices dominate the LSD session, the transformations
sonality, attitudes and motives, and the problems and conflicts in the therapeutic
have a very different quality. If it is BPM IV, the therapist can be perceived as a
relationship, are seen as if through a magnifying glass. The patient's perception of
triumphant military leader celebrating victory over a vicious enemy, the Savior,
the therapist can be-a reflection of his or her experience in the murderous birth
the embodiment of cosmic wisdom, a teacher of the deepest secrets of life and to
canal, and the.LSD process can appear at this point as a diabolic scheme
nature, a manifestation of the divine principle, or essentially God. The activation eternity, or steal their
destroy the patients, brainwash them, enslave them for
of BPM I has many of the elements of BPM IV, such as the radiance, sacredness,
souls.
and humor; however, these have a timeless quality instead of occurring as a stage
After the crisis of trust has been worked through and the bond of confidence
in the process of transition from death to rebirth. The subject can experience loss
 Personality of the Therapist or Guide 107
102 CRITICAL VARIABLES IN LSD THERAPY

, psychodynamic level, they cannot be deciphered and interpreted as symbolic

re-established, the transference phenomena tend to swing to the other extreme. A
representations of certain aspects of the patient’s present existence. Even those
subject influenced by BPM I or IV can see the therapist as the ultimate source of
patients who enthusiastically help to analyze various projective phenomena on the
love, security, and nourishment. He or she can experience the therapist as being
psychodynamic level refuse the Freudian approach to the transpersonal realm as
the good breast and the good womb at the same time. There do not seem to be any
more individual boundaries, only a continuous, free flow of thoughts, emotions, superficial, inadequate, and inappropriate.
and good energy. The patient experiences this as the ultimate process of nursing, The enormous significance of the therapist or sitter during the LSD sessions
in which the milk seems to be coming from a spiritual source and has miraculous has its consequences for psychotherapeutic practice. On the one hand, the role fre-
healing propertics. The same expericuce also seems to lave entbryonal qualities; quently presents serious problems for the therapist, who may come under emo-
the circulation of different kinds of spiritual emotions and energies seems to have tional pressures of various kinds and has to guard against all the intricate pitfalls
strong elements of the placentary exchange between the mother and child. Once of the transference and countertransference situation. On the other hand, the in-
this biological, emotional and spiritual link is established, the therapist can be tensification of the therapeutic relationship goes far beyond the limits of conven-
perceived not only as one’s own mother, but as the good inother in general-—the tional psychotherapy, frequently reaching the point of caricature. This makes it
archetypal image of the Great Mother, Mother Nature, and ultimately the entire easier for the patient and therapist to recognize and understand the transference
cosmos or God. nature of the problems involved. To an experienced therapist, the dimensions of
In LSD sessions of a transpersonal nature, the transference relationship has a
the therapeutic relationship reached in psychedelic sessions offer a unique oppor-
completely different quality. The illusive transformations of the therapist can no | tunity to mediate powerful corrective emotional experiences on very deep levels
longer be interpreted in the same way as those on the psychodynamic level-—as that are not easy to reach by conventional psychotherapy.
complicated symbolic images with a multilevel and overdetermined structure, or To be able to face all the challenges of psychedelic therapy, the therapist has
as projections reflecting various layers of the COEX systems. These illusive trans- to have special training that involves personal experiences with the drug. Because
formations also differ from the perinatal transference phenomena, which can be of the extraordinary nature of the LSD states and the limitations of our language
understood as repetitions of the nourishing and destructive aspects of the symbiotic in describing them, it is impossible for the future LSD therapist to acquire deeper
understanding of the process without first-hand exposure. Reading about psyche-
relationship with the mother. Transpersonal projections are phenomena that sui
generis defy further psychological analysis. delic experiences, attending seminars and lectures, or even witnessing sessions of
In general, almost all of the many types of transpersonal experiences can other people can only convey a superficial and inadequate knowledge. Personal
sessions have another important function: they offer an opportunity to work
find specific reflections in the therapeutic relationship. Thus the therapist can
through one’s own areas of conflict and problems on various levels. Some of the
assume the forms of powerful archetypal images, such as sacralized representatives
crucial issues that a future LSD therapist has to confront remain essentially un-
of various roles, or deities and demons. The transformations into the Cosmic Man,
the Wise Man, the Great Hermaphrodite, the Animus or Anima, Shiva, Kali,
touched in most forms of conventional therapy. Fear of death, total loss of con-
Ganesha, Zeus, Venus, Apollo, Satan, Isis, Cybele, or Coatlicue, would be ex-
trol, and the specter of insanity can be mentioned here as salient examples. Unless
amples in this category. Equally frequent are transformations of the therapist into the therapist deals successfully with these issues, the manifestations of the deep un-
a great religious teacher—Jesus, Moses, Mohammed, Buddha, Sri Ramana conscious of the patient will tend to activate his or her own problem areas and
Maharishi, and others. When the patient is experiencing elements of the racial and trigger difficult cinotional and psychosomatic responses. This can be conducive to
collective unconscious, the therapist may be transformed into a representative of serious transference-countertransference problems and places increased demands
another culture and/or a person existing in a different century. Such an episode on the defense system and self-control. LSD sessions in whtich the therapist has to
can also have a “past-incarnation experiential quality.” In that case, the patients struggle with his or her unresolved problems can become a real burden; they are
feel convinced that they are reliving memories from their past lives and that usually experienced as mutually draining and result in excessive fatigue.
the present situation is a replica or variation of an event that occurred in the Other important qualities and abilities of a good LSD therapist come from
remote past. It is quite common for clients to feel that they have met the therapist long clinical experience. With the increase in the number of sessions that he or she
in many of their previous incarnations. Occasionally, this can involve very com- has witnessed, the therapist becomes more comfortable with and less threatened
plex situations from different cultures and centuries which may be visualized in by various unusual phenomena that are quite common in psychedelic therapy. In
everyday practice he or she observes a great number of people suffering through
considerable detail.
Inclusion of the therapist into ancestral or phylogenetic memories occurs
quite frequently. In that case the therapist appears transformed into a specific
| dramatic experiences of dying, going crazy and feeling possessed by evil spirits, or
claiming that they went beyond the point of no return. Witnessing positive resolu-
tions of such states and seeing the same subjects only a few hours later radiant and
human or animal ancestor of the same or opposite sex. In general, the projective
joking, the therapist gradually devclops equanimity, confidence and tolerance in
transformations of the therapist on the transpersonal level are quite different from
regard to the entire spectruin of psychedelic phenomena. This attitude is trans-
those of a basically psychodynamic, Freudian nature. The former feel very
ferred onto the patients and makes it possible for them to allow themselves to
genuine, authentic and convincing; they frequently contain valid and objectively
experience whatever is emerging in the LSD sessions in order to find the roots of
verifiable information that seems to go far beyond the subject’s educational
their emotional problems.
background and level of information. Unlike the projective transformations on the
 HABLES IN LSD THERAPY Set and Setting of the Sessions Tn)

SET AND SETTING OF THE SESSIONS basis of endogenous psychoses, or to mental health professionals for didactic and
training purposes—to send them on a reversible journey into the world of the
schizophrenic.
In addition to the factors associated with the personalities of the subject and the A completely different set for LSD sessions emerged when it became obvious
therapist or sitter, there exists a broad complex of non-pharmacological that the drug experiences could enhance creative potential in certain individuals.
parameters usually referred to as “set and setting.” Any understanding of the LSD The drug became popular among artists as a source of inspiration and many hun-
for
reaction and its therapeutic use is superficial and incomplete if it does not take dreds of painters, sculptors, musicians, architeets, and writers voluntcered
into consideration all the determining elements belonging to this category. LSD experiments. Somewhat later, scientists, philosophers and other highly
The term set'includes the expectations, motivations and intentions of the creative individuals became favorite subjects for LSD sessions. This was based on
subject in regard to the session; the therapist's or guide's concept of the nature of the observation that the unusual states of consciousness induced by LSD can
the LSD experience; the agreed-upon goal of the psychedelic procedure; the generate important insights, facilitate problem-solving, and lead to valid intui-
preparation and programming for the session; and the specific technique of guid- tions or unexpected resyntheses of accumulated data.
ance used during the drug experience. Another important set for LSD sessions was developed after experimenters
The term setting refers to the actual environment, both physical and in- had repeatedly observed that the drug experience could take the form of a pro-
terpersonal, and to the concrete circumstances under which the drug is found religious or mystical experience. Some researchers interested in exploring
administered. this “instant” or “chemical mysticism” tried to create frameworks and circum-
stances facilitating the incidence of these spiritual phenomena.
Many different sets have been used in sessions exploring the therapeutic
THE IMPORTANCE OF SET
potential of LSD for psychiatric patients and the terminally ill. Various methods
Since LSD is a non-specific amplifier of mental processes, the LSD phenomena of LSD therapy have been described in an earlier chapter and will be only briefly
cover an extremely broad range, extending potentially to all aspects of human ex- reviewed here. In some of these studies LSD was administered routinely, as any
perience and behavior. For this reason there can be many different sets for the other pharmacological agent, without regard to its specific psychedelic properties.
LSD sessions. The fierce controversies surrounding LSD could be dispelled easily if This strictly medical model was applied in approaches using LSD as an anti-
those involved in arguing about the dangers and benefits of LSD would clearly depressive, abreactive, or activating agent. In others, LSD was seen as a catalyst
recognize the critical relevance of the non-drug factors. In most instances, dis- of mental processes and an adjunct to psychotherapy; psycholytic, anactitic, and
cussions that pretend to be about LSD are actually about different uses of the hypnodelic therapy are examples of this approach. Certain therapeutic orienta-
drug, and about the influence of set on the outcome of the LSD experience. Hum- tions such as psychedelic therapy or Salvador Roquet’s psychosynthesis have a
phrey Osmond, an early pioneer of LSD research, analyzed this situation in a con- clearly religious emphasis and stress the “mysticomiinetic” effects of LSD.
ference on LSD psychotherapy. He emphasized the fact that LSD is a tool, and The drug can be administered in the context of individual or group psycho-
the way it is employed is of crucial importance. To illustrate his point, he asked therapy and its use may lean in theory and practice on various therapeutic systems
the audience to imagine a situation in which a group of people with different —Freudian psychoanalysis, Jung's analytical psychology, Moreno’s psychodrama,
backgrounds and different sets of observations try to assess whether a knife Perls’ Gestalt practice, or existential psychotherapy. The anaclitic approach puts a
is a dangerous object or a useful tool. In this context, a surgeon would present great emphasis on physical contact and mothering behavior. Psychedelic therapy
statistics of successful surgical operations, a chief of police would talk about can use the framework of different religions; its individual variations also stress
murders and mutilations, a housewife would consider the knife in relation to cut- particular aspects of the set and setting, such as music, elements of nature, the use
ting meat and vegetables, and an artist would think about it in connection with of universal symbols, or readings of specific passages from sacred books.
carving wood, In such a situation any attempt to choose one view over the other is Almost infinite variations of set are associated with non-medical use and un-
clearly absurd and inconceivable; it would be obvious to everybody that the supervised self-experimentation. Some individuals have a sitter for their sessions
critical factor is the use the knife is put to. Nobody would seriously consider that while others take LSD on their own or participate in group experiences. The set-
the dangers and positive potentials of this tool represent its intrinsic properties. Yet tings for these experiences cover a wide range, from private apartments, beautiful
this is exactly what has been done in the past in various discussions about LSD. natural locations, or rock concerts to streets with busy traffic and cars on the
In the following text, we will briefly review the most important sets in highways. The quality of the street samples of LSD is questionable, and possible
which LSD has been adininistered, and discuss their specific characteristics. The impurities include substances such as amphetamines, phencyclidine, STP, and
first major conceptual framework for the administration of LSD was the so-called even strychnine. The quantity of the active substance is equally unpredictable.
“model psychosis” approach. It dominated LSD experimentation in the years im- The unreliability of the drugs, absence of a support system, and illegal framework
mediately following the discovery of the drug. The LSD experiences were viewed of such self-experiments are conducive to paranoia and panic reactions. For this
in a clearly psychopathological connection and labeled “experimental psychoses” reason the incidence of serious psychological complications under these circum-
or “chemically induced schizophrenia.” In this stage, the drug was administered stances cannot be considered an indication that the use of LSD is intrinsically
to volunteers for research purposes, with the aim of exploring the biochemical dangerous.
 CRITICAL VARIABLES IN LSD THERAPY Set and Setting of the Sessions lll
110

LSD and some other psychedelics have been listed as narcotics. This is incor- viduals added LSD secretly into the food or drink of relatives, friends or strangers,
rect and has no scientific justification. No genuine physiological addiction to LSD as an “initiation,” “psychedelic defloration,” entertainment, or just a mischievous
or related substances has been demonstrated. The reasons for their use and abuse and vengeful act. Sometimes this has been combined with other activities that fur-
are extremely complex and can have very deep psychological roots. Any legislation ther accentuate the hazards of this situation. I can refer here to an encounter with
that overlooks or ignores this fact is necessarily doomed to fail. The individuals in- a group of youngsters several years ago in Washington Square in New York City.
volved in non-medical self-experimentation with psychedelics belong to different When they heard that I had been doing research with LSD, they proudly shared
categorics and have very different motivations. Some of them are immature and with me their own “experiinents,” in which strangers were given LSD without
irresponsible youngsters who lack or ignore serious information about the nature knowing it. After ingestion of the drug, these involuntary guinca pigs were taken
of the LSD effect and take the drug for kicks, rebellion, or group orgies. Others into a private apartment. Here the “experimenters” performed a wild dance
are pleasure seekers trying to enhance their sensory experience for aesthetic, around their victims clad in bizarre aboriginal masks and costumes, swinging dag-
recreational and hedonistic reasons. Some couples use joint psychedelic ex- gers and spears. The objective of this “research” was to study the reactions of
pericnces to work through emotional problems within the dyad, improve the various subjects to this unusual situation. It is obvious that under these cir-
quality of their relationship, open new channels of communication, and explore cumstances, LSD can have a profoundly disorganizing effect and precipitate
various levels and dimensions of their sexual interaction. A not insignificant group acute, uncontrollable panic and even psychotic decompensation. If LSD is given
of self-experimenters seem to be people with serious emotional problems for whom to another person covertly, without his or her informed consent, I would not hesi-
traditional psychotherapy is inaccessible, or who are disappointed by its inef- tate to use the term criminal set for such a situation.
ficacy. They are desperately looking for therapeutic alternatives, and since respon- During the last twenty years 1 have had the opportunity to conduct, observe
sible and professional LSD treatment is not available, they make attempts at and personally experience psychedelic sessions in several different sets. I started
self-therapy. There also exists a large group of responsible and sophisticated in- working with LSD at the time of the “model psychosis” approach, and J also ran
tellectuals who see repeated psychedelic sessions as a unique opportunity for didactic sessions with my professional colleagues during this period. Occasionally,
philosophical and spiritual scarch, comparable to the way offered by traditions artists, philosophers and scientists came to our facility and had LSD sessions for
such as Tibetan Vajrayana, Zen Buddhism, Taoism, Sufism, or different systems inspiration and insight. Later, I started using LSD as an adjunct to systeinatic
of yoga. dynamic psychotherapy and conducted an exploratory study of its diagnostic and
Thus the motivations for psychedelic experimentation can be extremely therapeutic potential within the framework of a specially structured patient com-
serious and reflect the most fundamental needs of human beings—cravings for munity. During this work, I developed a therapeutic technique using repeated ad-
emotional: well-being, spiritual fulfillment and a sense of meaning in life. ministrations of LSD. Although it was originally conceived as drug-assisted
However, there is no doubt that, whatever the motivations and intentions of the psychoanalysis leaning in theory and practice on Freudian concepts, it gradually
subjects may be, the LSD sessions should be conducted in a safe situation and in became a treatment modality sui generis. In addition to working through
the context of a trust relationship with an experienced and responsible sitter. If traumatic material from childhood, as practiced in psychoanalysis and psycholytic
these requirements are not met, the dangers and risks of such an undertaking far therapy, this approach puts great emphasis on the importance of the death-rebirth
outweigh the potential benefits. process and transpersonal experiences.
The last area of LSD experimentation that will be mentioned in this context After many years of clinical experimentation with LSD in Prague, I was
is characterized by what can be referred to as destructive sets. Here belong “ex- able to spend some tine in London and to acquire first-hand experience of
periments” which explore the potential of LSD for the psychological liquidation of anaclitic therapy as it was practiced by Joyce Martin and Pauline McCririck. In
certain individuals, eliciting of confessions, brain washing, and chemical warfare. 1967, I moved to the United States and joined the research team at Spring Grove
We could include here situations in which an individual ingests LSD without in Baltimore, where I learnt and practiced the psychedelic treatment technique.
knowing it and frequently without any previous knowledge of its effects. The During this time I was occasionally called in as a consultant on cases of non-
danger of this situation cannot be sufficiently stressed; not only the sanity, but the medical experimentation with LSD which involved various complications and I
life of the subject can be at stake under these circumstances. Sometimes this can became quite familiar with the counterculture’s use of psychedelics. All these ex-
happen by accident when LSD is mistaken for other pills, or sugar cubes con- periences have been a rich source of important observations, and they clearly in-
taining LSD for plain sugar. However, secret police, intelligence agencies and dicate the paramount significance of set as a determinant of the LSD reaction.
military experts have in the past systematically exposed naive and unprepared sub- Certain aspects of set are quite obvious and explicit. It is not difficult to see
jects to the effects of the drug to test its destructive potential. In several instances that specific programming during the preparation period, certain techniques of
this even has been done by psychiatric researchers; the objective of these experi- conducting the sessions, or props and paraphernalia to which the subject is ex-
ments was to test whether in unprepared and surprised subjects the LSD reaction posed can influence the LSD experience. However, some other important factors
would resemble schizophrenia more closely than when the drug is administered have been overlooked in the past, or were uot appreciated sufficiently because
with informed consent. they are much more subtle and not easily identifiable. One of thein is the presence
It has also happened quite frequently in the past that irresponsible indi- or absence of verbal communication between the subject and the sitter. Talk that
112 CRITICAL VARIABLES IN LSD THERAPY Set and Setting of the Sessions 113

goes beyond a certain necessary minimum during psychedelic sessions tends to The questions characteristic of this approach would be: “Do you have any
make the experience more superficial and is generally counterproductive in terms visual or acoustic hallucinations?”, “Are your emotions inappropriate to the con-
of effective self-exploration. However, in those situations where there is a continu- tent of your thoughts and visions?”, “Do you have any strange sensations or
ing dialogue between the subject and the sitter, the nature of their verbal ex- bizarre changes of your body image?”, “How does your experience compare with
change becomes a factor of considerable importance. This is particularly true in schizophrenia?”, “Are you getting any insights into the psychotic process?”
regard to the choice and formulation of the questions that arc asked. In addressing In sessions where the emphasis is on aesthetic experiences and artistic inspir-
the subject, the sitter continuously reinforces and redefines the set that has been ation, LSD subjects are primarily interested in changed perception of forms,
established in the preparatory period of the session. A specific wording of the colors and sounds. They focus their attention on such phenomena as the intricacy
questions can attract the subject’s attention to certain aspects of the multi- of geometrical patterns, dynamics of optical illusions, and richness of synaesthesias.
dimensional and multifaceted content of the LSD experience. In the extreme, it They frequently try to relate their experiences to various modern movements in art
can significantly determine the direction in which the experience moves, modify or the work of individual artists. Abstractionism, impressionism, cubism, surreal-
its content and influence its course. ism, superrealism, and concrete music seem to be particularly relevant from this
In the descriptive approach to an LSD session, which tries to capture the point of view. Another typical feature of these sessions is preoccupation with
phenomenology of the drug reaction, the subject is encouraged to focus on some technical problems and difficulties in expressing these unusual phenomena in
formal and relatively superficial aspects of his or her experience. The elements artistic forms. The following questions would be characteristic of this type of ses-
that are of interest in this context are the presence or absence of physical symp- sion: “Do your visions resemble the work of some famous artist?”, “What are the
toms, direction of emotional changes, quality of perceptual distortions, and the predominant colors you see?”, “Are your visions geometrical or figurative?”,
degree of psychomotor excitement or inhibition. The experimenter wants to know “What material and what technique would be best to express what you see?”, “Is
if the subject's vision is sharp or blurred, if objects are perceived as steady or un- this a picture of a vision you had or an automatic drawing?”, “How is your coor-
dulating, if the visions are of a geometrical or figurative nature, if hearing is more dination?”, “Is it difficult to concentrate on painting?’”, “Does the music you are
or less acute than usual, and if synaesthesias are present. Under these circum- hallucinating remind you of any piece you know?”, “Which instruments would
stances, the subject usually experiences all the LSD phenomena in a rather imper- you use in composing this music?”, “Do you now have a better understanding of
sonal way, as a spectator watching an interesting movie. Whatever is happening modern art?”
in the session is seen as a result of the interaction between the drug and the In psychotherapeutic sessions of psycholytic orientation, the patients are en-
subject’s brain; the experient is used as an observer and reporter of these changes. couraged to use the sessions for self-exploration and dynamic understanding of
Even if relatively strong emotions are involved, they are attributed to the their emotional problems. The LSD phenomena are seen as complex symbolic for-
chemical effect of the drug rather than seen as a manifestation of the subject’s per- mations that reflect important unconscious processes in the patient. There is a
sonality; they are simply noticed and recorded. In the sessions focusing on psycho- systematic effort to decipher all the manifestations of the experience and use them
pathological description, relevant dynamic material is seldom recognized and as clues in the process of tracing psychopathological symptoms back to their
never pursued any further. Typical questions redefining this experimental frame- original sources. The psychodynamic set is continuously redefined by such state-
work are sentences such as: “Are you sweating?”, “Are your hands trembling?”, ments as: “Try to understand why you have this particular experience,” “What do
Do you feel dizzy?”, “Are the colors different from the usual?”, “Do you have any you think it means?”, “Does this remind you of something in your past?”, “Try to
strange feelings in your body?” The records of early LSD experiments and the attach these feelings of aggression to the original target!”, “Where does your fear
questionnaires used in this period abound in questions of this kind. come from? Trace it back to its sourcel”, “Why do you think you see me trans-
When LSD was administered in the context of the model psychosis research, formed in this particular way; could it have some symbolic meaning?”, “Do you
the sessions were connected with strongly negative programming. They were ex- have any associations or memories connected with this vision?”
plicitly referred to as “experimental psychoses” and psychedelic drugs as In sessions where the main objective is to have a religious or mystical ex-
“hallucinogens,” “psychotomimetics” or “psychodysleptics.” The subjects would perience, there is a definite tendency to deemphasize or ignore descriptive aspects,
both expect and selectively focus their attention on phenomena that are usually psychopathological phenomena, and traumatic personal material. The aesthetic
associated with schizophrenia, such as paranoid feelings, panic anxiety, disso- elements are considered important, but the major focus is on the supraindividual,
ciation between affect and thought, various perceptual distortions and distur- transpersonal, and transcendental. To a great extent, this is also characteristic of
bances, delusional interpretation of the environment, or disorganization and psychedelic therapy. In sessions aimed at achieving a psychedelic peak experience,
fragmentation of the ego. In LSD sessions conducted with mental health profes- there is usually very little verbal interaction between the therapist and the patient.
sionals for training purposes, the psychopathological focus was particularly If it occurs, it tends to take the form of simple directive statements rather than a
strong. These individuals would try to properly identify and diagnose various +question. Some typical examples would be the following: “Don’t be afraid to die;
perceptual disturbances, abnormal thought-processes, and unusual emotional this is not really dying. The moment you can accept death, you will experience
qualities, assigning the appropriate clinical labels to them, and comparing them i rebirth” ... “It is not really annihilation and disintegration—it is dissolving, dis-
with those occurring in schizophrenic patients. solving in the universe”. . . “Try to use the music—let the music carry you; be in
 114 CRITICAL VARIABLES IN LSD THERAPY
Set and Setting of the Sessions LS

it and stay with it, try to become the music” . . . “Do not fight it; let it happen, let sterile surroundings tend to facilitate experiences related to diseases, operations,
go, try to surrender completely to the experience” . . . “We can think and talk accidents, pain, agony, and death. For obvious reasons, the traditional at-
later; for now just try to experience whatever is happening, be yourself, simply mosphere of psychiatric facilities can, in addition, facilitate experiences related to

ee
bel” prisons, concentration camps, or military barracks.
Similar relations exist in regard to the elements of the interpersonal setting
THE IMPORTANCE OF SETTING of the sessions. In this sense, the optimal arrangement seems to be the presence of a
few well-known persons whom the subject trusts; this generally has a very favor-
During my clinical work with LSD, I have made numerous observations indicat- able influeuce on the course of the session. As will be discussed later, a therapeutic
ing clearly that the physical and interpersonal elements of the setting can also pro- dyad that combines the male and the female element in an atmosphere of trust
foundly influence the nature of the LSD reaction. Most situations in which exter- seems to be the ideal solution. Negative consequences can be expected from fre-
nal stimuli have a stroug influence on the subject and modify his or her LSD expe- quent changes in the interpersonal situation, where many persons unknown to the
rience can eventually be understood in terins of the content of underlying dynamic subject appear and disappear in an unpredictable way. This is the case with LSD
governing systems and their complicated reciprocal interaction with the en- experiences in party settings or even for some sessions in university hospitals where
vironmental stimuli. If the setting involves elements that characteristically occur medical students occasionally drop by, observe the subject for a short time, make
as components of positive COEX systems or positive perinatal matrices, they tend jokes or inappropriate comments, and leave. The same is true for experimental
to facilitate the emergence of pleasant or even ecstatic experiences. Since such ex- settings in which the subject is sent from one testing situation to another, is wired
periences have a great healing potential and therapeutic value, this association up and attached to various gadgets, has to undergo strange laboratory examina-
should be systematically utilized in psychedelic sessions and as many elements as tions, and is asked to urinate into containers and give samples of blood every hour
possible that are related to positive systems should be incorporated into the treat- on the hour.
ment setting. The importance of this principle was empirically discovered and is It has already been mentioned that certain physical stimuli from the envi-
utilized by psychedelic therapists. , ronment can change the session in a very dramatic way if they happen to be
The treatment room should be quiet, comfortable, tastefully decorated, and similar to or identical with the elements of a COEX system or a perinatal matrix
furnished in a homelike fashion. Much attention should be paid to the choice of which is activated at that time. This may be observed in connection with certain
fabrics, pictures, and flower arrangements. Beautiful natural scenery or certain accidental sounds; thus barking of a dog, sound of a jet, explosions of fireworks,
objects that reflect nature's creativity usually have a very positive influence on the factory or ainbulance sirens, or a particular tune inay have a specific biographical
LSD experience. This can be understood from the fact that visions of beautiful meaning that can elicit quite unexpected responses from the subject. Sometimes
landscapes occur in the context of BPM I as part of the intrinsic symbolism of this the general character of the treatment room, specific pieces of furniture and trivial
matrix. Similarly, memories of excursions to or stays in beautiful and nourishing objects, or certain aspects of the view from the window can function as powerful
natural settings constitute important layers of some positive COEX systems. There selective triggers of experiences.
exists sufficient empirical evidence that the ideal location for psychedelic facilities The same mechanism can be observed in regard to the people the subject
of the future would be in a natural environment such as by mountain lakes, on sees during the session. Various persons tend to evoke quite specific and differen-
ocean beaches, on little islands, in deserts, in wooded areas, or in old parks. Clean tiated responses. We have observed numerous situations in which dramatic reac-
water in any form scems to have a particularly powerful impact on LSD subjects; tions occurred every time certain nurses entered the treatment room. The
a swim, shower, or bath can frequently dispel negative experiences and facilitate manifestations triggered in this seemingly innocent way covered a rather wide
an ecstatic reentry. One of the most significant factors of the setting is good range and involved such diverse reactions as violent shaking, nausea with vomit-
stereophonic music of high aesthetic quality. ing, intense headache, disappearance of colors from the vision, and hallucinations
In contrast, elements that are usually associated with negative COEX of a particular color. Conversely, we have also noticed sudden experiences of
systems tend to precipitate unpleasant LSD experiences when they are part of the light, ecstatic feelings, a sense of tranquility, or feelings of emotional nourish-
setting or occur as accidental stimuli. An extreme example of this would be a ment. Occasionally the entire character of the session changed in a specific way
small, ugly, claustrophobic and tastelessly furnished treatment room, with a win- with the change from the day shift to the night shift, when a new team of nurses
dow overlooking unpleasant scenery such as industrial areas with factories, junk- entered the patient's experiential field. With some of the nurses the patients felt
yards, high smokestacks, and an atmosphere of chemical pollution. Loud human safe and protected and had predominantly positive experiences; with others, the
voices, unpleasant music, the noises of machinery, and sounds of sirens, am- same subjects on the same session day became anxious, hostile, or suspicious.
bulances, fire-engines and jets, exemplify the interferences that can have a very These differences were to a great extent individual aud were inostly biographically
disturbing influence on a psychedelic experience. For the same reason, the setting determined. We did not find that some nurses always had with absolute constancy
of the sessions should not remind the subject of a hospital, doctor’s office, or and just because of their personalities, a positive or negative influence on all the
laboratory. As a result of COEX and BPM dynamics, medical elements such as subjects.
white tiles, medicine cabinets, white coats, syringes, vials with pills, and generally Subsequent analysis usually provided an explanation of these idiosyn-
 Set and Setting of the Sessions 117
116 CRITICAL VARIABLES IN LSD THERAPY

crasies in terms of the personal history of the subject and his or her interaction approach of Dr. van Rhijn (2) from Holland, who described at an LSD con-
with a particular nurse. In some instances the clue seemed to be physical resem- ference his vision of the psychiatric facility of the future. It involved a system
of small treatment cells in which patients would spend their days alone work-
blance of the nurse to a relevant figure in the subject's past; in others, similarity of
ing through their emotional problems with the help of LSD.
behavior patterns, habits, or approach to the subject. Sometimes the patients’ 6. The interested reader will find a good example of an LSD session entirely
reactions could be explained by the fact that they put tbe nurse into an inter- dominated by the transference aspects in my first book, Realms of the Human
personal category toward which they had either a particularly good or a conflict- Unconscious. (32) (The case of Charlotte, p. 224).
laden attitude, for example, a possible sexual partner, dangerous seductress, erotic 7. The description of the LSD session of Charlotte, published in my first book,
rival, competitor, maternal woman, understanding person, domineering type, Realms of the Human Unconscious, p. 224, has many good examples of the
authority figure, or personified superego. illusive transformations described above. (32)
Successful therapy with LSD requires intimate understanding of the signifi- 8. The interested reader will find a condensed case history of Renata in my
cance of set and setting, so that these factors become powerful tools in the book Realms of the Human Unconscious. p. 52. (32)
therapeutic process instead of operating in an elemental fashion and presenting
unpredictable problems and complications.

NOTES

1. The interested reader will find more information on the multilevel over-
determination of LSD experiences in the first volume of this series, Stanislav
Grof: Realms of the Human Unconscious. (32) ,
2. It is interesting to compare this psychedelic cartography with the four levels
and stages described by R.E.L. Masters and Jean Houston in their pioneering
book The Varieties of Psychedelic Experience. (65) The authors distinguish (1)
The sensory level (eidetic images and other perceptual changes, altered body
image, temporal and spatial distortions), (2) The recollective-analytic level
(reliving of important emotional experiences from the past, confronting
personal problems, conflicts in relationships, life goals), (3) The symbolic level
(historical, legendary, mythological, ritualistic, and archetypal images), and (4)
The integral level (religious enlightenment, mystical union, illumination,
psychological integration). The first two levels of both cartographies show
essential correspondence with each other. The Masters-Houston map does not
specifically mention the level of the death-rebirth process which plays an
important part in my conceptual model. Their symbolic and integral levels are
combined in the cartography presented here and appear in the category of
transpersonal experiences.
3. In this context, the significance of COEX systems for the dynamics of LSD
sessions can only be briefly outlined. The interested reader will find a detailed
discussion of this theme with several clinical examples in my first book, Realms
of the Human Unconscious. (32) Another source of information about this topic
is Hanscarl Leuner’s book, Die experimentelle Psychose (Experimental
Psychosis) (57). His concept of “transphenomenal dynamic systems” is closely
related to, but not identical with, that of COEX systems. C. G. Jung’s (43)
definition of a “complex” represents yet another approach to the same problem
area.
4, It is interesting to point in this context to the striking parallels between this
observation from psychedelic therapy and Abraham Maslow’s (64) concept of
metavalues and metamotivations derived from the study of spontaneous peak
experiences occurring outside the drug context.
5. The therapeutic philosophy of those early days can be exemplified by the
PSYCHOLYTIC AND
PSYCHEDELIC THERAPIES
WITH LSD: TOWARDS AN
INTEGRATION OF
APPROACHES
The Search for an Effective Technique of LSD
Psychotherapy
Advantages and Drawbacks of the Psycholytic
roach
Pros ap Cons of Psychedelic Therapy

THE SEARCH FOR AN EFFECTIVE TECHNIQUE

OF LSD PSYCHOTHERAPY ‘
It would be very difficult to describe in a systematic and coinprehensive way the
therapeutic procedure used in my clinical research with LSD psychotherapy in
Prague. When this study began, very little was known about LSD and its thera-
peutic potential. The purpose of the research was to investigate whether LSD
might be a useful tool for personality diagnosis and the therapy of emotional
disorders. Since the project was a pilot study designed to collect new observations,
in its initial phases it combined therapeutic efforts based on conventional under-
standing of the psychotherapeutic process with first orientations in an entirely new
world of clinical phenomena. As a result, the treatment technique was being
developed and constantly modified as the research proceeded. The changes of
therapeutic approach reflected my increasing clinical experience, deeper under-
standing of the effects of LSD, and immediate inspirations from various accidental
observations. In the following text I will briefly outline the major trends and
stages of development of the new therapeutic technique.
When I started conducting therapeutic LSD sessions with psychiatric
patients, as an enthusiastic and convinced psychoanalyst I automatically chose the
classical Freudian arrangement. | had no doubts about the conceptual framework
of psychoanalysis and the validity of its therapeutic technique. My intention was
to explore the possibility of intensifying and accelerating the psychoanalytic pro-
cess, which I found intellectually fascinating in theory but painfully ineffective in
practice. .1 hoped that the use of LSD as an adjunct to the therapy would yield
more impressive results than classical analysis, which requires years of intensive

119
 PSYCHOLYTIC AND PSYCHEDELIC THERAPIES WITH LSD The Search for an Effective Technique of LSD Psychotherapy 121

work and offers relatively meager returns on an enormous investment of time and framework and world-view of Freudian psychoanalysis. Almost every day, we
gy. However, in the course of iny LSD research I was led by everyday clinical were confronted in psychedelic sessions with new and puzzling phenomena such as
bservations to drastic departures not only from the Freudian therapeutic tech- sequences of death and rebirth; intrautetine, ancestral, racial, and phylogenetic
e, but also from its conceptual framework and basic philosophy. memories; animal and plant consciousness; or past-incarnation experiences. The
In the first therapeutic LSD sessions I conducted I asked the patients to lie on therapeutic changes associated with some of these unusual experiences were often
a couch, and I sat in an armchair situated near the head of the couch so that they much more dramatic than those achieved in the context of biographically oriented
could not easily see me. I expected to get almost continuous accounts of their LSD work, A typical early LSD researcher, encountering some of these extraordinary
eriences and occasionally offer interpretations. It soon became obvious that episodes, risked having his or her own rationality severely tested, and quickly
this arrangement was not appropriate for LSD psychotherapy and I was not able learned to censor reports of them to avoid having sanity questioned by others. At
o maintain it for more than a few sessions. The nature of the experience and of present, twenty years later, we are much more open to the existence of these
the process seemed to be incompatible with the Freudian teclinique and required a phenomena, but still lack a comprehensive conceptual framework to account for
more human approach, genuine support, and personal involvernent. I first moved them.
my chair to the side of the couch, and later kept leaving it more and more fre- Descriptions of the exciting adventures in early clinical research that led to
quently to sit on the side of the couch, entering into direct physical contact with the development of the present therapeutic technique might be of historical
he patient. This ranged from simple support such as hand-holding, reassuring interest, but are of little practical value. Instead of guiding the reader through a
ouches or cradling to deep massage, bioenergetic-type maneuvers, or psycho- complicated sequence of trials and errors I will focus on the final product of this
dramatic enactment of struggle. Because of my training as an analyst, the shift process—a therapeutic technique that has emerged from years of clinical experi-
om a detached attitude to direct participation in the process occurred gradually mentation and crystallized into a more or less standard procedure. In my ex-
and not without hesitation and conflict. It appeared quite appropriate to offer this perience, this approach minimizes the risks and maximizes the benefits of the
egree of support to subjects who were suffering through extraordinary emotional psychedelic process. It makes LSD-assisted psychotherapy a powerful, effective
ordeals and frequently showed signs of quite authentic regression to early periods and relatively safe method of treatment and personality change.
f infancy. However, the description of this process has to be considered in its At this point, it seems appropriate to briefly discuss the major existing tech-
historical context; it might appear almost comical in the age of growth centers, en- niques for the therapeutic use of LSD, and indicate their advantages and
counter groups, sensitivity training, neo-Reichian therapies, and nude marathons. drawbacks. This discussion should provide a basis for understanding the rationale
t I made the first moves to violate the Freudian taboo of touch while attending of the treatment procedure which will be described later in detail. In an earlier
seminars in which my teachers seriously discussed whether shaking hands with pa- section of this book, I described the techniques and underlying concepts of what I
tients presented dangers to the transference-countertransference process. Another consider to be the four viable approaches to LSD psychotherapy, the psycholytic,
r modification of the treatment technique was a shift from extensive verbal psychedelic, anaclitic, and hypnodelic methods. The use of LSD in a hypnodelic
interaction and occasional eye contact to internalized sessions with minimal ex- context seems to be the least useful of these. [t is a specialized procedure, discus-
change of words, and use of eyeshades, headphones, and stereophonic inusic. sion of which would require a considerable detour into the theory and practice of
Even more drastic than the modifications of the therapeutic technique were hypnosis. It has been used by only a few researchers in the past and will probably
changes in the conceptual framework and basic paradigms underlying not be widely used in the future. Similarly, anaclitic therapy in its extreme
sychotherapy. Everyday observations from psychedelic sessions put many com- form—the fusion technique—is practiced only exceptionally, although a mitigated
monly held scientific assumptions to serious test, and showed an urgent need for version has been assimilated by many LSD therapists. For practical purposes we
revision on such fundamental issues as the cartography and dynamics of the un- can focus our discussion on the two most important approaches, psycholytic
conscious, the nature of memory, the origin of consciousness, the definition of therapy and psychedelic therapy, with occasional reference to specificities in-
mental health and illness, the therapeutic goals and hierarchy of values, the troduced by anaclitic treatment.
hilosophy and strategy of psychotherapy, and even the nature of reality and of At first sight, psycholytic and psychedelic therapies seemed to differ both in
human beings. We will discuss here only those observations that are of direct theory and in practice to such an extent that most LSD therapists found them irre-
relevance for psychotherapy. The ontological and cosmological insights from concilable. They felt the gap between them and between their underlying philos-
psychedelic research and their relationship to the revolutionary concepts of ophies to be so fundamental that they could not conceive of bridging it; as a result,
modern physics will be described in a future volume. they committed themselves clearly to one or the other modality. Only a few
At present, many professionals recognize the need to acknowledge the ‘researchers were able to feel comfortable with both approaches and use them
wisdom of ancient and Oriental spiritual disciplines, and assimilate it into alternately. This dichotoiny is quite surprising in view of the fact that both ap-
psychology and psychiatry. ‘Transpersonal psychology is becoming increasingly proaches use the same chemical compound, deal with emotionally disturbed
popular, and obtaining wide recognition. It is hard to expect a professional living human beings, and have the saine goal—therapeutic help for the patients. Al-
n the late seventies to appreciate the difficulties that we faced in the late fifties though extrapharmacological factors, such as the personality of the therapist or
d early sixties, exploring LSD psychotherapy equipped with the conceptual the set and setting, play a very important role in the LSD experience, it seems
 122 PSYCHOLYTIC AND PSYCHEDELIC THERAPIES WITH LSD Advantages and Drawbacks of the Psycholytic Approach 123

reasonable to assume that psycholytic and psychedelic therapists deal with of LSD psychotherapy. The practical implication of this new understanding of the
phenomena that occur on the same continuum and are closely related, if not iden- mechanisms operating in LSD sessions is the development of an integrated treat-
tical. The differences seem to lie, not in the nature of the experiences themselves, ment procedure combining the advantages of psycholytic and psychedelic
but in the quantitative incidence of certain elements in the sessions, and the thera- therapies, and minimizing their shortcomings.
pists’ emphasis on certain phenomena and tendency to discourage others.
It is well known that psycholytic therapists frequently see transpersonal phe-
nomena in their clinical practice. However, they tend to discard them, either as ADVANTAGES AND DRAWBACKS
an escape from important traumatic childhood material, or as undesirable “psy- OF THE PSYCHOLYTIC APPROACH
chotic” enclaves in the LSD procedure.! Within the psycholytic framework, trans-
personal phenomena are not acknowledged and their therapeutic value is not An unquestionable advantage of psycholytic therapy is its heuristic value. The
recognized. Patients are thus implicitly or explicitly discouraged from entering slowly progressing unfolding of various levels of the unconscious has been com-
transcendental states; moreover, the low and medium dosages used in psycholytic pared by some patients to chemoexcavation, the careful archaeological work that
therapy are generally less conducive to perinatal and transpersonal experiences sequentially explores layer after layer and studies their mutual interrelation.
than the high dosages employed by psychedelic therapists. Other subjects refer to this process as “peeling the onion” of the unconscious
The frequent occurrence of transpersonal states in psycholytic treatment has mind. THe richness of the material obtained in repeated sessions using medium
its counterpart in the fact that many patients in psychedelic therapy relive dosages of LSD provides unrivalled insights not only into the nature of the LSD
traumatic childhood memories and are confronted with other material of a clearly reaction, but also into the dynamics of emotional disorders and the functioning of
biographical nature. Many psychedelic therapists, with their one-sided emphasis the human mind in general.
on transcendence and on mystical and religious experiences, have very little appre- This aspect can be important not only for the therapist, but also for many
ciation of or even tolerance for psychodynamic issues. The implicit or explicit scientifically, artistically, or philosophically oriented subjects. In addition to
message in psychedelic therapy usually is that a session spent in this way is inferior therapeutic benefit, these individuals receive unique lessous about huinan nature,
to one that involves transpersonal experiences. Under these circumstances patients art, philosophy, history, and the natural sciences. Psycholytic therapy usually
who have predominantly biographical sessions in the course of psychedelic takes much longer than psychedelic therapy to achieve comparable results;
therapy tend to develop a feeling of personal failure. Not infrequently, the sense of however, it gives an individual a much better knowledge of the territories of the
“a lost opportunity” is shared by the average psychedelic therapist, no matter how mind and the mechanisms through which the change was achieved, and it may be
important the biographical material uncovered and worked through in such a the preferred treatment for subjects with less serious and urgent problems who
session. have deep intellectual interest in the nature of the process. As an open-ended
As mentioned earlier, my Own developinent was such that [ had first-hand situation, psycholytic therapy gives a better opportunity for the patient to work
experiences of psycholytic, psychedelic, and anaclitic therapies. Being an orthodox through and resolve important problems of his or her life than the hit-or-miss ap-
psychoanalyst, I started my LSD work in Prague following the principles of proach of psychedelic therapy, which is limited to just one or a few high-dose LSD
psycholytic therapy. When numerous observations in my everyday clinical prac- sessions.
tice made this orientation untenable, [ moved far beyond the narrow psycho- At the present stage of development, psycholytic therapy is more understand-
analytic framework to full recognition of the practical and theoretical significance able and acceptable in conventional professional circles and to the “scientifically-
of the death-rebirth process and transpersonal phenomena. During my stay in minded,” since it leans in theory and practice on widely accepted psychothera-
London in 1964, 1 participated in the work of Joyce Martin and Pauline Mc- peutic concepts. This seems to be true despite the fact that many observations from
Cririck, and acquired intimate insights into the nature of anaclitic therapy as both psychedelic research clearly and unequivocally demonstrate the limitations of the
experient and observer. Since my arrival in the United States in March 1967, I existing paradigms and the need for their revision ard reformulation.? However,
have practiced psychedelic therapy for a number of years in the Maryland the psycholytic emphasis makes it possible to ignore or disqualify most of these
Psychiatric Research Center in Baltimore, working with alcoholics, heroin ad- challenging discoveries.
‘dicts, neurotics, mental health professionals, and individuals dying of cancer. An obvious disadvantage of psycholytic therapy is that it is much more time-
In addition, I have met most of the therapists practicing in the psycholytic consuming. Although according to one of its foremost representatives, Hanscarl
and psychedelic orientations during various LSD conferences and during my visits Leuner, psycholytic therapy can shorten the psychotherapeutic process to take ayap-
to therapeutic facilities in Europe, the United States and Canada. The discussions proximately one-third of the time required by psychoanalysis, it still requires an
during these encounters, study of LSD literature, and my own clinical experiences enormous amount of the therapist's time. The first statement is based on clinical
have gradually convinced me that the differences between these two treatment impressions; no comparative study of psycholytic and psychedelic therapies has
techniques are not as irreconcileable as is usually assumed. I came to the conclu- ever been conducted. Any attempt to compare the efficacy of these two ap-
sion that it is possible to reduce the phenomena involved in both approaches to proaches on the basis of the existing literature runs into considerable difficulty. In
certain common denominators and to formulate a comprehensive general theory addition to the general problems related to the evaluation of psychotherapeutic
 THERAPIES WITH LSD Advantages and Drawbacks of the Psycholytic Approach 125
PSYCHOLYTIC AND PSYCHEDELIC
124 *

eighty or more, depending on the nature of the clinical problem) and thus presents
results, which have been discussed in the literature over the last two decades, one
numerous opportunities for temporary activation and insufficient completion of
encounters certain complications specific to LSD therapy.
unconscious gestalts. In the course of psycholytic therapy, the patient’s clinical
Whereas psychedelic therapy has been used in the past primarily with alco-
condition undergoes dramatic changes in both directions, and sometimes the
holics, drug addicts and terminal cancer patients, psycholytic treatment has
therapist has to face a serious transitional worsening of the symptoms or even
focused on other categories of emotional disorders, such as psychoneuroses,
decompensation, when the patient is approaching an area of deep and important
character disorders, and psychosomatic diseases. It has been pointed out that the
conflicts. This intensification of symptoms sometimes occurs after earlier therapy
result of psycholytic therapy is more solid and permanent, because the underlying
had brought about a considerable improvement, and the therapist continues the
material gets thoroughly worked through, than the dynamic shift or trans-
sessions with an intent to “insure the result and prevent a relapse.” Although
modulation that occurs in psychedelic treatment. If the results of the two methods
psychedelic therapy does not eliminate the possibility of activation followed by an
could somehow be compared, the time aspect would be very much in favor of
incomplete integration of unconscious material, it certainly considerably decreases
psychedelic therapy. My impression is that the use of higher dosages and inter-
the probability of such an oceurrence.
nalization of the process, as practiced by psychedelic therapists, deepens the effect
A potentially negative aspect of psycholytic therapy is the enormous intensi-
of LSD and is much more productive therapeutically. However, I would still like
fication of transference that almost inevitably develops in its course. This presents
to see an open-ended situation, which would allow for a series of such experiences
unique therapeutic opportunities, and also considerable dangers and difficulties.
if necessary, instead of the all-or-nothing philosophy of the psychedelic approach.
The issue of transference and its analysis is an important theoretical and practical
As mentioned above, a systematic and well-controlled comparative study, though
problem in LSD psychotherapy and in psychotherapy in general. There is no
highly desirable, does not exist at present.
doubt that the qualityof the therapeutic relationship is one of the most important
For those who want to take a conservative stance, the number of exposures
factors determining the course and outcome of LSD sessions. However, it is much
to LSD and the overall amount of the drug used in psycholytic therapy can repre-
less certain that the development of transference and its analysis is essential for
sent an important issue. Although none of the suspicions about the biological
therapeutic progress. This is something which is taken for granted in classical
dangers of LSD have been substantiated, it should still be considered an experi-
psychoanalysis and in psychoanalytically oriented psychotherapy, but that does
mental substance whose long-term physiological effects have yet to be fully
not exclude the possibility that there exist other effective mechanisms of thera-
determined.
peutic change. Observations from LSD psychotherapy suggest very strongly
Another aspect of psycholytic therapy that should be discussed is the use of
that the intensity of transference is directly proportional to the resistance to facing
low and medium dosages of LSD. as compared to the high or very high dosages
the original traumatic material. In a certain sense, therefore, an LSD therapist
used in psychedelic treatment. Although this might be contrary to popular belief,
who puts great emphasis on identification. and analysis of transference
high-dose sessions are generally much safer. There is no doubt that high-dose ses-
phenomena, instead of acknowledging them and directing the patient’s attention
sions present more real or potential problems at the time of the actual pharmaco-
beyond them, is cooperating with the defense mechanisms. It happens quite
logical effect of the drug. Under the circumstances of unsupervised use, the col-
regularly in the course of LSD psychotherapy that various transference problems
lapse of psychological defenses, the massive emergence of deep unconscious
clear up automatically after the subject has been able to face and work through
material, the loss of effective control and the resultant lack of reality-testing
underlying unconscious material of a psychodynamic, perinatal or transpersonal
occurring in high-dose experiences present grave potential dangers. An experi-
nature. '
enced therapeutic team, however, can usually handle these quite easily. In the
A definite disadvantage of psycholytic therapy is its theoretical dependence
long run, the very aspects of high-dose exposures that make them a greater risk at
on conventional dynamic psychotherapy. For this reason, it does not offer an ade-
the time of the drug action turn out to be their advantages. Lessened ability to
quate framework for many experiences that occur in the LSD sessions. Some of
fight the effect of the drug and more complete surrender are conducive to better
them lave extraordinary therapeutic potential, such as the death-—rebirth process,
resolution and integration of the experience. Low and medium dosages activate
past-incarnation memories, various archetypal phenomena and, especially, the ex-
latent unconscious material very effectively and bring it closer to the surface, yet
periences of cosmic unity. The latter are closely related to, although not identical
they also allow an unwilling subject to avoid having to face it fully and deal with
with, the oceanic feelings experienced by the infant at the breast and in the
it effectively. Sessions of this kind can result in feelings of excessive fatigue after
womb. They seem to have as fundamental a significance for the success of LSD
the experience, a sense of incompletion, /arious unpleasant emotional and psycho-
therapy as the natural experiences of symbiotic unity with the mother have for the
somatic aftereffects, and prolonged reaction or a precarious emotional balance
developinent of an emotionally healthy and stable personality. A tendency to
conducive to later recurrences (“flashbacks”). In the next chapter we will discuss
discard and discourage perinatal and transpersonal phenomena, or to interpret
various principles and techniques of conducting psychedelic sessions that lead to
thein in terms of more superficial levels, limits the therapeutic potential of LSD
better resolution and reduce the incidence of prolonged reactions and flashbacks.
psychotherapy and frequently confuses the patient.
Psycholytic therapy involves series of medium-dose LSD sessions, (sixteen to
126 PSYCHOLYTIC AND PSYCHEDELIC THERAPIES WITH LSD Pros and Cons of Psychedelic Therapy 127
e ?

PROS AND CONS OF PSYCHEDELIC THERAPY lasting therapeutic changes are possible without working through early childhood
material, reenacting the original traumatic relationships in the transference situa-
Some of the advantages of psychedelic therapy are practical, others are of a theo- tion, and subjecting these anachronistic replicas to transference analysis. Although
retical nature. In general, the therapeutic changes achieved in a single psychedelic observations from LSD research strongly suggest that there exist important alter-
session are much morc dramatic and profound thau those observed as a result of a natives, these will have to remain on the level of clinical impressions until they are
single psycholytic session. Certain aspects of the psychedelic treatment teclinique systematically studied aud validated.
represent a great acceleration and deepening of the therapeutic process, as well as A much more serious problem that psychedelic therapy—as presently prac-
a definite increase in its efficacy and safety. This approach seems to have fully ap- ticed—has to face is the fact that in spite of the efforts at positive structuring of the
preciated the importance of positive experiences, which are usually underesti- ‘LSD sessions, it is not possible to guarantee that all the subjects will have deep
mated in’psycholytic therapy; the latter shares with psychoanalysis a one-sided transformative experiences. In the Spring Grove program, where the therapeutic
emphasis on psychopathology and traumatic material. Explicit focus on the potential of psychedelic therapy utilizing just one session was systematically ex-
positive potential in human beings is an important therapeutic factor; so is the em- plored in various categories of subjects, the incidence of “psychedelic peak ex-
phasis on positive structuring of the set and setting for psychedelic sessions. Exter- periences” ranged between 25 and 78 per cent, depending on the population
nal circumstances have a profound effect on the termination period of the session studied. It was the lowest in neurotic patients and highest for narcotic drug
and thus on the final outcome of the psychedelic experience. The discovery of the addicts, with mental health professionals, individuals dying of cancer, and atco-
critical importance of this phase represents a major contribution of psychedelic holics falling in between.
therapists to the LSD procedure. The psychedelic peak experience is certainly an important factor mediating
There seem to be several reasons for the greater efficacy and safety of deep personality transformation; however, its occurrence is not a conditio sine qua
psychedelic therapy. High dosages and internalization of the process lead to non of successful therapy. Different degrees of improvement can be observed in
greater depth, intensity, and spontaneous flow of the experience; this results in many patients who have not reached the transcendental level of consciousness in
more emotional turmoil, but also in a better chance for a positive breakthrough. A their psychedelic sessions. Unfortunately, the candidates for a productive and suc-
single psychedelic session can achieve dramatic therapeutic results by penetrating cessful psychedelic session eannot be selected in advance with a reasonable degree
or bypassing the psychodynamic levels and utilizing powerful mechanisms of of certainty by any known criteria. Since the important variables determining the
transformation on the perinatal and transpersonal levels. This is facilitated by full outcome of the session are insufficiently understood, the psychedelic approach,
theoretical acknowledgement and validation of transpersonal realities. Careful with its extreme “all-or-none” philosophy, still remains very much a “hit-or-miss”
positive structuring of the reentry is another important factor ‘of therapeutic procedure.
change. ; The theoretical drawbacks of psychedelic therapy are probably more impor-
As a result of a favorable combination of the above factors, a good thera- tant than its practical shortcomings. This approach may produce very dramatic
peutic outcome can be obtained even if the patient does not explicitly confront therapeutic changes with minimal understanding of the underlying mechanisms.
certain areas of major difficulty and conflict on the psychodynamic level; in The material from psychedelic sessions can offer new insights into some phe-
systematic psycholytic treatment these would inevitably have to be faced. Under nomena of a very general nature, such as the dynamics of positive and negative
these circumstances, there is certainly less risk of a worsened clinical condition, memory systems, the existence of new mechanisms of personality transformation,
even with severely emotionally disturbed patients, than after individual dimensions of human experience and the human mind, states of consciousness
psycholytic sessions. associated with dying, or the mystical nature of the universe. It contributes rela-
If we consider the other important advantages of psychedelic therapy, such tively little to our knowledge of the effects of LSD, cartography of the human
as reduced time investment, less intense exposure to the drug, and fewer trans- mind, psychodynamics of mental illness, or mechanisms of therapeutic change.
ference problems, it would seem that the psychedelic procedure is clearly superior This aspect of psychedelic therapy will be seen as a great disadvantage by
to the psycholytic approach. It is therefore important to discuss some of the those who judge the scientific returns of this procedure by Western standards. It
theoretical and practical disadvantages of psychedelic therapy, which should be will be highly rewarding for those who seek an alternative to linear, rational and
taken into consideration in the formulation of an integrated therapeutic approach. logical approaches to knowledge. The insights emerging from high-dose psyche-
An important question that would have to be clarified is the nature of the changes delic sessions are of a global, intuitive and holographic nature. The transcendental '
observed in psychedelic therapy. The major objection raised against these sudden “ahal” experience of this kind cannot be dissected easily by the Western analytical
clinical improvements and personality transformations is that they represent only mind, nor can it be exploited in a pragmatic sense. It is an illuminating insight
temporary shifts rather than deep changes of dynamic structures. From this point ,
into the very essence of existence. The experient does not gain rational understand-
of view psycholytic therapy, dealing slowly and patiently with various levels of ing of the cosmic process, but reaches instant compreliension by losing his or her.
unconscious conflicts, would provide more lasting results. There are no com- q separate identity and literally becoming the process. |
parative studies that would answer the fundamental question whether deep and This intuitive insight into the universal scheme of things is quite similar to
 128 PSYCHOLYTIC AND PSYCHEDELIC THERAPIES WITH LSD
th4
\

the process described in the Upanishads as “Knowing That, the knowledge of

which gives the knowledge of everything.” This does not involve a total and all-
encompassing intellectual comprehension of the universe, in the sense of causal
connections and pragmatic know-how concerning objects and events in the phe-
nomenal world, but a transcendence of phenomena, space, time, and causality.
It is necessary to add that this is frequently accompanied by the conviction
that some of the questions that were previously considered important or even
urgent are irrelevant in the context of the new system of reference. Instead of find-
ing answers to specific questions, one reaches a state in which those questions do
not exist or are not relevant, or where there is no need to ask them; both finding
the answers and transcending them represent solutions to the problem, although
on different levels and of differing kinds.
The fact that certain questions appear irrelevant to LSD subjects in the con-
text of mystical consciousness will not relieve the frustration of a scientifically-
minded researcher trying to draw some general conclusions from the observations
of psychedelic therapy. The enormous interindividual variability precludes any
valid generalizations based on the material from single sessions with many dif-
ferent subjects. The definite spiritual emphasis of psychedelic therapy, its recogni-
tion of mystical states of consciousness, and the inclusion of what might appear to
a superficial observer as elements of religious indoctrination, will certainly make
this approach less appealing to skeptical and critical professional audiences. This
will continue to be true until an adequate paradigm is developed that will make
it possible to assimilate all the extraordinary new phenomena into the body of ex-
isting psychiatric knowledge and general scientific theory.

NOTES

1. Arthur Janov has a similar approach to the spiritual experiences occurring in

some patients during primal therapy. His original emphasis was exclusively on
early childhood material. Later, he was forced by clinical observations to
incorporate the birth trauma, whose significance he originally denied, into the
theory of primal therapy. At present, he still lacks genuine recognition of the
value of transpersonal experiences, and considers them a “cop-out from primal
pain.” The most serious dilemma of primal therapy is the fact that it uses a
tool that has the power to elicit experiences for which the limited primal
theory does not have an adequate conceptual’ framework.
2. Transpersonal psychology and the mystical world-view are frequently, and _
erroneously, referred to as unscientific. This reflects the fact that psychology
and psychiatry (as well as the general public) still adhere to the old.model of
the world, based on the Newtonian image of the universe and the Cartesian
dichotomy between mind and matter. In actuality, the mystical world-view is
surprisingly compatible with revolutionary discoveries in modern science, such
as relativity theory and quantum physics. Both modern physics and the |
mystical world-view violate common sense and are inconsistent with what can
men

be called “the pedestrian consciousness and world-view,” which has not caught -
up with either. The interested reader will find an excellent discussion of the
convergence of modern physics and mysticism in Fritjof Capra’s book The Tao
of Physics. (18)
i
i

PRINCIPLES OF
LSD PSYCHOTHERAPY
The Preparation Period
Psychedelic Sessions
Integration of the Drug Experiences

Having discussed the most general problems related to LSD psycliotlerapy, I will
describe the basic principles of an LSD procedure which, according to my past
clinical experience, can bring the best therapeutic results in the shortest possible
time and with the least risk of complications. The procedure is also in full agree-
ment with clinical common sense and with present theoretical understanding of
the mechanisms of the LSD reaction.
An ideal course of LSD psychotherapy involves an open-ended situation in
which the number of sessions is not limited a priori. In general, the treatment pro-
cess consists of three separate but mutually interrelated phases. The first of these is
the preparation period: it involves a series of drug-free interactions during which
the subject is prepared for the drug experience. For obvious reasons, the nature of
the preparatory phase will be quite different for the first psychedelic session; when
the sessions are repeated, certain generalities will be omitted and in-depth atten-
tion will be focused on certain specific problems suggested by earlier sessions. The
second phase is the drug session itself; during the session day the patient spends
many hours in a special treatment suite assisted, ideally, by a male-female
therapeutic dyad. The third phase involves several non-drug interviews in the
post-session period; the purpose of these is to help the subject integrate the content
of the psychedelic experiences into his or her everyday life.

THE PREPARATION PERIOD

A sufficiently long period of drug-free interaction between the subject and the sit-
ters should precede the first LSD session. The amount of time that is necessary
to prepare a person adequately for a psychedelic session depends on the nature of
the problems involved and on the circumstances; normally the range is somewhere

131
 PRINCIPLES OF LSD PSYCHOTHERAPY The Preparation Period 133
132

between five and twenty hours. It is understandable that it takes much less time to ever overwhelming and crippling they might seem. The traumatic past is seen as a
work with an emotionally relatively stable subject who volunteers for the LSD ses- complex of factors and situations that has alienated the patient from his real self.
sion for the purpose of professional training, personal growth, or enhancement of The image of human nature on which this approach is based is closer to
creativity, than to prepare a severely disturbed patient with serious neurotic, Hindu philosophy than to Freudian psychoanalysis. Behind the barrier of negative
psychosomatic or borderline psychotic symptoms. instinctual forces associated with early biographical traumas and the hellish
Since every situation is different and every client presents quite specific realms of the perinatal matrices there exist vast transpersonal realms of the super-
probleins, no concrete and detailed guidelines can be offered for the nature, con- conscious mind, and a system of positive universal values not dissimilar
tent and duration of the preparation period. However, it is possible to give some to Abraham Maslow’s metavalues. In the psychedelic model the human mind is
general recommendations and outline certain basic principles and strategies for not limited to biographically determined elements of the Freudian unconscious; it
preparatory work. has no boundaries or limits and its dimensions are commensurate with those of the
entire universe. From this point of view, it is more correct to see human nature as
If the session is run for therapeutic purposes the therapist should discuss in
considerable detail the subject's present life situation, emotional, interpersonal divine than as bestial. Although the specificities of this philosophy are not com-
and professional adjustment, and the dynamics of various psychopathological municated to the patient as part of the preparation for the sessions, this world-
symptoms. It is also important to get sufficiently acquainted with the candidate's view characterizes the approach of a psychedelic therapist.
biographical data from early childhood to recent past. This will be very useful for In working with LSD patients, whether during the preparation or later on,
a deeper understanding of various episodes of a psychodynamic nature that might it is not necessary to avoid all value judgments and direct advice. The therapist
occur in the LSD sessions. A therapist who is familiar with the client's should not try to give the patient specific guidance on concrete life situations, such
as whether or not to get married, file for a divorce, have children, get an abor-
developmental history will be able to offer much effective support and guidance.
Knowledge of the subject's family dynamics, characteristic interpersonal patterns, tion, and leave or change a job. Here the psychoanalytic principles are certainly
and idiosyncratic emotional reactions in different periods of his or her life makes it justified. The situations involved are usually too complex and contain many un-
much easier to recognize specific biographically determined distortions in the predictable factors; the therapist cannot evaluate them objectively enough to sug-
therapeutic relationship and deal with them effectively. A particularly important gest the optimal course from the point of view of the client’s needs. Under these
part of the preparatory work is to recognize certain recurrent themes, repetitive circunstanees, it is very likely that the advice would reflect the therapist's un-
patterns, vicious circles, and self-perpetuating elements in the client's inter- conscious fears, wishes and needs, instead of representing an “objective profes-
personal interaction, since these are likely to be reenacted in the transference sional judgment.” However, a directive approach seems to be indicated and useful
relationship. in regard to a general philosophy of existence and life strategy. Here the LSD
During the exploration of the subject's life history, the therapist should share therapist can base his or her guidance on a set of values that seems to be intrinsic
any meaningful insights and observations that he has concerning the emerging and universal. These values tend to emerge independently and quite consistently
matcrial. One important task is to develop an effective framework for organizing during successful psychedelic therapy with various subjects and appear to be
the subject's understanding of the relationship between his or her traumatic past associated with healthy functioning.
and the existing problems and difficulties. Another area that deserves special at- One of the basic messages of this existential strategy is the emphasis on life in
tention is the connection between psychopathological symptoms and interpersonal the here-and-now—the present moment, this hour, today—as compared to
maladjustment. It is very important to depart at this point from the classical rumination of memories front several past decades and indulgence in fantasies or
psychoanalytic approach, and conduct the interviews in the spirit of the basic plans for inany years to come. At the same time, the awareness of the client is
philosophy underlying psychedelic therapy. The psychoanalytic approach is pri- directed from grandiose scliernes toward simple and ordinary situations in every-
inarily concerned with psychopathology, and thus focuses selectively on the day life, not only as a new and untapped source of potential gratification but as
negative aspects of the patient's personality. The Freudian image of man is in- the only real basis of satisfaction in life. The client is not necessarily discouraged
stinctivistic and essentially pessimistic. Psychoanalysis sees human behavior as from pursuing complicated and involved long-term projects, but is led to an in-
motivated by primitive impulses of a sexual and aggressive nature, and interprets sight that external achievements alone will not bring the expected satisfaction and
any higher values as reaction formation or compromise with the repressive forces peace of mind. A deep confrontation with death, which is an important part of
of society. Unhappiness is the normal human condition; the purpose of psycho- the psychedelic process, will inevitably make people realize that a good self-image
therapy is to change the excessive suffering of the neurotic into normal human suf- and positive feelings about oneself, the ability to enjoy the life process, and a deep
fering. The psychoanalyst is basically non-directive; he or she avoids value sense of meaning with regard to one’s existence are not contingent on complicated
judgments and any active guidance of the patient. It is very rare that a psycho- external conditions. They represent a primary organismnic state and a way of being
analyst trained in the classical tradition gives a clear answer to a specific question. in the world that is basically independent of the material conditions of life, with
In the preparation for an LSD session, we also discuss symptoms and life the exception of some drastic extremes.
problems. However, the therapist tries to relate to whatever is available of the If this fundamental affirmation of existence is present, then even the com-
healthy core of the patient's personality. The basic message is that there is a deep monest life conditions can be experienced as worthwhile. In a sense even the sim-
positive potential in every human being that is hidden behind the symptoms, how- ple fact of participating in consciousness and in the cosmic process, in whatever
 134 PRINCIPLES OF LSD PSYCHOTHERAPY The Preparation Period 135

way, appears to be very precious. Ordinary activities such as everyday work, tween religion and science, and conflicts between various creeds. For those clients
physical exercise, eating, going for a walk, watching a sunset, or making love can who a priori have strong negative feelings about the religious aspects of psyche-
become a joyful expression and celebration of life. When this basic appreciation of delic therapy, it is helpful to emphasize that spiritual experiences in LSD sessions
the fact of existence is missing then external success and achievement of any kind usually do not take the form outlined by orthodox religions. More frequently, they
and any scope will not provide it. Under these circumstances, frantic pursuit of are close to what Albert Einstein described as cosmic religion. This form of spiri-
what appear to be sclf- and life-validating goals will trap the individual into a net tuality does not involve a personified godhead, a pantheon of intermediary saints,
of vicious circles without bringing the expected satisfaction. The positive life feel- regular church attendance, and formalized divine service. The focus is on the
ings, if absent, have to be sought inside, through a process of deep self-exploration failure of the rational approach to grasp the many mysteries of nature and on the
and inner transformation, not by manipulation of external circumstances alone. | awe and wonder experienced in confrontation with the creative forces of the
The philosophy underlying psychedelic therapy thus definitely emphasizes _orien- universe.
tation on the process, rather than on the outcome or goal. How and with-whatat;. In this context, spiritual feelings are associated with such issues as the
titude one performs certain activities becomes very important in this context, not enigma of time and space; the origin of matter, life, and consciousness; the dimen-
only what the specific choices are and what the final result of one’s effort will be. sions of the universe and of existence; the meaning of human life; and the ultimate
During the preparation for the session, the above system of values can be ex- purpose underlying the process of creation of the phenomenal world. Spiritual
plicitly and implicitly communicated to the client whenever there is a good oppor- experiences of this kind can occur in individuals of high intellectual caliber and
tunity. It seems appropriate to actively discourage excessive dwelling on the past rigorous scientific training, in fact, they are fully compatible with observations ac-
for sentimental reasons or nostalgia, questioning of old decisions and choices, ex- cumulated by various branches of modern research. An important illustration of
amination of actions associated with guilt, or retrospective rumination on failures. this point, for those who emphasize the scientific world-view, is the recent con-
In a similar way, clients can be warned that they might not achieve the expected vergence of quantum-relativistic physics and various mystical traditions.
happiness by pursuing elaborate plans for the future involving money, power, In some instances, perinatal and transpersonal experiences in psychedelic
status, or fame. This is particularly important if the schemes for the future are ir- sessions can occur in specific synibolic forms typical of certain cultures aud histor-
rational, unrealistic, and exaggerated, or if the client is obviously wasting time in ical periods. Without special training and sophistication in archaeology or myth-
futile daydreaming and building “castles in the air.” ology, knowledge of the cultural heritage involved, or even adequate general in-
It seems fully justified to emphasize the deep wisdom of the emotional and tellectual background, an individual may experience mythological and symbolic
philosophical (though not necessarily pragmatic) orientation towards the present sequences from ancient Egypt or Greece, Africa, India, Tibet, China, Japan,
moment, and of a reliance on ordinary situations for basic life-satisfaction. We Australia, or Pre-Columbian countries. However, images of specific personified
can also point to the futility and self-defeating nature of various attitudes and deities from these cultures are not usually felt to be the supreme and ultimate force
behaviors reflecting desperate needs to prove oneself, to please or convince one’s in the universe. Like the endless variety of beings and objects constituting the phe-
parents, peers or unidentified “others,” or to fight irrational authority. Since the nonienal world, such deities appear to be manifestations of a creative principle
above value system and life strategy was derived from the psychedelic process, that is transcendent and beyond form. If the psychedelic experience occurs in the
there is a good possibility that the drug sessions will provide a powerful experien- context of one of the traditional sacred frameworks, it is usually congruent with
tial validation of various issues conveyed during the preparation in a more or less the teachings of the mystical branches of that particular religion rather than with
intellectual way. its orthodox mainstreain form. It is thus closer to Christian mysticism than tradi-
An important part of the initial work focuses on philosophical and religious tional Christianity, to the Kabbalah or Hassidism rather than Old ‘Testament
issues. Although it has occasionally been done by psychedelic therapists, 1 would Judaism, or to Sufism rather than the Moslem faith.
not recommend the use of a specific religious system as part of the framework for The psychedelic experience frequently involves elements totally alien to an
the sessions, whether it is Christianity, Judaism, Hinduism, or Tibetan Buddhism. individual’s own religious tradition. Thus a Buddhist can experience identification
This can frequently interfere with a symbolic framework that is emerging spon- with the crucified Christ and emerge from the session with a new understanding
taneously from the subject's collective unconscious and is the most appropriate of Christianity; a Christian can have experiential sequences in which he or she
form for that person’s spiritual experience. In addition, explicit introduction of the discovers and appreciates Sufism; a Moslem may get insight into the law of
elements of a specific religion or church affiliation can be experienced as inappro- karma and cycles of reincarnation; and a Rabbi may experience a conversion
priate and irritating not only by atheists and skeptics or followers of other creeds, toward Zen Buddhism. In whichever way the subject experiences and concep-
but also by those who have been brought up in that same tradition and have tualizes the transcendental realities, he or she will usually accept that form as ap-
developed serious conflicts about it. However, it seems useful to increase the propriate and fully compatible with his or her personality.
client’s awareness of the aesthetic aspects of the world, his or her interest in basic A very important element of the preparation is the developnient of a trust
philosophical questions of life, and recognition of the spiritual dimension of exis- relationship between the guide and the client. The ability of the subject to let go
tence in a non-specific way. of psychological defenses and surrender to the experience, which is crucial for suc-
Clarification is frequently required in regard to the subject's understanding cessful outcome of the session, is directly proportional to the degree.of trust in the
of the term “religion,” the role of spirituality in human life, the relationship be- sitters. Trust is thus the single most important prerequisite of safe and effective
 the freparation teria
136 ‘ PRINCIPLES OF LSD PSYCHOTHERAPY

professional literature. Of these, the most important are concepts of the LSD state
as “model schizophrenia” and of LSD as a substance that can cause or precipitate
psychosis; the issue of prolonged reactions and “flashbacks”; the danger of organic
brain damage; and the possible adverse influence of LSD on chromosomal struc-
ture and heredity.
The “model psychosis” concept was discussed earlier; it is outdated and was
replaced by a new understanding of LSD as a catalyst or amplifier of mental pro-
cesses. The occurrence of transitional psychotic states after some sessions represents
one of the risks of LSD therapy even under supervised conditions. fLowever, in
supervised LSD work these occur very rarely, and only in people with severe emo-
tional problems and borderline symptomatology. They are not created by the
drug but represent exteriorization of important, deep unconscious material. The
activation and conscious manifestation of large quantities of such material can
present a clinical problem; however, it is also an opportunity for therapeutic
change, if approached and handled properly. In a later section we will discuss in
detail the mechanisms of prolonged reactions, “flashbacks,” and psychotic decom-
pensations associated with the administration of LSD, as well as certain principles
of conducting sessions that can minimize the occurrence of these phenomena.
The only serious and unquestionable somatic danger associated with
psychedelic sessions is the stress on the cardiovascular systein caused by the inten-
Through illusory transformation, the rotating plastic wheel of a Lape recorder becomes an sity of emotions and physical tensions typically triggered by the drug. Careful
ancient Egyptian ornamental motif showing the heads of three hicrophants. selection of the candidates and screening out of persons with a history of myocar-
dial infarction, decompensated heart failure, malignant hypertension, severe
arteriosclerosis, tendency to brain hemorrhage and similar conditions, eliminates
this risk. A disposition to seizures may be a contraindication for a psychedelic ses-
psychedelic therapy. In the most general sense it is of great relevance to the course
sion unless a well-equipped pharmacy is readily available. In individuals with a
of any LSD session; however, there are certain specific situations in which the ele-
history of epilepsy LSD can occasionally trigger a sequence of seizures, or status
ment of basic trust plays a particularly crucial role. Any work on the roots of one’s
epilepticus, which can be extremely difficult to control outside of a medical
distrust of other people and the world at large is critically dependent on the
setting.
quality of the relationship between the experient and the guides. Similarly, the
There are no indications that pharmaceutically pure LSD in the dosages
ability to face the experience of ego death in all its complexity and depth usually
that have been used in psychotherapy (50-1500 micrograms) causes organic brain
requires good external grounding in a dependable therapeutic situation. In view of
damage. The allusions to this possibility that have occurred in professional
the importance of the relationship between the guides and the client, the prepara-
literature were based on two observations. The first of these was the frequent
tion for a session should not be just a one-sided flow of information but should
occurrence of tremors, jerks and comptex twisting movements in the subjects dur-
give the subject a chance to get to know the future sitters. Ideally, instead of being
ing LSD sessions. These motor manifestations ean be observed even in individuals
a conventional exchange of clichés, the preparation period and the therapeutic
without an epileptic disposition and they bear a certain similarity to symptoms
process should represent a genuine human encounter.
seen in a variety of organic diseases of the central nervous system. According to
When the therapists feel that the preparation has accomplished the objec-
clinical observations from LSD therapy, they represent release and discharge of
tives described above and the client is psychologically ready for the first drug
deep, pent-up energies associated with emotional abreaction and actually have a
experience, they schedule one last meeting before the session. This focuses ex-
great therapeutic potential. The most dramatic motor abreactions of this kind
clusively on various technical aspects of the procedure and usually takes place on
occur in connection with the death-rebirth process. They tend to diminish or
the day immediately preceding the drug session. The discussion concerns the
disappear when the individual moves beyond the perinatal level, despite the fact
nature of the psychedelic experience, the range of unusual states of consciousness
that by then the total amount of the drug ingested is much higher than at the time
that can be induced by LSD, and the most useful ways of dealing with the ex-
when they first occurred. Also, the great individual variability and lack of a direct
perience. At this point, unless it happened earlier in the process, the therapists
dose-effect relationship weigh strongly against there being an organic basis for the
should encourage the client to voice all the fears and doubts that he or she might
motor phenomena in LSD sessions. In general, testing of LSD subjects during
have about the drug and the procedure. This is the last opportunity to answer
various stages of the psycholytic series failed to detect any indications of brain
general or specific questions and to clarify all the misconceptions and half-truths
damage, even in those cases where the total nuinber of sessions was close to one
that the subject might have picked up from sensational publicity and even from
138 PRINCIPLES OF LSD PSYCHOTHERAPY The Preparation Period 143

hundred. The techniques used in this context were basic neurological examination, persons with serious cardiovascular problems and pregnant women, and proceed
electroencephalography, and psychological tests that are routinely used for with caution when there is a predisposition to epileptic seizure. Ail other dangers
establishing organic brain damage in clinical practice. seem to be of a psychological nature. To a great extent these are not inherent in
The second observation that some authors interpreted as indicative of brain the drug itself, but are determined by a complex of extrapharmacological factors,
damage was the incidence of certain personality changes observed in some LSD such as the personality of the subject, the set and setting, and the specific tech-
users. Among these were loss of ambition, dropping-out from school, growing niques used in the process. The most important aspects of this problem are dis-
long hair and a beard, wearing unusual clothes, a lessened concern about personal cussed in detail in other parts of this book.
hygiene, departure from a rational orientation, and preoccupation with After all the fears, doubts and apprehensions have been discussed with the
philosophical and religious issues. Careful analysis of the “hippie. personality” client, the therapist should convey his or her understanding of the effect of the
clearly indicates that it cannot be attributed exclusively to the use of psychedelic drug and of the therapeutic potential of the experience. It is important to empha-
substances. It is a complex phenomenon which involves important sociopolitical size that LSD is a catalyst or amplifier of mental processes, a tool facilitating deep
factors and elements of juvenile revolt reflecting the deepening generation gap. It self-exploration. Ingesting it does not send one into an alien world of “toxic
was clearly demonstrated in our patient population that profound personality psychosis” or “chemical phantasmagoria,” but mediates an adventurous journey
changes, including philosophical and spiritual transformation, can occur without into the hidden recesses of one’s own unconscious mind and through it into realms
the external changes characterizing the hippie personality. To equate the per- that can best be described as superconscious.
sonality changes of American LSD users with the deterioration observed in In the early years of LSD research, influenced by the “model schizophrenia”
patients with organic brain diseases such as prefrontal tumors shows grave hypothesis, psychedelic sessions were routinely referred to as “experimental
misunderstanding of the problems involved. In addition, the poor quality of many psychoses” even when they were conducted for therapeutic purposes. It is impor-
of the street samples of LSD and the overlapping of the psychedelic scene with the tant to avoid terminology and metaphors of this kind, since they are not only
use of amphetamines, barbiturates, phencyclidine, STP and other drugs, raises scientifically incorrect, but involve a danger of heavy negative programming for
serious doubts whether one can draw any conclusions about LSD from observa- the session. In such a context, episodes of anxiety, aggression, mistrust and other
tions made in connection with the non-medi¢al use of so-called “street acid.” difficult emotions will be interpreted by the subject as indications of the “psycho-
Unfortunately, the negative publicity concerning LSD and other psyche- tomimetic” effect of the drug, instead of being seen as unique opportunities for
deiics not only influenced the attitudes of the general public, educators and legis- confronting and working through certain problematic areas in one’s own mind. In
lators, but also the opinion of many professionals. The national hysteria of the six- addition, the allusion to schizophrenia or psychosis has a frightening connotation
ties and sensational newspaper headlines had a greater influence on psychiatrists of irreversible and permanent loss of sanity. More appropriate and useful meta-
and psychologists than the results of clinical studies indicating the relative safety phors are those using the images of an “intrapsychic movie,” a “vivid fantasy,” or
of LSD when used under responsible circumstances. As a result of this, many of a “waking dream.” It is particularly helpful to remind the future candidate for
the statements made about the drug by professionals reflected a strongly irrational psychedelic therapy that in our sleep we all have episodes of unusual states of con-
emotional bias rather than solid scientific evidence. This is best illustrated by the sciousness during which we can vividly see, hear, smell, taste, and feel things that
fact that among the psychiatrists who raised fierce objections to the use of LSD as do not exist in the phenomenal world. This reference to dreams is a useful em-
a therapeutic tool, because they were concerned it may cause some subtle brain phasis of the fact that all phenomena which deviate from the common experience
damage not yet detectable by our current methods, there were some individuals of reality and the usual logic of things do not necessarily imply insanity.
who did not hesitate to recommend patients for pre-frontal lobotomy.’ Another important part of the preparation is to inform the client briefly of
The last area that should be mentioned in this context is the effect of LSD on the range of experiences that can occur during the session, such as perceptual
the chromosomes, fetal development and heredity. Sensationalizing has succeeded changes in various sensory areas, rcliving of emotionally relevant experiences from
in programming the general public so thoroughly that this issue is almost bound to childhood, sensations related to diseases and operations, elements of the death-
come up during the preparatory talks. The problem is of critical importance for rebirth process, and various transpersonal phenomena. Since many of these are
psychedelic psychotherapy and its future, and one of the appendices to this book beyond the conventional frameworks, it is useful to encourage the client to give up
presents a critical review of over one hundred scientific papers on the subject. I intellectual analysis during the session and focus on the experience itself. Other-
will only briefly summarize my own opinion on this matter, based on twenty wise, reason can become a powerful obstacle to exploring new areas of experience.
years of clinical experience and a thorough study of the existing literature. There The intensity of psychedelic states also deserves notice; it is important to prepare
does not seem to be any indication that the administration of pharmaceutically the client for the fact that the dimensions of the experience will probably be
pure LSD has any specifically deleterious effect on chromosomes or heredity. It beyond anything that he or she has ever faced before or could even imagine in the
should not be administered to a pregnant woman, however, because of an in- usual state of consciousness. Although no words can adequately conmmunicate the
creased danger of abortion and possible interference with fetal development. intensity of a high-dose LSD experience, such a warning can save the candidate
LSD thus appears to be a very safe substance biologically, if we screen out from shock and panic during the session.
 144 PRINCIPLES OF LSD PSYCHOTUERAPY The Preparation Period 145

It is essential to discuss in advance several situations that are the most fre- text the vagina appears to be a murderous organ and the individual cannot imag-
quent sources of difficulty in LSD sessions. The first of these is the experience of ine ever approaching it again as a source of pleasure.
dying, which can be so dramatic, realistic and convincing that the subject can Various physical feelings that can occur in LSD sessions should be men-
easily mistake it for a real physiological emergency. This is particularly true for tioned here. On occasion, they reach sufficient intensity to present real problems.
the confrontation with death that occurs on the perinatal level; it may be It is important to make it clear to the client that LSD in the dosages commonly
associated with many acute biological signs that can alarm not only the subject used in psychotherapy does not produce any somatic symptoins just by virtue of its
but also an inexperienced sitter. The drastic changes of color, seizure-like motor pharmacological effect. Nausea, vomiting, headaches, various muscular pains,
activity, projectile vomiting, profuse sweating, and fast thread-like pulse that ac- suffocation, painful cramps of the uterus or the gastrointestinal tract, increased
company the experience of dying can be very convincing as indicators of physical inotor activity, and other physical manifestations in LSD sessions are always of a
crisis, and may contribute to the failure to recognize its symbolic nature. There psychosomatic nature. They are associated with important psychological material
exists another type of confrontation with death that occurs on the transpersonal and experiencing them fully is of great therapeutic value.
level. It does not usually have the same heavy biological emphasis or the form of a Every preparation for a psychedelic session should involve discussion about
violent life-threatening assault. The major focus of the transpersonal form of con- the possibility that the client might experience at some point a profound crisis of
frontation with death is on the relative ratio between attachment to the world and basic trust, no matter how good the therapeutic relationship seems to be before the
the desire to leave it. As a process it is much more subtle, and tends to have the drug experience. The essential characteristics of this important crisis were de-
quality of relatively free decision-making. It is primarily the perinatal encounter scribed earlier. It is vital to prepare the client for this possibility and strongly sug-
‘with death that presents problems in the sessions, and it should be discussed with gest that he or she try to look inside themselves for possible sources of such mistrust
the subject in advance. It is important to convey that the perinatal experience of before focusing their attention on the external circumstances. It is obviously more
dying occurs in the context of the death-rebirth process, and that total surrender reasonable to assume that one’s perception was changed by the influence of a
to it is always followed by feelings of liberation, whereas struggle against it pro- powerful psychoactive drug, than to suspect that within half an hour a drastic and
longs the suffering. unexpected change occurred in the external situation or in the personalities of the
The second frequent problem in LSD sessions is the feeling that the experi- sitters. The very fact that the possibility of the crisis involving trust was discussed
ence will never end or that permanent insanity is imminent. A special instance of in advance usually helps to mitigate it when it occurs.
this state is the no-exit experience described earlier. It is of critical importance for A basic rule that is of critical importance in LSD psychotherapy is to keép
the subject to know that the fastest way out of this condition is to accept the con- the sessions internalized. Since the psychedelic experience represents a process of
tent of the experience. No judgments about the outcome of the session made while deep self-exploration, a journey into one’s own mind, consistent introspective
it is still in progress should be considered valid assessments or predictions; they orientation is by far the most productive approach. LSD subjects are therefore en-
should be treated as part of the experience. Thus, paradoxically, accepting that couraged to stay for most of the experience in a comfortable reclining position
one will stay in the hellish experience forever leads to its termination, and total with their eyes closed; the best technical solution here is the use of soft eyeshades.
surrender to permanent insanity results in a move to higher sanity. As in the case Exposure to complex stimuli from the external world, especially if combined with
of the death experience which frequently accompanies the fear of psychosis, fight- moving around, excessive talking and social interaction is, in general, counter-
ing the specter of impending doom and insanity prolongs the unpleasant state and productive. It tends to keep the experience on a superficial level and interferes
keeps the subject in the sphere of its influence. with the process of self-exploration. On occasion, expressive dancing can be very
The third most common source of panic is the fear of becoming homosexual. useful in psychedelic sessions if the subject keeps his or her eyes closed and does not
It is usually initiated by feelings of very authentic identification with representa- lose the introspective connection with the inner process.
tives of the opposite sex. A male subject can experience not only an authentic I would not like to deny that there can be positive value in psychedelic ex-
female body image, but also a very genuine sense of what it feels like to be preg- periences in which the subject is oriented toward the external environment. The
nant, to deliver a child, or to have a vaginal and clitoral orgasm. The less frequent drug can open and sensitize all the sensory channels to an extraordinary degree
equivalent experience in the female usually does not involve a sense of having a and make it possible for the subject to perceive the world in a totally new way.
masculine body, but male psychological characteristics. It is necessary to reassure The ensuing aesthetic, emotional and spiritual participation in the environment
the subject that this is a very unique opportunity to gain access to the experiential can be a very profound and valuable experience, especially if the session takes
world of the opposite sex. It will ultimately strengthen the sense of one’s own sex- place in a beautiful natural setting. An externalized psychedelic experience in the
ual identity rather than cause a homosexual transformation. Another source of mountains, on the seashore, in the woods, or even in one’s own garden can
homosexual fears can be sudden feelings of physical attraction to the sitter of the become a unique and unforgettable event. However, if one is taking LSD for this
same sex. These can usually be deciphered as transference of early sensual feelings purpose, it is important to stay in the lower dosage range, below 100 micrograms.
toward the parent of the same sex. The deepest source of hhomosexual panic in a Higher dosages tend to activate iinportant unconscious material that can surface
male subject seems to be the emergence of frightening birth memories; in this con- and distort the perception of the environment. For a person who takes LSD in a
 146 PRINCIPLES OF LSD PSYCUOTHERAPY The Preparation Period 147
4
“4
complex physical and social setting, relevant psychological elements and external preteding session and remained unresolved. The concept of temporary worsening
sensory stimuli fuse into an inextricable amalgam that obscures the emerging per- as an unfinished gestalt helps the patients to tolerate difficult post-session inter-
sonal material. Under these circumstances, the LSD state tends to become an in- vals, approach them constructively, and maintain optimism in regard to the final
comprehensible mixture of external perception and experiences of one’s inner outcome of the treatment.
world; as a result of this, such situations are generally not very conducive to pro- Before I start describing the actual technique of conducting the LSD ses-
ductive introspection. Sessions using higher dosages for the purpose of personal sions, I would like to mention briefly several observations from my European
growth, working through the emotional problems, and philosophical or mystical study of psycholytic therapy. They can be used as empirical and theoretical justi-
quest should, therefore, be internalized. fication of some of the principles outlined later. During psycholytic therapy, the
An even more important reason for keeping the focus on the inner process is clinical condition of the patients in the free intervals between LSD sessions showed
the element of safety. The ratio between the potential benefits and possible risks is considerable oscillations in both directions. After some sessions, clinical symptoms
much more favorable for internalized sessions conducted in a simplified and pro- were alleviated or even disappeared and patients felt “cured,” free from conflicts
tective setting, than it is for the outward-oriented experiences practiced by many and problems, and ready to start a totally new chapter in their lives. After other
people in the subculture. It is essential for a good outcome of the session that a sessions the clinical condition obviously deteriorated, as compared to the pre-
balance be kept between the lowering of psychological defenses and effective session period. Sometimes the original symptoms were intensified, at other times
working through of the emerging unconscious material. Whatever deep contents entirely new and unexpected forms of psychopathology emerged, after a poorly
have been released, the energy associated with them should be channeled to the resolved session. Occasionally, we witnessed prolonged reactions or even tem- *
‘periphery. Maximum awareness of the inner process and its full emotional, porary psychotic decompensations in some borderline patients. In several instances
perceptual and physical expression is of paramount importance for a good integra- a striking clinical improvement was reached in patients who had a very dim prog-
tion of the LSD experience. Sessions in which the drug activates areas of difficult nosis, but continuation of LSD therapy with the intention of stabilizing the results
emotional material and the individual tries to avoid facing them can lead to pro- in fact opened new areas of problems.
longed reactions, unsatisfactory integration, subsequent residual emotional or Although there is a general trend toward more positive LSD experiences and
psychosomatic problems, or a precarious mental balance that becomes the basis better functioning in life with the increasing number of sessions, it seems inipossi-
for later “flashbacks.” ble to eliminate all areas of conflicts and problems. Ilowever, the nature of these
In view of the above observations, much emphasis is placed during the problems changes successively from psychodynamic, autobiographically deter-
preparation period on explaining to the client how important it is to maintain a mined issues through derivatives of the death-rebirth process to various transper-
reclining position during the LSD session, to keep on the eyeshades and head- sonal elements. In the most general sense, and with some reservations, it is possible
phones, and to face, experience and express fully whatever is surfacing. Most of ,to talk about the Freudian, Rankian, and Jungian phases of psychedelic therapy.
the technical problems in the sessions occur when the client, instead of treating the ‘It is important to emphasize that the sequence of these stages is not necessarily
experience as an internal process, projects the emerging unconscious material onto linear and that there exist many individual patterns of unfolding. However, if we
the sitters and the treatment situation. This attitude functions as a powerful look statistically at a large number of records froin serial LSD sessions, the bio-
defense and represents a serious obstacle to therapeutic progress. Instead of facing graphical material tends to occur in early sessions, the middle part of therapy is
the problem in the inner world where it can be identified and resolved, the client dominated by the death-rebirth process, and advanced sessions tend to be all
creates a pseudoreal situation by projecting and focusing attention on manipula- metaphysical and philosophical in nature. In all these stages, there seems to exist
tion of the external world. Preventing such counterproductive situations is one of the possibility of the negative outcome of a particular session with an adverse
the important tasks of the sitters and it begins in the preparation period with a effect on the clinical condition.
detailed description and explanation of the basic rules. Retrospective analysis of the records from psycholytic therapy shows that
One inore important aspect of psychedelic therapy should be discussed with good, free intervals usually followed sessions in which important partial resolu-
the patient in considerable detail. In medicine and conventional psychiatry, there tions were achieved. The termination periods of such sessions were characterized
is an implicit rule that in successful therapy the degree of improvement should be by tension-free, pleasant or even ecstatic experiences of the here-and-now. In this
directly proportional to the number of therapeutic interventions or to the duration state, there were no unpleasant physical or emotional symptoms and no preoccu-
of treatment. In the psychedelic procedure, as in other forms of uncovering pation with the past or future; only a sense of pure being with enhanced sensory
therapy that focus on solving the problems instead of relieving symptoms, this is awareness of the present moment. The achievement of sucli a condition should be
not necessarily true. Here it can happen that the symptoms are temporarily inten- the ideal goal of every psychedelic experience. Since the positive outcome of an
sified after some of the sessions; this frequently occurs just before a major LSD session seems to correlate with a good resolution of the activated unconscious
therapeutic breakthrough. It should be explicitly stated in the instructions that it is material and with a pleasant termination period of the session, the sitters should
not a failure of LSD therapy if after certain sessions the client feels worse. It sim- exert active effort at the time when the pharmacological action of the drug is
ply reflects the fact that important unconscious material was activated in the wearing off to facilitate a successful completion of the experiences.
148 PRINCIPLES OF LSD PSYCHOTHERAPY Psychedelic Sessions LAD

the process. If the unit is not in a small separate building but part of a larger com-
Observations from psycholytic therapy provide important clues to how this
can be done most effectively. Spontaneous experiences of tension-free, oceanic plex, adequate acoustic insulation might be necessary.
The treatment room should be homelike, comfortably furnished and taste-
ecstasy in psychedelic sessions are typically associated with visions of beautiful
as clear lakes, calm oceans, tropical islands, luscious forests, fully decorated. Soft padding and cushions are preferable to sharp edges and hard
natural scenes such
flourishing meadows, and blue or star-filled skies. Equally common in this context inctallic surfaces. This not only gives the patient a sense of comfort and pro-
is experiential confrontation with artistic creations of high aesthetic value— tection, but can become an important safety factor in more animated episodes in
struggle.
visions of beautiful temples, sculptures or paintings, and spontaneous hallucina- sessions that involve physical movement or psychodramatically enacted
of assorted fresh and dricd fruits and nuts, a
tions of inspiring music. ‘The experience quite regularly has a definite spiritual and Freshly cut or potted flowers, a bowl
pictures and art books, and various natural objects of great
mystical emphasis, and this typically takes the form of enchantment with the collection of inspiring
and inte-
inysterics of nature and the creative forces of the Universe, although concrete beauty such as shells and stones, have become over the years a standard
lic
archetypal symbolism related to specific religions and mythologies of different gral part of our treatment setting. Music is an essential part of psychede
fidelity stereo record player and tape deck, several sets of
cultures is as frequent. Some patients also report quite authentic experiences of the therapy, and a high
nes, and an extensiv e collectio n of tapes and records of good quality
good womb and good breast, as well as episodes involving ideal maternal care, headpho
love, and friendship. should always be available.
Many of the above elements that occur spontaneously in the context of If possible, the treatment facility should be situated in a beautiful natural
which the
ecstatic episodes in LSD sessions have been routinely used by psychedelic and ana- setting. Although this is of little relevance in the first four to five hours
spends with the eyeshade s and headpho nes on, it becomes importan t dur-
clitic therapists as tools facilitating positive experiences. Walks in nature and the patient
lic experien ce tends to
use of various objects reflecting nature’s creativity, beautiful pieces of art, sym- ing the termination period of the session. The psychede
nature and dramatic ally enhances his
bolic paintings of the sacred traditions, sculptures related to various spiritual bring the subject into intimate contact with
at its best
disciplines, readings from religious texts, and the use of physical contact can be or her sensory perception of the world, and an encounter with nature
and spiritual experien ce of lasting value. It not only con-
mentioned here as salient exaniples. Although the positive influence of these fac- can become an aesthetic
the positive
tors was discovered empirically, their use can be theoretically justified and their tributes considerably to a good integration of the session, but connects
deserves special
unusual efficacy explained on the basis of a deep unconscious association between energies and emotions to elements of the everyday world. Water
LSD
oceanic ecstasy and the experiences of natural beauty, inspired artistic creations, notice; during the session it assumes an almost magical significance for many
of the ses-
spiritual feelings, and highly satisfactory human relationships. Some of these subjects and has extraordinary capacity to facilitate a positive outcome
the ter-
elements and principles should be integrated in a comprehensive program of LSD sion. A swim in the ocean, a clear lake, or a stream can work wonders in
the use of a
therapy; they facilitate the occurrence of positive experiences during psychedelic mination period of LSD sessions. Under more modest circumstances,
swimming pool or bathtub, or a good shower will serve a similar purpose.
sessions, as well as in the termination periods. This makes psychedelic treatment
in
more meaningful and effective and increases its therapeutic potential. It is preferable to start LSD sessions in the morning; if the drug is taken
can continue until late in the evening and the subject
the afternoon, the experience
to be
might find it difficult to sleep that night. The optimal dosage of LSD seems
patients. It is determi ned
PSYCHEDELIC SESSIONS somewhere between 200 and 400 micrograms for most
ity
primarily by the nature of the psycholo gical problem s involved , the personal
and certain physical concerns such as age and general
In the following text, I will outline the most important characteristics of an ideal structure of the subject,
ty or
treatment setting as I see it on the basis of past clinical experience with psychedelic health. Body weight seems to play a relatively minor role; the sensitivi
y a function of the system of
therapy. Obviously, in practice these absolute demands will seldom be met and resistance toward the drug appears to be primaril
ed earlier that patients with severe obsessive -
LSD therapists have to be prepared for various degrees of compromise. Ideally, psychological defenses. We mention
seem to represen t an extreme of resistanc e, while persons
LSD sessions should be conducted in a specifically designed treatment unit or compulsive neuroses
other end of
suite. This should be situated on the ground floor and isolated from the rest of the with a hysterical personality structure or syniptomatology are at the
for LSD somewhe re around
facility, with a separate entrance. A small kitchenette and easily available lavatory the spectrum. There seems to be a saturation point
of the dose beyond this point does not
would make it possible for the therapists to stay with the patient the entire day four or five hundred micrograms; increase
al effect. It is generall y more useful to identify the
without undue interruption, and to choose the optimal moments for a physiologi- seem to produce much addition
sms of resistanc e and try to influenc e them psycholo gically than
cal break or a snack. It is important that the patient be able to reach the bathroom specific mechani
in a short time without having to interact with the external world and to face a to use heroic dosages in an effort to “break down the defenses.”
by injec-
complex social situation. At times, the abreactive episodes in sessions make it LSD is fully effective orally in most individuals and administration
slight shorteni ng of the latency period that this
necessary to encourage loud noises such as screaming, growling, or banging, tion is of little practical value. The
the inconve nience of the injection techniqu e and the in-
which can be quite upsetting for other patients or visitors. Adequate provision gives is usually not worth
of a powerful element of the traditio nal medical inodel into the setting.
should be made for such situations so that the therapist and the patients do not feel troduction
clinical
constrained or restricted by external concerns and can follow fully the dynamics of Intramuscular administration is occasionally useful for patients whose
150 PRINCIPLES OF LSD PSYCHOTHERAPY Psychedelic Sessions 151

problems involve a predisposition to nausea and vomiting. In the case of vomiting In general, excessive talking should be discouraged during the period of
early in the session, an uncertainty might arise as to the actual amount of LSD intense drug effect; this is particularly true for the compulsive, incessant talking
that was resorbed. For similar reasons, LSD was administered by injection to and intellectual analyzing that is usually a manifestation of resistance and inter-
some cancer patients where there was concern about the degree of resorption feres seriously with the experience. Long explanations and interpretations offered
because the gastrointestinal system was afflicted by the disease. by the therapist, or involved discussions, are also usually counterproductive. The
In general, fasting for a day or two before the LSD session seeins to have some psychedelic experiences in high-dose sessions usually have many levels and facets;
advantages. It tends to potentiate the effect of LSD, make the subject more open their rapid unfolding and change make compreliensive reporting impossible. In
to unusual states of consciousness, and reduce the incidence of unpleasant gastro- addition, the ability to articulate and communicate verbally is frequently
intestinal symptoms in the session, particularly nausea and vomiting. A compro- impaired by the influence of the drug.
mise solution should be used almost routinely if the subject has not fasted; we Verbal exchange between the therapists and the client, although very useful
usually recommend a light dinner on the night immediately preceding the session during the preparation, in the termination period of the sessions, and on the
and only liquids (milk, fruit juice, or tea) for breakfast. This tends to shorten the following days, should be kept at an absolute minimum during the culminating
resorption time and reduce the incidence of nausea. hours of the drug session. The subject is occasionally asked to give a brief report
The subject should have light, casual and comfortable clothes; any restrict- limited to a few sentences to provide clues for the sitters. An experienced sitter can
ing garments or potentially dangerous personal belongings should be removed usually get a sufficient understanding of the nature of the subject’s psychedelic
from the body. If this is not done before the session the patient might ask for it state on the basis of external behavior and sporadic verbal communications. This
later in the experience, or it may become necessary in view of certain special situa- is particularly true if the sitter can draw on his or her own experiences of a similar
tions. It is thus easier to eliminate beforehand bras, belts, tight pants, watches, kind. Thus, general tension, an aggressive facial expression, clawing or clenching
pieces of jewelry, artificial dentures, glasses, contact lenses, keys, pocket knives, of the hands, and occasional primitive sounds, together with statements like: “All
and similar objects. this incredible butchery” or “I have been in all the wars since the beginning of the
LSD should be adininistered without much delay, after a brief focusing on world” give sufficient information to the sitter. Similarly, a statement such: as “I
the “here-and-now.” Many patients show a high level of excitement, apprehen- cannot differentiate boundaries anymore; all seems to be coming together, flowing
sion, or anxiety, and as a result lose a few hours of sleep before the session. This is into One” from a relaxed, ecstatic subject does not require any further
quite common before the first psychedelic experience, but is not exceptional even explanation. Sensual movements of the body with ai intense involvement of the
for experienced LSD subjects. It is useful to discuss briefly the physical and pelvic area and occasional utterances about love-making, sex, or orgies convey
emotional conditions and give time for last-minute questions that might be the enough content. Any further narratives and descriptions serve the needs of the
product of a sleepless night. However, much delay tends to increase the anxiety sitters rather than the experient. Memories of the session are usually quite
instead of reducing it. Facing the drug state once it sets in is usually easier than adequate and discussions and analyses can be postponed to a later time. The only
dealing with all the fantasies as to what the experience will be like. exception is a situation of strong resistance where the sitter needs to have exact
After the administration of LSD there is a latency period of about twenty to information to help the experient through the impasse.
forty minutes before the drug takes effect. Its duration depends on the route of If the client is not giving any feedback, the therapist should interrupt briefly
administration, the amount of food in the stomach if the drug is ingested, and the every half-hour or so; the purpose of this “checking-in” is to re-establish contact,
level of psychological defenses. The time before the onset of the drug effect can be obtain some clues about the process, and give reassurance if necessary. One of the
spent in meditation, listening to quiet music, looking at pictures, or in relaxing reasons the sitters should know the nature of the subject's experience is that music
discussions. Sometimes it is interesting to leaf through the family album or look at for the session should be chosen with sensitivity to match the psychological state of
pictures of close family members if one wants to use the experience for a deeper the experient. Apart from this, mostly non-specific support should be given
insight into and work on relationships with close relatives. through non-verbal channels. This can involve hand-holding, reassuring touches,
As the patient begins to feel the effect of the drug, he or she is encouraged to cradling, or various forms of psychodramatic involvement in the experience. It
lie down on the couch and put on eyeshades. This helps the individual to focus on might prove helpful at times to provide resistance for a client who needs to strug-
the inner world that is beginning to unfold and prevents distraction and inter- gle or push, to emphasize certain physical feelings by pressure or massage, or to
ference from the outside. From then on the reclining position is generally encour- use some other maneuvers of a similar kind. This becomes more common as the
aged for the next four or five hours, and the experience is almost fully inter- session is approaching the termination period. Early in the experience physical
nalized. The subject receives stereophonic headphones and listens to specially interventions require great sensitivity and good rapport. It is important to main-
selected music; the objective is to let go and surrender to the experience. The task tain a trusting relationship, a sense of cooperation, and a general framework of a
of the sitters is to give support and protection to the subjects, take care of their play. However, the “as if” atmosphere of synergistic play can be easily lost in the
various psychological and physiological needs, facilitate the full unfolding of the intensity of the experience and the therapist might risk being perceived as an at-
experience, and deal with various forms of resistance as they occur during the tacker rather than as a helper. Unless the sitters have intuitive certainty about the
session. quality of the relationship, these maneuvers should not be used in the early stages
152 PRINCIPLES OF LSD PSYCHOTHERAPY Psychedelic Sessions 153

of the session. Another important aspect of the therapeutic interaction is sensitive nature of the experience calls specifically for a male figure. This is true for situa-
response to the client's needs—offering a blanket when he or she appears to be tions in which the subject is dealing with the psychological impact of the absence
cold, wiping the sweat off the brow, cleaning mucus or saliva from the face, wet- of his or her father in childhood, or feels a need to express affection in relation to a
ting the lips when they are dry, or bringing a glass of water. father-figure.
All that has been said above applies to psycliedclic sessions which lave an Conversely, psychodramatic enactment of struggle might require physical
uncomplicated and relatively smooth course. In such sessions, the elient is able to strength and be better suited to a male therapist, unless the content of the expe-
maintain the reclining position, stays with the eyeshades and headphones on, rience calls specifically for a female. It is also quite common that various problems
keeps the experience internalized, and is capable of handling the emerging un- related to the Oedipal triangle in the client’s childhood first become manifest as
conscious material adequately. In the best sessions of this kind, there is very little projective distortions of the relationship with the therapeutic dyad. There are also
for the sitters to do; they listen to music, meditate, and try to tune empathically certain transpersonal experiences, such as archetypal constellations and past-
into the client's experience. A very different situation occurs when the subject is incarnation memories, for which the presence of both sexes is important or
not able to tolerate the experiences and refuses to “go with it.” facilitating. Thus representation of both the male and the female element is useful
Minor examples of this are various evasive maneuvers, such as a tendency to not only in terms of division of tasks, but also as specific facilitation of certain ex-
take off the eyeshades and sit up, have a cup.of coffee or a cigarette, chat about periences and for evocative projection screens. Although deep involvement in pro-
trivial things, pace around, or go for a walk. A more dramatic manifestation of jections is generally counterproductive and should be discouraged, the projective
resistance is projection of the emerging material onto the sitters and the treatment distortions can become an extremely powerful source of insight if approached by
situation. The client wants to look at the sitters, get involved in intellectual the subject in a constructive way.
arguments, discuss their life situation or their problems, or criticize the rules and Since. music is such an important and integral part of LSD psychotherapy,
circumstances of the session. Extreme complications involve a total loss of we will briefly discuss its role, the basic principles of selecting appropriate pieces,
awareness of the symbolic nature of the experience and confusing it with reality. and the specific way in which these are used in the sessions. Music seems to serve
These usually occur in connection with the experience of dying, fear of insanity, several important functions in the context of psychedelic therapy. It tends to evoke
or homosexual panic. The patient may experience acute mistrust and want to a variety of powerful emotions and facilitates deeper involvement in the
escape the situation and the room, confusing the internal danger with the external psychedelic process. It provides a meaningful structure for the experience and
situation. creates a continuous carrier wave that helps patients to overcome difficult parts of
When the client cannot maintain the recommended position, starts perceiv- the sessions and move through impasses. LSD subjects frequently report that the
ing and interpreting the situation in a grossly distorted way, or shows a tendency flow of music helps them to let go of their psychological defenses and surrender
for acting-out behavior, the sitters must move from their passive stance to active fully to the experience. Another function of music is to provide a sense of contin-
intervention. A less urgent indication for therapeutic action is a situation in which uity and connection in the course of various unusual states of consciousness. It is
the patient stays in the eyeshades and headphones but tends to project his or her quite common that clients have difficulties with the periods when the music stops
feelings on the sitters, rather than tracing them back to their origins. The basic and the records or tapes are being changed; they complain that they feel sus-
strategy and techniques for dealing with various difficult situations in psychedelic pended in midair, and sense a painful gap in the experience. An additional func-
sessions will be discussed later in a special section. (pp. 166-85) tion of the music deals more specifically with its content; it is often possible to
An atmosphere of security, privacy, and full committment is absolutely facilitate the emergence of a certain emotional quality such as aggression, sexual
necessary for a successful psychedelic session. Sitters who answer telephone calls feelings, “psychedelic breakthrough,” or a transcendental experience, by a specific
during the sessions, permit people to knock on the door, or leave the treatment choice of music. The significance of music for the positive structuring of the reen-
room to carry out various parallel activities can hardly expect smooth, fully pro- try period has already been described.
ductive and successful sessions. A single major distraction or unpredictable with- , As far as the choice of music is concerned, I will outline only the general
drawal of support at a critical time in the session can become a long-term obstacle principles and give a few suggestions based on my own experiences.? Each
in treatment. The patient can lose trust in the unconditional and constant support therapeutic team develops after a certain tine, a list of its favorite pieces for
of the therapist and never again dare to abandon control and face certain difficult various phases of LSD sessions and for certain specific situations. The basic rule is
aspects of his or her unconscious. ‘ to respond sensitively to the phase, intensity and content of the experience, rather
Ideally, the patient should be attended during the entire time of the drug than to try to impose a specific pattern on it. Preference should be given to music
action by two sitters, a male-female therapeutic dyad, who never leave the treat- of high artistic quality, but little concrete content. One should avoid playing songs

n
ment unit. The sitters should know each other well, get along with each other, and other vocal pieces in which the verbal content suggests a specific theme.
and be used to working together. There are several reasons for having therapists of Where used, vocal compositions should involve a language unknown to the ex-
both sexes in the sessions. There are certain activities which are much more perient so that the human voice becomes an unspecific stimulus. For the same
natural for men than for women, and vice versa. By and large, women seem to be reason, it is preferable to avoid pieces with which clients have specific intellectual
more appropriate for comforting, cradling, and physical support, unless the associations. Thus, the beginning of Beethoven’s Fifth Symphony in C minor is
 PRINCIPLES OF LSD PSYCHOTHERAPY Psychedelic Sessions 155
154

usually associated with the imminence of a fateful event (Symphony of Destiny); masters would be appropriate. Johannes Brahms, Robert Schumann, Sergei
the use of the wedding marches from Wagner’s Lohengrin or Mendelssohn’s A Rachmaninoff, Edvard Grieg, Ludwig van Beethoven, Hector Berlioz, Richard
Midsummer Night’s Dream suggest a nuptial atmosphere; and Bizet’s Carmen Strauss, Richard Wagner, Antoin Dvorak and especially Alexander Nikolaevich
would evoke through a similar mechanism the theme of a bull-fight. In Czech Scriabin are examples of composers whose music was frequently used by the
subjects, Liszt's Les Préludes tends to bring memories of the war, because it was Spring Grove therapists in this phase. In the fourth hour the LSD session tends to
used by Nazi propagandists as an introduction to the daily news broadcasted on culminate, and in most instances seems to build up to a resolution. This is an
street loudspeakers. opportunity for a major emotional or spiritual breakthrough, depending on the
The major objection to the use of music in psychedelic sessions is that even if level on which the session is experienced. It seems appropriate at this point to
we avoid the gross programming illustrated by the above examples, we will exert introduce powerful, overwhelming music with a transcendental quality; oratoria,
a strong strueturing effect on the experience by our choice of music. This seems to requieins, and masses, combining a full orchestra with a multitude of human
be in sharp contrast with the tendency to internalize the sessions and eliminate voices, can be extremely evocative and effective. Sacred music of Wolfgang
specific optical stimuli by the use of eyeshades, and there is a certain element of Amadeus Mozart, Johann Sebastian Bach, George Frederick Handel, Hector
truth in this objeetion. The ideal solution seems to be to play a tape of “white Berlioz, Giuseppe Verdi, Charles Gounod, or Francis Poulenc would be typical
noise” -—a sequence of random acoustic patterns produced by a sound generator. examples of this category. The music of the American composer of Armenian-
Listening to intense white noise through headphones, LSD subjects usually create Scottish extraction, Alan Hovhanness, can be unusually powerful and effective in
their own inner music which seems to fit the nature and content of the experience this context. It is extremely evocative and transcendental, yet not sufficiently well-
perfectly, since it is coming from the same source. Thus, only non-specific acoustic known to produce standard associations. For the termination period of the session
stimulation is provided, which is then illusively transformed by the subject into quiet, relaxing, and flowing music with a timeless quality is chosen, such as the
musie. Monotonous sounds, noises coming from various electric appliances, or classical guitar, compositions for harp, and certain pieces by Johann Sebastian
recordings of the ocean tide can play a similar role. Bach or Antonio Vivaldi. Many records of contemporary composers such as Georg
However, the danger of programming associated with specific music is not Deuter, Steve Halpern, Paul Horn and Paul Winter are also useful in this context.
as serious as it might seem. The potential for manipulating and controlling the ex- Oriental selections would include records of Ravi Shankar, music for Zen medita-
perience is rather limited. If the subject is in an extremely difficult emotional tion, Japanese music for the bamboo flute, or Polynesian songs.
place, any music, no matter how inspired and ethereal, will be distorted and may The above directives represent a very general outline; in practice the choice
sound like a dirge. Conversely, during a deep positive experience just about any of music will depend on the LSD subject and on tle circumstances. The sitters
music will be enthusiastically accepted by the subject, who will find it fitting and should respond very sensitively to the specific content of the sessions, providing
interesting from some point of view. Only in the medium range somewhere bet- Russian, Middle Eastern, Indian, African, Chinese, or other music if the subject
ween these two extremes can music effectively shape the experience. Even then, reports experiences in those cultural contexts. Specific pieces of music might also
although a certain general atmosphere or emotional tone will be suggested froin be selected to deepen an experience of aggression, sexuality, physical and emo-
the outside, the subject will elaborate it very specifically. The resultant sequences tional pain, or transcendental feelings.
will still be manifestations of the individual's own unconscious, reflect the content Over the years I becarne particularly impressed by the profound impact of
of his or her memory banks, and represent a meaningful self-revealing gestalt. ethnic music, especially those sound performances froin certain religious traditions
Moreover, the external input does not seem to reduce the therapeutic significance which were specifically designed as techniques for altering consciousness. Some of
of the psychedelic experience that it triggers or inodifies. these are so unusual for an average Westerner that they should be used only with
It is useful to discuss the subject's taste in music before the session and get an sophisticated individuals familiar with these traditions. Among the most powerful
idea of his or her preferences, idiosyncrasies, and general level of musical recordings in this category are the multivocal chanting of the Tantric Buddhist
sophistication. However, the actual selection usually reflects more the sitters’ tradition in Tibet; the Hindu kirtans; the monkey chant, or ketjak, and other
understanding of the process than the experient’s choice. Only the late hours of the trance-inducing music from Bali; shamanic music from various parts of Asia,
session, when no more therapeutic work has to be done, are an exception; this North America and South America; the hocketing of the Congolese Pygmies;
is a period of relaxation and the subject is given the opportunity to determine trance music of the |Kung! Bushmen of the Kalahari desert; and chants from the
the nature of the entertainment. In general, the music chosen reflects the usual Sufi ceremonies. Similarly, Greek sirtak dances, flute music from the Andes,
experiential trajectory of the psychedelic sessions. In the latency period, before the recordings of the African oud, songs of the Bauls of Bengal, Armenian liturgical
onset of the drug effect, quiet, flowing and calming music seems appropriate. This chants, Spanish flamenco guitar music, and other interesting ethnic pieces are
changes after the experience begins into music which has an opening-up and useful for psycheclelic sessions.
building-up quality. Within about an hour and a half, the patient is fully under If the subject can stay with the experience, the therapist's task is to change
the influence of the drug; this is the time for powerful and emotionally highly- records with sensitivity to the process, give support, protection, and encourage-
evocative music. If we are choosing from the Occidental repertoire, good classical inent, and take care of the patient’s basic needs. The time when the pharmaco-
music, such as less well-known symphonies, concertos, or overtures of famous logical effect of the drug is wearing off—usually the sixth hour after ingestion—is
. 156 PRINCIPLES OF LSD PSYCHOTHERAPY Psychedelic Sessions - 157
e
4

the most critical period of the session. This is the time for the sitters to move into ters have to use their imagination and intuition to enact the content of the unfin-
an aetive mode and try to facilitate a good resolution and integration of the expe- ished gestalt in the most realistic way. Although this technique was developed in
rience. The emotional aud psychosomatic condition of the subjects at the time the the context of LSD work, J have since used it with great success in experiential
session terminates is of crucial importance to the final outcome of the session and workshops where the drug was not administered.
the longer lasting effects. Even if the LSD subjects had deep transcendental The basic concept underlying this approach is that the subject's conscious
experiences earlier in the session, they can have negative aftereffects if, during the emotional and physical distress is a mitigated version of the actual content of the
reentry, they get “stuck” in some unresolved psychodynamic material. Conversely, ‘unconscious matrix that is trying to emerge. The resolution of that matrix occurs
a very difficult session with paranoid states and hellish experiences can be ex- when the unconscious content is experienced consciously in its original form and
tremely therapeutic if it is well resolved. Two ways in which the sitters can full intensity. By intensifying the existing sensations one thus facilitates the con-
facilitate the resolution and increase the probability of a good outcome of the ses- vergence of the conscious experience and the emerging unconscious gestalt, to the
sion are by helping the subject to work through the unresolved material, and by point that they become identical and merge. In this way the unconscious theme is
introducing into the situation certain eleinents that are conducive to positive emo- energetically reduced and ceases to exist as a symptom-producing dynamic struc-
tional states. ture; this is followed by sudden relief and a feeling of completion. Although it is
At the time when the effect of the drug is decreasing it is important to not always possible to reach optimal resolution and a tension-free, “oceanic” state,
engage in verbal exchange with the subject, to get detailed feedback on his or her the sitters should work toward this goal.
emotional and psychosomatic condition. If at this time he or she is experiencing The above technique seems to be a most powerful way of reaching positive
discomfort, such as depression, anxiety, blocked aggression, feelings of guilt, closure and good integration of an LSD session. As will be described later, it is
circular thinking, headaches, nausea, muscular pains, intestinal cramps, or diffi- fully compatible with other approaches of experiential psychotherapy and can be
culties in breathing, this is the time to suggest active intervention. The possibility combined with them. An eclectic therapist can use techniques of gestalt practice,
of this happening should have been discussed during the preparation period. The bioenergetic exercises, rolfing, guided affective imagery, asanas from Hatha yoga,
first step is to find out exactly what type of experience is involved; whether it is an elements of primal scream, and many other methods to great advantage. If the
unfinished reliving of a childhood memory, a perinatal sequence, a past-incarnation sessions are conducted in the context of a therapeutic community, other group
theme, or some other type of transpersonal phenomenon. It is also important to members can be introduced into the process during the termnination period to assist
encourage the subject to scan his or her body for signs of physical pain, tension, or the experient in working through the residual problems. They can facilitate the
other forms of distress indicating energy blockage. There is, in general, no emo- experience by enacting a simulated struggle in the birth canal, offering comforting
tional distress or disturbing and incomplete psychological gestalt that does not physical support, working with the subject in a warm pool, or creating a transper-
show specific somatic manifestations. These concomitant psychosomatic symptoms sonal field by group chanting.
then become the entry points for the sitters’ intervention. When it becomes obvious that the available pent-up energy has been re-
The sitters ask the experient to remain in the reclining position with eyes leased and further uncovering work would require maneuvers that were too
closed or covered by eyeshades. The instruction is to stop intellectual analysis forceful, the sitters offer positive inputs to facilitate integration. Physical contact,
(“turn off the head”) and start intense hyperventilation. The breathing should be individually or in a group, can induce nourishing feelings of comfort and security.
faster than usual and very deép; the experient should follow the air in his or her A walk in nature, with its variety of sensory experiences, seems to be conducive to
inind’s eye all the way down into the pelvis. This hyperventilation tends to acti- positive or even ecstatic emotional states. Looking at flowers or trees, sitting in the
vate any available emotional material. The sitters ask the subject to pay attention grass, smelling hay, or watching the sunset can be powerful experiences long to be
to his or her body and surrender fully to the experience that starts unfolding—to remembered. It was already mentioned that exposure to water in the form ofa
allow any postures, movements, grimaces, sounds, shaking, crying, coughing, or swim, bath or shower seems to be of special significance. LSD subjects frequently
experience contact with water at this stage as being not only physically cleansing,

‘em
gagging. At a certain point, the sitters enter the picture and, after having reached
agreement on their roles, they start artificially increasing the physical feelings but also emotionally and spiritually purifying. It can bring them into touch with
described earlier by the subject. For example, if there is pressure on the head or a memories of infant bathing, prenatal existence, or early phylogenetic stages, and
headache, one of the sitters produces more of the same kind of pressure by laying can induce a state of blissful merging and undifferentiated unity.
hands on the subject’s head. If the complaint is constriction of the chest or When all major residual problems have been worked through, it is time for
invite into the treatment room, with the
difficulties with breathing, more pressure is applied on the rib cage or under the socializing. At this point the sitters
previous agreement of the patient, friends or relatives who have been waiting out-
clavicles. Nausea can be activated by rhythmic stimulation of the upper abdomen,
side. Depending on the circumstances this inay be just one person, such as the
combined with massage of the stomach; muscular pains enhanced by deep
spouse, a sexual partner or good friend, or a group of fainily members and friends.
pressures approaching rolfing, and tension in the pelvic area intensified by holding
the loins in an elevated position. All this has to be done in synchrony with the All participants in this “reunion” are asked to respond to the needs of the experient
breathing rhythm and in tune with the general theme of the experience. The sit- and respect his or her special state of mind. It is up to the subject whether this
»
 158 PRINCIPLES OF LSD PSYCHOTHERAPY Integration of the Drug Experiences 159

meeting will take the form of a quiet meditation and wordless get-together, or a INTEGRATION OF THE DRUG EXPERIENCES
jovial social event. New channels of straight and honest communication can often
be opened in this situation. The morning after the session the client should be able to sleep as long as is
In our arrangeinent, a special “psychedelic dinner” was usually prepared by necessary. The general suggestion for the day is to rest, relax and stay in a
relatives or friends. It consisted of a variety of meals, snacks and fruits of in- meditative state of mind. Quiet walks in nature, basking in the sun, or swimming
teresting colors, tastes, and textures. Mandarin, Indonesian, Indian and Japanese are highly recommended. Listening to music, especially to the pieces that were
dishes became particularly popular in this context. After well-resolved psychedclic played during the LSD expcrience can be particularly useful. Later that day the
experiences most subjects love to experiment with food, and discover that eating sitters should schedule a long interview with the client. This is an opportunity to
can be an adventure involving qualities and dimensions they had never imagined. share in detail the experiences of the preceding day and also to discuss any puz-
However, it nay happen that the individual feels nauseated or does not show in- zling aspects of the psychedelic session; it also serves to facilitate the integration of
terest in food. This is accepted with understanding and no pressure is put on him the material and its application to everyday life. Special attention should be paid
or her to participate in the prepared meal. The instruction given to the par- to transference phenomena that occurred during the session, and to their analysis.
ticipants in the “reunion” is to respect the psychological space of the experient. At the Maryland Psychiatric Research Center both treatment units were equipped
This approach is in essential congruence with the basic orientation of the entire with closed-circuit television. Those subjects who requested or agreed to have
session day. The subject should feel free to do what he or she wants to do or has to their LSD sessions videotaped usually watched the tape the following day. We
do, and see the sitters and later the friends and relatives as helpers or assistants. found this procedure extremely useful; it provided a unique opportunity to com-
“This is your day” is the implicit and explicit message given to the subject before plement the subjective dimension of the experience with a more objective point
the session and reinforced or repeated in various ways during the day. The issue of of view.
a reunion is an important one and should be approached with great sensitivity. It The subject should be encouraged to write a detailed account of his or her
should not be done routinely, but always with respect to the specific cir- psychedelic experience. This process involves concentrated attention and seems to
cumstanees, In some instances, it might be wiser and more appropriate not to in- facilitate recall of otherwise forgotten episodes. Intense emotions can emerge dur-
vite the relatives, or even to cancel previous arrangements if the general condition ing this work, and the client might have an opportunity to complete an unfinished
or special emotional state of the subject seetns to indicate it. gestalt. In general, it seems that the work on the account greatly facilitates the in-
On the night following the session the subject should stay in the special tegration of the session and later this write-up becomes a basis for a deeper and
treatment suite. Unless the circuinstances or the condition of the client do not more detailed discussion of the psychedelic experience with the sitters. If the ses-
allow it or make it inadvisable, the spouse, close relative or good friend should sions are continued detailed records become essential, since old material can fre-
spend the night with the subject. A nurse and at least one of the sitters should be quently assume new dimensions of meaning in view of later psychedelic
on call in case any difficulties arise. On occasion, especially after poorly resolved experiences.
sessions, a belated upsurge of intense emotions might occur in the hypnagogic The clients should also be given ample opportunity to express their experi-
period, later at night, or in the morning during the hypnopompic state. ences in various artistic forms, such as paintings, mandala drawings, poems,
Jf the session started in the morning there are generally no problems with written stories or plays, sculptures, dancing, or musical compositions. In addition
sleep: this is particularly true if the experience was well resolved and integrated to their aesthetic, cathartic, and documentary value, these creations often provide
and the termination period was positive. After sessions that had a late start, or valuable material for a deeper understanding of the session. In several of our
where the subject did not complete the emerging emotional and psychosomatic patients, impulsive drawing and painting became an important channel for cop-
gestalt, sleep may not be easy. Generally, it is better not to use hypnotics and tran- ing with difficult unconscious material.
quillizers at this time, since they also inhibit the process of natural integration of Sometimes the integration of the session takes days or weeks. It is important
the unconscious material. Even if the subject loses a few hours of sleep, the com- to encourage the client to keep the emotional channels open and continue the un-
pletion is usually cleaner and the long-term results better without these. If too covering process, rather than try to shut them off prematurely by psychological
much excitement interferes with a good night’s sleep and this becomes a strong means or with tranquillizers. Belated completion of an unconscious gestalt is most
emotional issue for the subject, Librium, Valium, or a barbiturate might be likely to occur in the intermediate states between waking consciousness and sleep
appropriate. that characterize the hypnagogic and hypnopompic periods. Another important
The basic rule is that the subject should not be left alone for twenty-four opportunity of this kind is the dream life. After a well-integrated session, the
hours after the ingestion of LSD. During the evening and the night it is recom- nights tend to be dreamless and sleep very deep and refreshing. Conversely, a ses-
mended that he or she maintains a quiet meditative mood and does not embark on sion in which the subject did not reach emotional and psychosomatic closure is
solving heavy interpersonal problems. If the companion for the night is a sexual usually followed by extraordinarily rich and intense dream life. A powerful dream
partner, the suggestion is to spend the time in quiet non-verbal communication. can often mediate completion and final integration of material that had been
Talking and sexual interaction should not be enforced by the partner and should activated by the drug but remained unresolved.
reflect the inclinations of the subject. When the spontaneous process does not have enough dynamic strength to
 PRINCIPLES OF LSD PSYCHOTUERAPY Integration of the Drug Experiences 161
160

complete itself, the sitters should do intense activating work with the client, group process. LSD sessions regularly bring forth powerful unconscious material
following the principles outlined earlier for the reentry period. An interesting which would otherwise rarely appear in group work. The spectrum of experiences
alternative to the approach that encourages exteriorization and abreaction is the discussed in these meetings ranges from episodes involving various sexual perver-
sions, murderous aggression, sadomasochistic drives, incestuous tendencies, and
use of prolonged hyperventilation. This technique, based on the Indian science of
breath, pranayama, was recently rediscovered by Leonard Orr (72) and adopted primitive indulging in biological material, to states of ecstatic rapture, feelings of
in his rebirthing prograins. Intense breathing, continued for a period of about cosmic unity, and past-incarnation memories. This provides fairly unique oppor-
thirty to forty-five minutes, tends to collect the tensions in the body into a tunities for indirect corrective emotional experiences for group members, in terms
stereotyped pattern of armoring and eventually release them. This is associated of the therapist’s reactions toward potentially objectionable unconscious material
with activation of important material from various levels of the unconscious. The emerging in the LSD sessions of their co-patients. The therapist’s matter-of-fact
muscular tensions concentrate in the arms and legs (the so-called carpopedal approach to issues such as sadistic tendencies, grandiose fantasies and day-dreans,
spasms of medical terminology)* and in several circular constrictions of the head forbidden sexual wishes, or loss of control over bladder or bowels which may have
and body corresponding to the levels of the different chakras in the Indian system occurred in the sessions of various members of the group, helps others to accept
of Kundalini yoga. In this technique, vocalization and conventional abreaction is such elements and to allow themselves to experience such situations if they start
generally discouraged, and the subject is asked to continue breathing until all the ,emerging in their own psychedelic sessions. In this context, unconscious material
tensions are released. This is a very effective way of clearing residual problems that is usually anxiety-, guilt-, and conflict-laden can be treated with lightness and
after a psychedelic experience. Even without previous administration of the drug even humor. In addition to the advantages described above, the use of group work
this method can mediate access to deep and dramatic experiences of a also saves time for the LSD therapist; many of the general principles of therapy,
biographical, perinatal and transpersonal nature in a very short time. The use of experiential strategies, and interpretive possibilities can be communicated to the
this technique requires certain background information and special instructions, entire group instead of having to be repeated for each participant individually.
and it will be discussed in greater detail in the following volume. In the above discussion I have outlined only the most general principles of a
If neither of the above techniques brings a satisfactory psychological resolu- comprehensive program of LSD psychotherapy. The detailed therapeutic strategy
tion, another psychedelic session should be scheduled as soon as possible. The and tactics in each individual case depend on many factors and have to be
general principle applied here might seem paradoxical to a conventional creatively developed by therapists on the basis of their clinical experience and
psychiatrist: Psychedelic therapy can be discontinued at any time after a successful their own first-hand explorations in LSD training sessions. The actual practice of
session that was well integrated. If it resulted in an intensification of clinical psychedelic therapy is ultimately based as much on intuition as it is on knowledge
symptoms or a prolonged reaction, continuation of therapy is indicated. The basic of therapeutic principles, and it will probably always combine elements of art and
idea is that this is not due to some unpredictable effect of LSD, but represents an science.
unfinished unconscious gestalt that should be completed.
The use of group psychotherapy as part of a comprehensive LSD treatment
program deserves special discussion. After several unsuccessful attempts at using NOTES
LSD as an adjunct in group psychotherapy, we moved away from this model.
However, it proved extremely useful to combine individual LSD treatment with 1. Prefrontal lobotomy is a psychosurgical procedure developed by the Por-
drug-free group work in the context of a therapeutic community. The atmosphere tuguese neurologist, Edgar Moniz, and awarded a Nobel Prize for medicine in
of collective responsibility and support, opportunities for mutual help, and the 1949. It was used for chronic psychoses, impulsive behavior and some severe
specific power of the group process represent extraordinary therapeutic potential. obsessive-compulsive states. Its original form involved blind severing of connec-
In the context of a therapeutic community, LSD patients spend the late hours of tions between the frontal lobes and the rest of the brain. The damage was oc-
the sessions in the company of their co-patients. At this time they can have various casionally so excessive that most of the brain hemisphere turned into a large
interesting perceptions of other people and of their interaction; conversely, others blood cyst.
make valuable observations of the persons coming down from LSD sessions and of 2. The interested reader will find more information on the use of music in psy-
their own reactions toward them. In the next meeting where the patient shares his chedelic sessions and non-drug experiential work in a special article by Helen
Bonny and Walter Pahnke, The Use of Music in Psychedelic (LSD) Therapy
or her psychedelic experiences, this material becomes an important addition to the
(14) and in Helen Bonny and Louis Savary’s book Music and Your Mind. (15)
group dynamics. The subject's interaction with other members in the group can 3. In medical handbooks this is referred to as the “hyperventilation syndrome,”
contribute considerably to a deeper understanding of the material from the LSD and presented as a mandatory physiological reaction to intense breathing.
session, and also provides new insights into the problems of other patients in the Repeated observations from psychotherapeutic work utilizing breathing tech-
group. These group meetings typically have such evocative power that some pa- niques clearly indicate that this is not true. If the subject is encouraged to con-
tients, instead of communicating verbally, are moved into deep emotional states tinue hyperventilating after these spasms have developed, this will paradoxi-
that can lead to experiential therapeutic sessions. cally release the tensions. Moreover, after several initial sessions employing this
The use of the material from psychedelic experiences in meetings of the method the organism stops responding to intense breathing with the “hyper-
therapeutic community results in an unusual deepening and intensification of the ventilation syndrome.”
COMPLICATIONS OF LSD
PSYCHOTHERAPY:
OCCURRENCE,
PREVENTION, AND
THERAPEUTIC MEASURES
Physical and Emotional Contraindications
Critical Situations in LSD Sessions
Adverse Aftereffects of LSD Psychotherapy
Prevention and Management of Complications
in LSD Psychotherapy

While discussing the risks and dangers of LSD psychotherapy, we must distinguish
between those that are intrinsic to the drug and to the psychedelic process and
those that are critically dependent on extrapharmacological factors. The former
are involved every time the drug is taken without regard to the specific circum-
stances; the latter are to a great extent conditional and their incidence, degree and
relevance can be influenced by set, setting and the technique of conducting the
sessions. The dangers of LSD psychotherapy can be reduced considerably if we
screen out individuals who represent high risk, and if we conduct the sessions with
an awareness of and respect for the specific dynamics of the LSD reaction.

PHYSICAL AND EMOTIONAL CONTRAINDICATIONS

Ali clinical and laboratory evidence accumulated during the last three decades in-
dicates that from the biological point of view pharmaceutically pure LSD is a sur-
prisingly safe substance. This statement should not be automatically applied to so-
called “street acid.” The quality of samples sold in the black market varies con-
siderably and some of the impurities and admixtures are physiologically much
more dangerous than LSD. Chemical analysis detected amphetamines,
strychnine, STP, phencyclidine (PCP or “angel dust”), and other substances in
several street samples of what was sold as LSD.
In clinical work with pure LSD, the major physiological danger is not the
drug per se, but the intensity of emotions that it triggers. Only rarely is there a
high-dose LSD session in which the client does not experience at some point ex-
treme degrees of emotional and physical stress, the dimensions of which are

163
 COMPLICATIONS OF LSD PSYCHOTHERAPY Physical and Emotional Contraindications 165
164

beyond anything encountered in everyday life. It is therefore essential to screen If we follow the rules outlined above, LSD appears to be a drug with a wide
out in advance individuals for whom intense emotions can be dangerous or even range of biological safety. Dosages between 25 and 2000 micrograms have been
fatal. It was mentioned earlier that this involves in the first place persons with used in clinical settings without any detectable adverse physiological effects. In
serious cardiovascular problems, sucli as a high degree of arteriosclerosis, throm- our own research, we have administered LSD to persons up to the age of eighty-
bosis with a danger of embolisin, malignant hypertension, vascular aneurysms, a three and to a number of cancer patients in the terniinal stages of their illness,
history of myocardial infarction, myocarditis, decompensated cardiac failure, and without a single casualty. Our experience shows that the laboratory examinations
brain hemorrhage. Where there is the slightest doubt, the candidate for an LSD routinely used in medical practice to detect diseases and dysfunctions, such as elec-
session should have a physical examination, including an electrocardiogram. In troencephalography, electrocardiography, blood count, sedimentation, urine
case of mild cardiovascular problems, one should be conservative with the dosage analysis and liver tests do not show any pathological changes even after a series of
and proceed with caution. We have to bear in mind that we are not talking about eighty to one hundred LSD sessions.
direct noxious effects of LSD on the heart or vessels, but the risks associated with The situation is much more complicated in regard to emotional risks. Here
intense emotions. Although higher dosages usually evoke more powerful affective the degree of safety is critically dependent on the pre-session emotional balance of
responses, this relationship is not linear. In individuals who are very emotional or the subject, and on the external circumstances. I have never seen adverse after-
who have enormous amounts of unconscious material close to the surface, a effects of an LSD session in an individual who did not have considerable emo-
relatively small dose of LSD can trigger a very strong reaction. tional problems prior to the session. In a person who is reasonably balanced and
Pregnancy should be an absolute contraindication. Although the existence of adjusted, the negative sequelae the day after a supervised psychedelic session
a direct teratogenic effect of the usual doses of LSD is questionable, there is a seldom go beyond such complaints as feelings of fatigue, headache, or hangover.
danger of disturbing the biochemical balance between the fetus and the maternal These negative consequences can be much more serious after experiences in com-
organism. An even greater risk is the intense uterine contractions that are part of plex and erratic social situations, in those instances where the drug was given to an
many high-dose sessions, especially those involving perinatal material. As a result unprepared or even unsuspecting individual, or where traumatic circumstances
of a powerful LSD session female subjects may often start menstruating in the and pathological interaction complicated the course of the psychedelic reaction.
middle of their cycle. The issue of chromosomal damage and adverse effects on The risk of adverse aftercffects inercases considerably when the drug is ad-
heredity has caused much controversy in the past; at present very few scientists ministered to persons who have serious emotional problems, slow severe interper-
believe that such dangers really exist. Because of their practical significance these sonal maladjustment, or had psychiatric hospitalization in the past. Work with
problems are discussed in a special appendix to this book. (pp 318-47) psychiatric patients, even when conducted by an experienced LSD therapist under
All other biological dangers are relative. Many clinical observations suggest the best circumstances, involves certain risks. Careful preparation of the patients,
that special caution is indicated in persons who have an epileptic disposition, internalization of the experience, and active psychotherapeutic work reduces the
especially those with a history of grand mal seizures. In these individuals LSD can hazards, but does not eliminate them completely. There will always be a risk that
occasionally trigger not only individual attacks but entire chains of seizures in spite of all the precautions and palliative measures some important unconscious
following each other in a rapid sequence. This so-called status epilepticus can be material may remain unresolved. This can mean an iutensification of pre-existing
ee ati ie

very difficult to control. However, certain forms of epilepsy and other types of complaints, the occurrence of a new set of symptoms, incidence of prolonged reac-
seizure-like motor activity have responded favorably to LSD treatment in the past, tions, or later recurrence of unusual states of consciousness (flashbacks). When we
and so this issue has to be considered individually for each case. This observation work with persons who have borderline schizophrenic symptoms or have had
seems to be particularly true for temporal lobe epilepsy, though there is as yet no psychotic episodes in the past, triggering serious emotional reactions of a tem-
clear organic finding. porary nature represents a calculated risk.

¢
Sometimes the excessive muscular activity that frequently occurs in high- Unlike the case of somatic contraindications, where certain caveats are
dose LSD sessions can be a specific danger for some of the patients. Extreme ten- absolute, screening of LSD candidates on the basis of their emotional condition
sion, tremors, cramps, jerks and complex twisting movements might lead to com- depends on many external factors. Under optimal circumstances, which involve a
plications in individuals with pathological fragility of the bones, insufficiently specially structured treatment facility and an experienced therapeutic team, LSD
healed fractures, or a disposition to recurrent dislocation of the joints. psychotherapy can be experimentally conducted with any psychiatric patient
There are some indications that individuals with severe liver damage have a whose condition is clearly not of an organic nature. However, this requires an
tendency to prolonged LSD reactions, because the liver plays an important role in open-ended situation where no limits are placed on the number of sessions. In
detoxifying LSD and excreting it from the body. Some researchers therefore treating emotionally severely disturbed individuals, we have to be prepared to
tended in the past to screen out persons witli insufficient liver function associated deal occasionally with transient psychotic states, aggressive behavior, or suicidal
with cirrhosis, a history of hepatitis, or other pathological conditions. Our expe- tendencies inside and outside of the sessions themselves. Experienced therapists,
rience with chronic alcoholics and cancer patients, many of whom had consider- trained nurses, and the supportive atmosphere of a therapeutic community are
able liver damage, indicated that this factor is negligible unless the dysfunction is of necessary prerequisites for such an endeavor. Under circuinstances where these
a critical degree. criteria are not met, we have to carefully screen out individuals with borderline
166 COMPLICATIONS OF LSD PSYCHOTHERAPY Critical Situations in LSD Sessions _ 167

psychotic problems and a psychotic disposition. An example of this was the serious form of resistance involves removing the eyeshades and headphones and
situation at the Maryland Psychiatric Research Center. There the number of LSD simply refusing to continue, without excuse or explanation. When this happens the
sessions for all categories of subjects except cancer patients was limited by the sitters should use all their psychological skills to return the client into the original
research design to three. The center had laboratories and treatment suites, but no introspective mode. The only exceptions to this rule are situations where the sub-
bed facilities. In the case of a prolonged reaction or other complications, LSD ject wants to explore the external world and there is no doubt that the request is
patients had to be hospitalized at the Spring Grove State Hospital and, according genuine and does not serve the purpose of avoiding the inner experience. While
to the routine local policies, this meant a stay in a locked ward and administration negotiating with the client in these situations, the sitters can refer to the original
of phenothiazines. Despite these unfavorable conditions we worked with very contract made during the preparation period, when various forms of resistance
severely disturbed patient populations, such as chronic alcoholics and heroin were explicitly discussed with the subject and he or she accepted the importance of
addicts who were prison inmates, and we were uot overly anxious during the keeping the session internalized.
screening process. We had only two instances of prolonged reactions in our LSD In an extreme case, the relationship between the sitters and the LSD subject
subjects, both occurring in patients who had psychotic episodes in the past. They can be disrupted to the point where the latter perceives it as being not cooperative
lasted only a few days, and could be handled easily by conventional means. but antagonistic, and tries to act on his or her own. This can culminate in the
client attempting to leave the treatment situation altogether. These episodes are
not very frequent, but they are extremely critical for LSD therapists. The basic
CRITICAL SITUATIONS IN LSD SESSIONS rule here is to keep the subjects on the premises and guard against their hurting
themselves or someone else. Various degrees of compromise have to be made be-
While seriously adverse aftereffects of supervised LSD sessions tend to occur only tween the needs to restrain the subject, and to avoid an open confrontation and
in individuals who had considerable emotional problems prior to the drug experi- fight that would further impair the therapeutic relationship. In the most dramatic
ence, in the actual course of high-dose psychedelic sessions various emergencies situations of this kind, the best one can do is to play for time and keep the subject
can occur in anybody, without regard to his or her emotional stability. It is essen- safe until the receding pharmacological effect makes him or her more ainenable to
tial to inform a client during the preparation period that he or she may have diffi- active cooperation. Fortunately, such extreme situations are rather exceptional in
cult experiences during the sessions, and that these represent a meaningful and in- therapeutic LSD sessions conducted by experienced sitters. .
tegral part of the procedure. One of the major problems in the non-supervised use Before discussiug the specific difficulties and complications that can occur
of psychedelics was a false notion that the subject would experience only states of during LSD sessions, we will mention some of the general principles. The most
transcendental bliss and have a uniformly wonderful time. The occurrence of dif- important factor in crisis-handling is the therapist's emotional reaction to the
ficult emotional states was therefore perceived as an unexpected complication, emergency situation. A calm, centered, and supportive attitude toward the
and easily caused panic in the subject and his or her friends. various manifestations that occur in psychedelic sessions is much more important
The most common problem in psychedelic sessions is resistance to the emerg- than anything the therapist says and does. The ability to remain unperturbed
ing unconscious material and an unwillingness to “go with the experience.” The while facing dramatic instinctual outbursts, sexual acting-out, hostility and
form this resistance takes is usually indicative of the client's habitual mechanisms aggression, self-destructive tendencies, paranoid reactions, or extreme emotional
of defense. The evasive maneuvers that the sitters have to deal with cover a very and physical pain increases with clinical experience and the number of sessions
wide range. Sometimes, the subject accepts the eyeshades and headphones, but one has conducted. Participating in a number of critical situations and witnessing
argues against the use of evocative music. Here the therapists must be careful to their positive resolution is the best training for future emergencies. Working
distinguish constructive and appropriate objections from anxious efforts to fence- through one’s own emotional difficulties in psychedelic sessions conducted for
off the emerging emotions. Constant talking and intellectualizing which does not training purposes is equally, if not more important. Any serious unresolved prob-
leave space for deeper experiences is another common escape. Some individuals try lems in the sitters may easily be activated by participation in other people’s
to focus in their mind’s eye on the external environment and recall the surround- sessions.
ing reality in the most minute details. They try to remember the names of the co- If the emergency situation evokes anxiety, aggression, guilt or some other
patients, reconstruct the ground plan of the facility, and visualize the form and inappropriate “countertransference” reaction in the therapists, this can result in a
color of furniture in the room. Sudden sobering-up in the middle of a high-dose highly dangerous type of interaction with the patient. Since the sitters are the
session is another common form of psychological resistance against the psychedelic patient’s only hold on reality, their reaction is his or her ultimate criterion of the
experience. seriousness of the situation. Thus, anxiety manifested by the therapist represents
The next step involves unwillingness to keep the session internalized. Some- final proof to the patient that the situation is really dangerous. Not only are the
times the subject asks for permission and offers a reason—taking a break, smoking sitters sober and supposedly in a state of adequate reality-testing, but in the eyes of
a cigarette, drinking a cup of coffee, having a chat, or going for a walk. Frequent the client they are experts in dealing with unusual states of consciousness. Their
visits to the bathroom are a particularly common technique; sometimes they are evaluation of the situation and their emotional reaction thus reflects professional
physiologically justified, but often they have purely psychological motives. A more judgment. Whenever the therapists show strong negative reactions to emergency
 OF LSD PSYCHOTHERAPY Critical Situations in LSD
\ 168 COMPLICATIONS

In LSD psychotherapy, there is a continuity in the content of consecutive

situations in LSD sessions, destructive vicious circles are likely to develop between
sessions. If we terminate an unpleasant experience by administering tranquil-
the clients and themselves. The therapist may be upset by certain behavior or ex- in future sessions till
lizers, the unresolved material will continue to surface
periences that the patient manifests, and his or her emotional reaction has a rein-
the patient reaches the point where he or she is capable of confronting and resolv-
foreing effect on the patient. This intensification of the patient's difficulties causes
ing it. Therefore, the therapist should first exhaust all possibilities of a
in turn more emotional distress in the therapist. Because of this snowballing effect,
psychological intervention before considering tranquillizers. If a specific vicious
such situations can reach critical proportions in a very short time. Similar patterns
interaction has developed between the sitter and the client, and the situation ap-
have been described in psychodynamic literature as “diabolic circles” (ctreuli
pears to be irresolvable, another therapist should be called to take over the session;
diaboli); although this term might seein slightly exaggerated when used for situa-
provisions for such situations should always be made in advance.
tions in everyday life, it is certainly appropriate and justified for the dramatic cir-
If all psychological approaches fail and tranquillizers have to be used, it is
cumstances that might develop in LSD sessions.
much better to start with Librium (30-60 milligrams) or Valium (10-30 milli-
Adequate handling of critical situations is one of the crucial problems in
grams), which seem to alleviate painful emotions without interfering with the
LSD psychotherapy. A session in which the process gets out of control is not only
course of the session. As soon as possible, the patient should resume a reclining
fruitless, but harmful; it creates frustration and disappointment in both the
trust, and can shatter their feel-
position with eyeshades and headphones, to continue the introspective approach
therapist and patient, undermines their mutual
to the experience.
ings of personal security. For the therapist adequate experience and training, in- The situation that creates the most probleins in psychedelic sessions is the ex-
cluding his or her own LSD sessions, is therefore of paramount importance. At the
perience of dying that occurs in the context.of the death-rebirth process. This en-
time of my LSD research in Czechoslovakia, the training for future LSD thera-
counter with death is so authentic and conviucing that it can easily be mistaken
pists more-or-less followed the psychoanalytic model. It required a minimum of
for a real, vital emergency, not only by the experient but also by external
five personal LSD sessions under the guidance of an experienced therapist, and
observers and inexperienced sitters who are in a normal state of consciousness.
thirty therapeutic sessions with psychiatric patients conducted under supervision.
Because of this confusion between symbolic and biological dying, the resistance
LSD training sessions were also found very useful for those psychiatric nurses who
against the psychedelic process can be particularly powerful. Deep seated anxiety
functioned as female co-therapists or came into contact with patients under the in-
and activation of survival programs can make the subject fight the effect of the
fluence of LSD.
drug with the intensity and determination characteristic of an actual life-and-
The.use of tranquilizers is an issue of considerable practical significance and
death struggle.
deserves a special notice. In general, an experienced therapeutic dyad can handle
From the technical point of view this is a most critical and important situa-
all, or almost all, situations that occur in LSD sessions by psychological means
tion. It is absolutely essential to the smooth course of the session and its positive
alone. I have personally conducted more than three thousand sessions over the
outcome that subjects stay with the eyeshades and headphones at this point, and
years, and only three were terminated by tranquillizers. All three occurred in the
keep the process internalized. If the psychological aspects of this experience are
early years of my LSD research when my experience with drugs was very limited.
projected onto the therapeutic situation, this can result in dangerous acting-out
Thorazine and other major tranquilizers are not specific neutralizers of the LSD
behavior. Subjects may feel drawn to windows and doors, seeing them as escape
effect. Used in high dosages, they have a general inhibiting effect that overrides
routes out of the unbearable psychological situation; they may physically fight
and masks the psychedelic action of LSD. Detailed retrospective analysis of this
with the sitters, seeing them as the oppressive element; or be driven to violent self-
situation usually shows that the patient experiences the action of both drugs
destructive actions mistaking thein for the liberating ego death. The dangers of the

wa
simultaneously, and that the combined effect is rather unpleasant.
externalization of this process extend beyond the framework of the drug session
The use of tranquillizers in the course of psychedelic sessions is potentially
itself. Unresolved psychedelic experiences of this kind can result in very difficult
very noxious. The most dramatically negative LSD experiences have a strong
emotional states in the post-session period, which may last for days or months
tendency toward positive resolution; if they are well resolved they are extremely
unless properly treated.
beneficial for the subject in the long run. If tranquillizers are administered in the
If the client tries to tear off the eyeshades, and create a projective pseudoreal
middle of a difficult psychedelic state they tend to prevent its natural resolution
situation of the above kind, this is the time for active intervention. Since the issue
and positive integration. They “freeze” the subject in a negative psychological
has been discussed during the preparation period, the sitters can make references
frame and thus contribute to the incidence of prolonged reactions, negative
to that conversation to connect the client’s intellectual knowledge of the process
aftereffects, and “flashbacks.” The routine administration of tranquillizers in the
with the actual experience. This in itself can be helpful, although there is usually a
middle of negative psychedelic experiences is therefore a harmful practice that
fundamental gap between the death experience and its verbal des¢ription. This
should be discontinued. This is even more true of their use in the context of LSD
process can be so elemental and of such unimaginable experiential dimensions that
psychotherapy, which follows in general the strategy of an uncovering technique.
no words in the world are adequate to convey it. In any case, the critical factors in
Unpleasant experiences are caused by the emergence of highly-charged emotion-
fens

dealing with this situation are the non-verbal aspects of the sitters’ approach;
ally traumatic unconscious material. Since this material is the source of the
under these circumstances, metacommunication is more effective than anything
patient's difficulties in everyday life, negative episodes in LSD sessions, if properly
that is said or done.
approached and handled, represent great opportunities for therapeutic change.
t ; 170 COMPLICATIONS OF LSD PSYCHOTHERAPY Critical Situations in LSD Sessions 17]

The sitters should emphasize, repeatedly if necessary, that the client is not metaphysical quality. A person who is in a no-exit state experiences extreme
facing real biological death, however convincingly he or she might feel this. They distress of various kinds and is unable to see any end to this situation or any way
should offer reassurance that the feeling of a lack of oxygen is only subjective, and out of it. Thinking seems to have a circular quality and subjects frequently com-
that the breathing itself is adequate. It is also important to encourage the subject pare their thought-processes with closed loops running on a tape-recorder. A more
consistently to surrender to the process and accept the psychological death. In- appropriate and accurate description of this state is to liken the peculiar circular-
sistence that the quickest way out of this experience lies in going through its most ity of ideas and emotions to a moving Moebius strip that turns into itself while also
difficult parts, and references to the positive “other side” can be of great help. involving a paradox in regard to the usual spatial and temporal configurations.
llowever, the sitters’ centeredness, familiarity with the process, and trust in its in- The basic strategy in dealing with the no-exit situation should be to empha-
trinsic trajectory are ultimately the most critical factors, since they supply the size and clarify the distinction between psychological time and clock-time. The
non-verbal or metacommunicative components which make their statements feeling of eternal doom with no hope of escape is an essential experiential charac-
experientially real and convincing. teristic of the no-exit situation. In order to work through and integrate this ex-
In the course of repeated LSD sessions that focus on the perinatal level, the perience one has to accept its full content, including the feeling that it will last
experiences of dying usually become deeper and more complete. When the process forever and that there is no way out.! Paradoxically, a person who desperately
reaches the stages of the final ego death, special technical problems can occur. The resists and fights what he or she feels would be an experience of endless suffering,
ego death involves an experience of the destruction of everything that the subject prolongs his or her tortures; conversely, if he or she capitulates and accepts staying
is, possesses, or is attached to. Its essential characteristics are a sense of total an- in hell forever, the very depth of the infernal matrix has been experienced, that
nihilation on all imaginable levels, loss of all systems of relation and reference, particular gestalt is completed, and the process will move further.
and destruction of the objective world. As it is approached in different directions A difficult situation that seems to be closely related to the no-exit matrix in-
and on different levels, the process requires more and more _ psychological volves repetitive verbal or motor behavior; in classical psychiatric terminology this
sacrifice. In the final stages, subjects have to face and confront experiences, situa- is known as verbigeration and perseveration. For a period of time that can last
tions and circumstances that are unacceptable or even unimaginable to them. anywhere from minutes to hours the individual behaves like a robot whose
The nature of the experiences that represent the final obstacle for the mechanism has been broken. Subjects in this state keep repeating the same
completion of the death-rebirth process varies from subject to subject. For some, it movements, sentences, or words. There is usually no meaningful contact with
can be certain critical physical conditions, such as a high degree of suffocation, them, and no external intervention of any kind can break the automaton-like
agonizing physical pain, blacking out, or violent seizure-like activity. Others have behavior. In most cases, the only solution is to wait until the reaction spontaneous-
to face a situation which is psychologically utterly unacceptable to them, and sur- ly terminates and contact with the client can be re-established. This problem
render to it. The most frequent of these are vomiting, losing control of the bladder seems to occur when the drug activates unconscious material with excessive emo-
or bowels; sexually unacceptable behavior; confusion and disorientation; making tional charge. Less dramatic forms of this pattern can accompany the emergence
various inhuman sounds, and humiliation or loss of prestige. A very difficult and of a particularly strong COEX system; extreme cases are almost always associated
importaut experience that occurs in the context of the ego death is the expectation with the perinatal process. Subjects frequently have total amnesia, or very in-
of a catastrophe of enormous dimensions. Subjects face agonizing tension increas- complete memory, regarding episodes of this kind.
ing to fantastic proportions and develop a conviction that they will explode and One of the common problems in psychedelic sessions is fear of insanity,
the entire world will be destroyed. This fear of disintegration represents a difficult usually associated with a feeling of losing control. It occurs most frequently in in-
experiential barrier; in their special state subjects may generate a strong convic- dividuals who have a strong need to maintain control and are afraid of losing it
tion that not only their own fate, but the fate of the entire world depends on their even under circumstances of everyday life. The general strategy, discussed during
ability to hold on. In this situation it is extremely important that the sitters the preparation period and reinforced verbally during the session when loss of
repeatedly emphasize the safety of this experience. No matter how catastrophic it control becomes an issue, is to encourage giving up control. The usual misconcep-
might appear from the subjective point of view, this explosion is ultimately emo- tion underlying this problem is the fear that even a momentary abandoning of
tionally and spiritually liberating. What is destroyed in this process is the old, control will result in its permanent loss, and insanity of some type would ensue.
limiting concept of oneself and the corresponding restricting view of existence and The new concept offered to the patient is that giving up control creates a situation
of the universe. Once the process reaches this point, it is absolutely essential to in which the suppressed material that has been kept in check can emerge and be
complete the experiential gestalt. Unfinished and poorly integrated sessions in this worked through. After an episode of dramatic and often chaotic release of pent-up
area can result in serious destructive behavior and suicidal ideation. energies through various available channels, the problem loses its charge and the
Another situation that can become a source of considerable problems in LSD individual achieves effortless control. This new type of mastery does not involve
sessions is the experience of no exit. Although it occurs most frequently in the con- stronger self-control, but no ueed for it, since there is nothing to control. The fre-
text of BPM II, there exist close parallels that can be observed in advanced sessions quent association of problems related to loss of control with concerns about
on the transpersonal level. The transpersonal versions lack the concrete element of sphincter function will be discussed later in the chapter.
mechanical imprisoninent and the gross biological dimension, and have a purely ‘In general;.any kind of “psychotic” experience should be encouraged during
 COMPLICATIONS OF LSD PSYCHOTHERAPY Critical Situations in LSD Sessions 173
172

7 16

The artist Harriette Francis documented aun LSD experience during a psychedelic program skeleton and annihilation (11), followed by renewal, ascent and return to life (12). After
at Menlo Park, California. Much of it had typical perinatal features and she has expressed what appears to be symbolic crucifixion (£3) and reminiscence of some surgical intervention
many of the symbolic sequences of the death-rebirth process. After the initial visions of geo- (14), she experiences rebirth, which is associated with the vision of a peacock (15), The next
metric ornaments (1), the process gradually deepens (2,3) and the artist faces an engulfing drawing, of the oceanic womb, suggests that the experience of birth opened the way to the
whirlpool drawing her into the world of death (4). In the underworld she is subjected to unitive state of prenatal consciousness (16). She returns from her journey with a sense of
piercing pains (5) and crushing pressures (6,7), experiences a strange combination of birth rejuvenation and revitalization (17).
and death (8), meditates on mysterious symbols on a eruciform altar (9) and is offered assis- (From LSD Journals of an Artist's Trip. Drawings by Harriette Frances. Courtesy of the
tance (10). In a sequence strongly resembling shamanic initiation she faces reduction to a International Foundation for Advanced Study, Menlo Park, California.)
174 COMPLICATIONS OF LSD PSYCHOTHERAPY Critical Situations in LSD Sessions 179

the sessions, and in specially structured situations also in the free intervals between resistance to deeper issues.A typical example would be a male patient who feels
‘sessions, as long as they do not endanger the client or anyone else. We are not the need for comforting contact on the infantile level and, fearing the dependency
dealing here with experiences produced by the drug but with areas of potential and helplessness that this entails, attempts to approach a feinale therapist in an
psychotic activity within the client that have been chemically exteriorized. It is adult sexual way. In situations like this the sitters should always direct the client to
more appropriate to see such episodes as unique therapeutic opportunities rather a deeper experiential level and discourage acting-out. This can be done in a con-
than as clinical probleins. Psychotic reactions that deserve special attention are structive way and does not have to involve rejection. Reference to the explicit rules
those associated with paranoid perception. They present particular technical agreed upon before the session can make this situation easier for the sitters.
difficulties since they affect the very core of the therapeutic cooperation, the rela- Adult sexual activities in LSD sessions can be very tricky; no matter what
tionship with the sitters. Problems in this area cover a wide range, from minor the external circumstances are, they are expericnced by the client on many dif-
mistrust to full-blown paranoid delusions. They also occur in many varieties and ferent levels since the ability for narrow and accurate reality-testing is impaired
can be anchored in different levels of the unconscious. During the work on the by the drug. Frequent involvement of the infantile levels can result in a specific
psychodynamic level they can usually be traced back to situations in childhood in vulnerability, particularly fear associated with the incest taboo. There is danger
which the client was actively abused and mistreated, or to episodes in early infan- that such experiences will be traumatic and have lasting negative consequences for
cy involving emotional deprivation and abandonment. Important sources of the client and the relationship with the sitter. I have seen several deterring ex-
paranoid feelings are BPM II and BPM III, particularly the onset of the no-exit amples of this kind outside of the medical context, especially in communes where
situation. Biologically, this would correspond with the beginning of the delivery, young people were sharing psychedelic experiences involving free sexual exchange.
when the intrauterine world of the fetus is invaded by insidious and intangible The result, in some instances, was contamination of everyday interpersonal rela-
chemical forces and starts to collapse. Some of the paranoid feelings can be traced tionships by deep unresolved transference problems and sexual confusion. In
back to early embryonal crises, traumatic past-incarnation experiences, negative. general, there should be no limits to what the client can experience on the fantasy
archetypal structures, and other types of transpersonal phenomena. level. However, the sitters should be very clear about their own attitudes and
Less serious forms of mistrust can be approached by reminding the clients of motives, and approach the subject with integrity and sensitivity. In my ex-
earlier discussions concerning basic trust, andby encouraging them to turn within perience, there is no need or justification for adult sexual activities in psycliedelic
and search for the sources of this mistrust in the emerging unconscious material. therapy, and whenever a sitter considers it seriously, he or she should examine his
This is usually possible only where there is enough trust left for the subject to be or her own motives. The only place for adult sexual activities during a psychedelic
able to communicate about the loss of trust. In more serious forms the client will experience should be between partners who have an emotional and sexual com-
deal with the paranoid thoughts and feelings internally, and the sitters might not mitment to each other in everyday life. Such an approach can add interesting
discover this until the experience is over and the trust bond reestablished. Extreme dimensions to sexual interaction, but is not without dangers and pitfalls even
degrees of paranoia can involve acting-out behavior; situations where an acutely under these circumstances; it should occur only between mature partners with
paranoid LSD subject tries to leave the room or attempts to attack the sitters are deep knowledge of, the nature of the psychedelic process.
among to the most difficult challenges of psychedelic therapy. Here the only resort It is clear that the question of sexual boundaries is much more problematic
might be to guard against irreversible damage to persons and objects, and play for in sessions that involve physical intimacy than in those where the sitters maintain
time. When the reaction subsides the sitters should return the patient to the reclin- a detached attitude toward the clients. Since the use of close physical contact is ex-
ing position, eyeshades, and headpliones, and try to facilitate complete resolution tremely useful in psychedelic therapy this issuc will be briefly discussed here. Deep
and integration of the problein by the methods described earlier. age-regression in LSD sessions is frequently accompanied by intense anaclitic feel-
On occasion, sexual acting out can present technical problems. When it does ings and tendencies, especially in patients who experienced serious emotional
not involve the sitters directly, as in the case of genital or anal masturbation, the deprivation in early childhood. They might want to hold, fondle, or suck the sit-
sitters should be sufficiently open-minded to allow it. Occasionally, one episode of ters’ hand, put their head in someone’s lap, or cuddle up and be cradled and
this kind properly handled by the therapists can provide a powerful corrective ex- caressed. Sometimes the regressive quality of these phenomena is beyond doubt
perience that will heal a long-lasting psychological trauma caused by insensitive and the patients show convincing signs of deep regression. At other times these
parents, who may have drastically punished infantile instinctual activities. If the activities can present technical problems because it may not be easy to distinguish
sitters have difficulty accepting such behavior, this should be an incentive towards whether a certain behavior is an authentic regressive pehnomenon, an inadvertent
and a unique opportunity for exploration of the roots of their own attitudes and occurrence, or a sexual overture on a more-or-less adult level. This is particularly
reactions. true in later stages of the sessions when the drug effect has subsided. Sometinies
The situation is more difficult if the acting-out behavior involves sexual ac- both levels seem to be involved simultaneously, and the client can oscillate from
tivities directed toward the sitters. The general rule here should be to exclude any one to the other.
explicit adult interaction that involves genitals, breasts, or the mouth. The reasons In the early years of my therapeutic work with LSD I used to discourage or
for this are serious and go beyond considerations of a moralistic nature. Sexual ac- refuse such manifestations, in accord with my strict Freudian background. Later,
tivity of this kind on the part of the patient is frequently a manifestation of
 \
181
180 COMPLICATIONS OF ESD PSYCHOTHERAPY Critical Situations in LSD Sessions

it became clear to me that periods of deep regression with strong anaclitic needs
are of crucial importance from the therapeutic point of view. I realized that the
therapist’s approach to such situations can represent a deep corrective emotional
experience or, conversely, perpetuate and reinforce old, pathological patterns of
deprivation and rejection. Even at a time when I was already using physical con-
tact almost routinely, I tended to withdraw it when the client crossed the sexual.
boundaries. At the present time, I do not see this as an either/or situation. The
boundaries can be defined and negotiated in very subtle verbal and non-verbal
ways. Lf the situation moves into problematic areas, it is possible to restore accep-
table limits without withdrawing close contact altogether. The key here seems to
be the therapist's clarity about his or her own motives and the ability to com-
municate clearly with the client, verbally and non-verbally. It is the therapist’s
ambiguities and conflicting messages that allow or breed problems. This is a com-
plex and sensitive area and it is difficult to establish any fixed rules. The therapist
has to rely on intuition and clinical experience in every individual case. The
nature and specific characteristics of the therapeutic relationship and the degree of
trust in it will remain the most important factors in charting the course.
One of the most important areas for psychedelic therapists to deal with is
the various forms of hostility and aggression. If the sessions are conducted in the

Hi
framework of a good working relationship, real technical problems with aggres-
sive manifestations are extremely infrequent, even in sessions in which destructive
tendencies are predominant. In most instances it is possible to maintain a syner-
gistic relationship even in the context of intense psychodramatic struggle. Most of
the technical problems occur when the sitters get physically involved with LSD
subjects in a playful fight which involves pressing, pushing, restricting, and some-
times inflicting pain. Under these circumstances, it is absolutely essential to rede-
fine the “as if” framework and prevent the situation becoming absolutely real and
serious for the subject. A skillful combination of verbal communication and
metacommunication can keep the play in that territory of experiential ambiguity
which seems to be optimal for therapeutic work. On the one hand, the situation
has to be sufficiently real for the subject to allow his or her full involvement and
release of emotions; on the other hand, it must not be so real as to be mistaken for
a dangerous or traumatic situation. Maintaining a trusting relationship has to be
the primary consideration.
In contrast to the frequency, intensity and scope of experiences involving ag-
gression, elemental and uncontrolled acting-out of destructive tendencies is ex-
tremely rare in supervised LSD sessions. When a situation of this kind seems to be
impending, the best approach is to encourage external expression in a cooperative
framework, as described above. Another effective technique is to relate to the
deeper level of anxiety, hurt, and helplessness usually underlying aggressive.
phenomena. Thus, comfort and reassurance can sometimes have an almost
magical influence on a patient who is aggressive and tries to threaten the sitters ori-
with an ostentatious display of power. Most effective approaches to aggression en- bolic self-portrait
A symbo from a session which was characterized by intense aggression .
of prey crushes a helpless mouse with its
tail identification of the specific problem involved in the case, and finding the ap- ented both inward and outward. A stylized bird
its own head. The an-
right claw » the left claw is transformed into a cannon turned against
propriate solution. As in other kinds of emergencies, the factor of critical impor- on words rait = auto-portrait), but also suggests
tique car ou top represent s a play (self-port
tance is the sitter’s own reaction and attitude to the situation. If the patient’s i
ructive uls
impulses frequently
the rela tionship between the mixture of aggressive and self-dest
behavior evokes anxiety or aggression in the sitter, they can get locked into a encountered in perinatal sessions and also in reckless, perilous
driving.

pare
 183
182 COMPLICATIONS OF LSD PSYCHOTHERAPY Critical Situations in LSD Sessions

vicious circle of interaction that tends to reinforce the pathological reactions. The parental figures without being rejected had helped him to overcome a sexual
following example from our early work in Prague can be used to illustrate some of trauma from his childhood and brought about a lasting liberation of his sex-
the above points. ual life.
This session was also quite important for Julia’s development. In
One day when I was conducting an LSD session with a neurotic retrospect, she appreciated this difficult experience as a great learning
patient, | was interrupted by loud knocking. Surprised by this interference, opportunity. It helped increase her tolerance of various unconventional
which was against the rules, I went to answer the door. An alarined nurse manifestations in LSD sessions and, subsequently, she became a better and
told me that my presence was urgently necded in the other treatment room more effective therapist.
where Henry, another LSD patient, had gone “berserk.” I left the nurse in
attendance and hurried to the place of the emergency. I found the treatment To complete the list of difficult situations that can occur in LSD sessions, we
room in a catastrophic condition; the patient had broken a mirror against should discuss various physical manifestations that are common concomitants of
the wash-basin, overturned all the furniture, and torn several books and psychedelic experiences. In their milder form, they usually do not present a par-
journals to shreds. He was standing in the middle of the room screaming ticularly serious technical challenge, but their extreme forms can be quite alarm-
and growling; his appearance was reminiscent of an angry ape. In the cor- ing. As I mentioned earlier, none of them are simple pharmacological effects of
ner stood Julia, a young colleague who had recently joined our team. She LSD; they represent complex psychosomatic manifestations. The general strategy
had sat in on LSD sessions before, although this was the first one she had toward somatic aspects in LSD sessions should be to experience them as fully as
run independently. She was pale, obviously frightened, and her hands were possible; clinical experiences have repeatedly confirmed the therapeutic value of
shaking. this approach.
I came up to Henry and took him by the hand; this established contact Probably the most common physical manifestations in LSD sessions are
and also reduced the chances for his attacking me. “It’s alright; don’t be various motor phenomena, such as generalized muscular tension, complex
afraid, nobody is going to hurt you,” I told him in a reassuring tone of postures and twisting movements, and a wide variety of tremors, jerks, twitches,
voice, and pointed to the couch, “Can we sit down? I would like to find out and seizure-like episodes. The'subject should be encouraged to let these happen;
what you have been experiencing.” We sat down and I started asking him they represent extremely valuable channels for effective discharge of deep, pent-
questions, trying to find out what triggered his aggression. It soon became up energies. It is important that the sitters watch for any attempts on the part of
apparent that earlier in the session he had regressed into early childhood the subject to control such phenomena, for aesthetic or other reasons. They should
and experienced a need for closeness and affection. He was seeking physical consistently encourage uninhibited discharge of energy, even if full manifestation
contact with Julia and put his head into her lap. She panicked, pushed him takes the form of a violent temper tantrum or an epileptiform seizure. If the drug
away, and admonished him for introducing sexual elements into therapy. effect is not strong enough to bring about a spontaneous release of tension, this can
This triggered a very painful memory of a childhood situation in which be induced by the subject forcefully tensing-up the areas involved, and holding
Henry was caught masturbating by his mother. She made a big scene and sculpture-like postures for long periods. Intense external pressures and deep
reported it to his father who punished him in a very cruel way. This se- massage are also quite useful for this purpose.
quence of events effectively blocked Henry's access to both the channel of Breathing difficulties are very common in psychedelic sessions. On occasion,
childhood dependency and that of sexual feelings. In addition, the combina- they can take the form of genuine asthmatic attacks; these usually occur in persons
tion of sexuality with punitive feedback and anxiety made the perinatal who have had problems of this kind in the past. In the context of LSD sessions it is
level of his unconscious experientially available. At this point, Henry important to encourage full experience of the unpleasant feelings of suffocation, at
“chose” the path of aggressive behavior. the same time reassuring the subject that there is no real danger, since the
During this discussion, Julia recovered from the shock of her psyche- breathing difficulties are only subjective and respiration is adequate. It is essential
delic baptism. With iny psychological support, she allowed Henry to put his that the,sitters give the experient honest and objective feedback on this issue. Fre-
head on her lap and held his hand. However, another difficult test was yet quently gagging, coughing, or screaming, if it forms an integral part of the ex-
to come. About half an hour later, Henry, by that time back in the expe- perience, can bring dramatic release. It should be encouraged if the process moves
rience with his eyes closed, started playing with his penis. While doing this in that direction, but not mechanically suggested as a specific remedy.
he occasionally opened his eyes, obviously checking our reaction. When the Physical pain is an important and integral part of the psychedelic process
expected feedback was not forthcoming, he gradually unzipped his pants and should also be experienced fully if it starts emerging in the session. It usually
and started to masturbate by pulling his foreskin back and forth. His occurs in the context of reliving actual physical traumatizations such as diseases,
ejaculation brought a dramatic relief of [lenry’s physical and emotional ten- accidents and operations, or the birth trauma, although it can also have various
: sion; its psychological impact went far beyond that of the physiological symbolic connotations. Intense physical pain may sometimes be associated with
'; release. Henry felt that being able to masturbate in the presence of surrogate various transpersonal phenomena such as past-incarnation memories and ancestral
 185
184 COMPLICATIONS OF LSD PSYCHOTHERAPY Adverse Aftereffects of LSD Psychotherapy

unnecessary. When I
or phylogenetic experiences. In later stages of the sessions, when the phar- to twenty visits to the toilet in a single session, most of them
of resistan ce, I made the necessary
macological effect of the drug is not strong enough, it is useful to increase the sen- recognized that this was a very powerful form
on in the form of a rubber sheet and discouraged
sations by pressure or deep massage in the places indicated by the patient. In provisions for involuntary urinati

ore:
working with pain the sitters should always emphasize full experience of the pain h to urethral urges. Patients who had strong objecti ons to this
the adult approac
it were advised to use surgical
and the physical or emotional expression of the emotion that is inevitably behind arrangement and an insurmountable resistance to
severe urethral conflict s and blockag es could be
it. Quite commonly patients themselves ask for more intense pressure, sometiines rubber pants. With this approach,
, whether or not involun tary urinati on actually occured .
considerably beyond the point which the therapists feel comfortable with. Under resolved in a few sessions
experie nce, it is usually
unsupervised conditions individuals nay actually try to hurt themselves to ex- When a patient loses control of the bladder during an LSD
which involved ridi-
teriorize the pain. This seems to be the mechanism behind some of the self- associated with reliving traumatic incidents from childhood
urethral accident s. This release opens the way to the
mutilations and self-inflicted injuries in LSD sessions which have received so much cule by peers or parents for
n, removes the psycho-
publicity in the media. libidinal pleasure originally related to unrestricted urinatio
level, it frequently connects
Nausea and vomiting usually occur in individuals who have suffered from logical block, and facilitates letting go. On a deeper
where a fundame ntal relief after hours of
this problem in childhood or in whom this is a habitual reaction to stress in every- the patient with the moment of birth,
day life. Nausea should not be alleviated by any ineans and the sitters should on agony can sometimes be associat ed with reflex urinatio n.
They typically
courage vomiting whenever the patient seems to be fighting it. Breakthrough Problems related to defecation follow a similar pattern.
in males with latent or mani-
vomiting has a powerful purging effect, and in many instances ineans a positive occur in obsessive-compulsive patients of both sexes,
ities. On the psycho dynamic level
turning point in a difficult LSD session. It can be of particular significance in per- fest homosexual tendencies, and in anal personal
conflict s around toilet training , gastroin testinal
sons who have a very strong negative charge about it in everyday life. Unwill- they are usually associated with
ingness to vomit can represent a very important block and may be associated with od, and a history of enemas. Deeper perinata l roots of anal
disorders in childho
s about it charact erize
powerful emotional material on various levels. After having thrown up in the retention are in BPM II; an urge to defecate and conflict
of anal control is psychol ogicall y
middle of an LSD session, some patients talk about having dumped generations of BPM III, and explosive bowel release or loss
of birth. Althoug h anal problem s of
garbage. Others feel that they rid themselves of the introjected image of a bad associated with the ego death and the moment
in LSD sessions, actual uncontrolled defecation
parent or step-parent. In some instances, projectile vomiting can be associated various kinds are very common
encountered it only
with a sense of expelling alien transpersonal energy forms, almost in the sense of and manipulation of feces has been extremely rare; I have
studied. This may be an
exorcism. about ten times in over five thousand LSD sessions I have
techniq ue rather than clinical
Problems related to urination and defecation are unusually frequent in artifact of cultural programming and therapeutic
is much stronger than that against urine, and the
psychedelic sessions. They either take the form of urethral and anal spasms and an reality. Our taboo against feces
of the experie nt and the sitters to deal with the afterma th
inability to evacuate or, conversely, an intense physiological urge in these areas common unwillingness
timated . I realize
and fear of losing control over bladder and bowels. Difficulties with urination of anal letting-go is also a factor that should not be underes
LSD candidates the
typically occur in persons who in their everyday life respond to various stresses b retrospectively that for many years we discussed with
tried to alleviat e their concerns about it;
frequent micturition (pollakisuria), or show the classical Freudian characteristics possibility of loss of bladder control and
reassurance was never offered in regard to
of a urethral personality, such as intense ambition, concerns about prestige, a at the same time, however, similar
patient with severe
disposition to shame, and fear of blunder. If the LSD subject had problems with defecation. In 1972, I saw a dramatic improvement in a
psychoa nalysis for eigh-
enuresis (wetting the pants or bed) at some point in his or her past, one should ex- obsessive-compulsive neurosis which had resisted classical
control of his bowels and
pect the probleins in this area to be reenacted sooner or later in the sessions This is teen years; it occurred in an LSD session in which he lost
That made clear
also true for women who suffer from an orgastic insufficiency or frigidity that is in a deeply regressed state played for several hours with his feces.
associated with fear of losing bladder control at the same time as sexual orgasin is of the factors that might have been respons ible for our chronic
to me some
ve-comp ulsive neuroses. If
supposed to occur. On the psychodynamic level, urethral problems are associated therapeutic failure with patients with severe obsessi
ng in LSD therapy , the patient should be
with specific traumatic biographical material in agreement with psychoanalytic problems of an anal nature keep occurri
descriptions. However, they always have deeper roots on the level of the birth pro- concern s and be willing to abando n control if it
encouraged to give up adult
during the experie nce. As in the case of urinatio n, surgical
cess; there exist quite specific associations between urethral dysfunction and cer- becomes necessary
well as the sitters.
tain aspects of perinatal matrices. Thus, a block of urination comes in the context pants can be a great psychological help, for the patient as
of BPM II, a painful urge to void and conflicts about it is an almost standard com-
PT mM loss of bladder control characterizes the transition from
DVERSE AFTEREFFECTS OF LSD PSYCHOTHERAPY
In the early years of my LSD work, patients with the above problems often
material, its exterior-
delayed confrontation with the urethral material for weeks or months by inter- LSD psychotherapy involves activation of deep unconscious
sessions represent the most
rupting the experience and leaving for the bathroom. Some of them made fifteen ization, and conscious integration. Although the LSD
 Adverse Aftereffects of LSD Psychotherapy 187
186 COMPLICATIONS OF LSD PSYCHOTHERAPY

fluence the subject’s thought-processes. Certain ways of thinking about various

dramatic aspect of this treatment modality and ideally form a relatively com-
issues such as sex, men, women, marriage, and authority, or philosophical specu-
pleted psychological gestalt, psychedelic therapy is a continuous uncovering pro-
lations about the meaning of existence, the role of religion in life, suffering, in-
cess which includes the dynamics of the free intervals between sessions. Within the
justice, and many other problems can be direct reflections of the underlying un-
framework of an LSD series, no clearcut boundaries can gencrally be drawn be-
conscious material. Strong opinions, judgments, and systems of values in various
tween the sessions and the events preceding and following them. The dynamic un-
arcas can change drastically when a previously unfinished unconscious gestalt is
folding of various governing systems in the unconscious continues in a more or less
completed.
subtle way for a long time after the actual pharmacological effect has subsided. A
The occurrence of various perceptual changes after unresolved sessions is
very convincing illustration of this process is found in dreams. The content of the
relatively less frequent. Long after the pharmacological effect of the drug has sub-
dreams seems to form a continuum with the content of the psychedelic sessions. It
sided, the patient may still report anomalies in color-perception, blurred vision,
is quite common that pre-session dreams anticipate the content of the LSD ex-
after-images, spontaneous imagery, alterations in body image, intensification of
perience and post-session dreains are attempts to complete the gestalts that re-
hearing, ringing in the ears, or various strange physical feelings. Sometimes,
mained unfinished and to elaborate on the material involved. ideational and
various combinations of the above emotional, psychosomatic,
Although internalization of the LSD sessions and active psychological work
perceptual changes constitute completely new clinical syndromes which the sub-
in the termination periods can considerably facilitate the integration of the
ject has never experienced before. The occurrence of new forms of psychopathol-
material, there is never any guarantee that all the psychological gestalts will be
ogy can be understood as a result of activation and exteriorization of the content
completed by the time the pharmacological effect of LSD terminates. The risk
of previously latent unconscious matrices. These symptoms usually disappear
that the integration of a session will be incomplete and will result in real clinical
instantly when the underlying material is fully experienced and integrated.
complications seems to be directly proportional to the degree of preexisting emo-
The general nature and specific characteristics of the adverse aftereffects of
tional problems in the subject and the negative circumstances in the session that
LSD sessions depend on the level of the unconscious that was activated and the
prevent consistent introspective work. The extreme examples of this are inten-
specific content of the matrix involved. An active and unresolved matrix, whether
sification of the original symptoms, emergence of new forms of psychopathology,
of a psychodynamic, perinatal, or transpersonal nature, will influence the
prolonged reactions, psychotic breaks, and reoccurrence of LSD symptoms at a
subject's perception of himself or herself and of the world, emotional reactions,
later date (“flashbacks”). All these should be seen as comprehensible phenomena
thought-processes, and behavior patterns in a specific way. The clinical symptonis
which are part of the dynamic unfolding of the uncovering process and represent
that are psychogenetically connected with the activated functional system may
calculated risks of LSD psychotherapy.
persist for days or weeks and even for unlimited periods of time. Sometimes the
Some of the papers discussing the probable mechanisms of these complica-
adverse aftereffects of the session are limited to accentuation and intensification of
tions entertained the possibility of actual pharmacological presence of a certain
the original emotional, psychosomatic or interpersonal problems of the patient. At
amount of LSD in the brain for indefinite periods of time. This explanation is
other times the post-session difficulties represent a recurrence of symptoms which
inconsistent with the basic principles of pharmacology and also with concrete
he or she suffered from in childhood, adolescence, or some later period of life. In
laboratory findings on the metabolism and distribution of LSD in the body.
still other instances, the adverse aftereffects constitute a repetition of the situation
According to these, the drug has left the brain by the time the psychedelic expe-
that typified the onset of the subject’s manifest neurotic or psychotic symptoms;
rience culminates. There secins to be sufficient clinical evidence that the adverse
aftereffects of LSD sessions reflect deep, basic dynamics of the unconscious pro- this is true not only in terms of clinical symptoms, but also for specific inter-
personal patterns.
cesses and should be understood and approached in this context.
One mechanism of crucial relevance has to be mentioned at least briefly in
The psychopathological symptoms that can manifest as a result of incom-
this context. We described earlier how an activated dynamic matrix determines
pletely resolved LSD sessions cover a very wide range. Essentially, any aspect of
the nature of the patient’s experience and the specific ways in which he or she
an activated dynamic matrix or specific unconscious material that remains unre-
perceives the environment. This is quite regularly associated with a strong ten-
solved can persist after the session for an indefinite period of time, or recur at a
dency to exteriorize the content of the unconscious constellation and enact its
later date. Most frequently, these are various emotional qualities, such as depres-
replica in the treatment situation, as well as in everyday life. If we carefully
sion, a sense of inferiority, suicidal feelings, affective lability or incontinence, a analyze the psychodynamics of this phenomenon, we find a very interesting
sense of loneliness, anxiety, guilt, paranoid feelings, aggressive tension, or manic
underlying mechanism that can be described as intolerance of emotional-cognitive
elation. Psychosomatic symptoms that can occur in this context involve nausea
dissonance. Apparently, it is very difficult and disturbing to experience a deep in-
and vomiting, difficulties with breathing, psychogenic coughing and gagging,
congruence between one’s inner feelings and/or sensations and the nature of events
cardiovascular distress, constipation or diarrhea, headaches and pains in various
in the external world, as cognitively interpreted. It seems to be much more accep-
parts of the body, chills and hot flashes, increased sweating, “hangover” feelings,
table to experience various unpleasant emotions as being reactions appropriate to
flu-like symptoms, hypersalivation, skin rashes, and different psychomotor mani-
or at least congruent with actual circumstances existing in objective reality, than
festations such as general inhibition or excitement, muscular tremors, twitches, to perceive them as incomprehensible and absurd elements coming from within.
and jerks. An activated and unresolved unconscious gestalt can also specifically in-

=
 Adverse Aftereffects of LSD Psychotherapy 189
188 COMPLICATIONS OF LSD PSYCHOTHERAPY

Thus irrational feelings of anxiety and a sense of threat originating in the instances the nature of the material to be experienced can be anticipated, at least
unconscious can result in maneuvers aimed at provoking hostility in the therapist, in a general form, from the specific characteristics of the adverse reaction. Many
spouse, or employer. When these maneuvers succeed, previously incomprehensible of the elements discussed above are illustrated by the following clinical example:
feelings of anxiety assume the form of concrete and familiar fears of losing the
therapist's support and endangering the continuation of treatment, worries about
the disintegration of the marriage, or unsubstantiated concerns about losing one’s Tom, a 26-year-old dropped-out student, was accepted into the pro-
position or job. In more intense forms of such fear that border on vital threat, the gram of LSD therapy for a severe impulsive neurosis with periodic running
patient might actually seek out dangerous situations in activities such as hazardous away from home, vagabondism, and excessive abuse of alcohol and various
car driving, parachuting, walks in bad neighborhoods, or visits to bars and night drugs (poriomania, dipsomania and toxicomania). His behavior during
clubs of questionable reputation. Similarly, an LSD patient tuned into deep irra- these episodes involved many distinctly antisocial elements. He usually did
tional guilt feelings may behave in an utterly inappropriate way, break the basic not pay in restaurants and inns: he either escaped without settling the bill or
rules of therapy, and try to offend, irritate, or verbally attack the therapist. He or left some personal belongings as guarantee for later payment. Occasionally,
she can also do things in everyday life that are highly objectionable and guilt- he stole money or various objects from relatives, friends or strangers to cover
provoking. As a result of this, the pre-existing guilt feelings can be rationalized, his expenses. He slept in forests, public parks, and railway stations, and
since they become attached to actual external events and appear to be congruent grossly neglected his personal hygiene. Tom was referred to the LSD pro-
with the objective situation. The above are just a few concrete examples of very gram after two years of unsuccessful therapy by various conventional
common mechanisms that can present considerable difficulties in the therapeutic methods. Some of his previous psychiatrists had diagnosed his case as schizo-
situation, as well as in the patient’s everyday life. It is absolutely essential for a phrenia, and the history of his treatment included a series of insuline comas.
successful course of psychedelic therapy that the therapist is familiar with this His first twenty-six LSD sessions followed an unusually monotonous
phenomenon and capable of handling it appropriately. course. He experienced anxiety, occasionally mounting to panic, and
The changes caused by activation of different levels of COEX systems are showed great agitation associated with massive muscular jerks and tremors.
usually not very dramatic and stay within the range of various neurotic and This was accompanied by recurrent visions of a pale, grimacing female
face. In later sessions, another element was added to the content of his ex-
psychosomatic manifestations, unless the activated layer is from very early
childhood and/or its emotional charge is excessive. When an important COEX periences. Every time he heard the sound of water running in a nearby
system is activated and remains unresolved, the subject experiences in the post- bathroom, he was overcome by anger and had great difficulty in controlling
session period an intensification of the clinical symptoms related to this system and his aggression. He also could not tolerate the presence of a female therapist
perceives the environment with specific distortions reflecting its content. In addi- or nurse, even briefly, and responded to them with irritation and rude ver-
tion, he or she may manifest a tendency to exteriorize the general theme of the bal attacks. The visions of the pale female face were now supplemented by
system, or certain specific characteristics of one of its layers, in the treatment images related to water. In this context, various dangerous situations asso-
with seas, lakes and rivers alternated with courageous sailors and
situation and in various aspects of everyday life. He or she may show peculiar ciated
idiosyncrasies and overreact to certain circumstances. The behavior of subjects aquatic animals of prowess, symbolizing mastery over the water element.
under these conditions can involve complicated psychological maneuvers that tend At this time, Tom’s problems in the free intervals between LSD sessions
to provoke specific reciprocal attitudes in the partners of their various interper- bordered on psychosis. He experienced bouts of unmotivated panic anxiety
sonal relationships. The external situations that result from such interaction repre- and felt intense hatred towards women. His idiosyncrasy in regard to run-
sent approximate replicas of the original traumatic events that remained unre- ning water continued and he almost physically attacked everyone who
solved in previous sessions. Since this section focuses on complications of LSD turned on the water tap. Tom’s behavior resulted in numerous conflicts with
tberapy, we are naturally discussing activation of negative COEX systems. the co-patients and nurses since he tended to provoke hostility by his intoler-
However, it is important to emphasize in this context that activation of a positive ance, recklessness, and aggression. He appeared agitated and manifested a
COEX system can have powerful positive consequences of a very similar kind. variety of involuntary motor phenomena, particularly massive jerks.
When the adverse aftereffects of an LSD session result from an incomplete Several sessions later, new elements appeared in the visions accompany-
resolution of a COEX system, their general nature and specific content can be ing Tom’s LSD experiences. At first, their content was quite puzzling and
understood once the unconscious material becomes fully availiable. The basic incomprehensible. He saw rapid sequences of various trivial objects related
characteristics of the emotional and interpersonal problems involved will reflect to bathing, such as shower nozzles, water taps, soap bars, tile patterns,
bath brushes, and bath toys. The innocent nature of these visions
the general theme of the system; specific details will then make sense in terms of sponges,
the individual layer of the COEX constellation that was activated. The therapist seemed quite incongruent with the intensity of anxiety and the powerful
will frequently not be able to understand the dynamics of the problem when it motor discharges that accompanied them. Tom was very dissatisfied with
occurs and he or she might have to wait until the time when the underlying un- these sessions and found them confusing; he referred to his experiences as “a
conscious material surfaces and the gestalt is completed. However, an experienced crazy pell-mell,” “mish-inash,” or “chaos.” All these disconnected experi-
LSD therapist is not always dependent on retrospective understanding. In many ences suddenly made sense when Tom relived in a complex way certain
190 COMPLICATIONS OF LSD PSYCHOTHERAPY Adverse Aftereffects of LSD Psychotherapy 191

traumatic memories from his early childhood. When he was two and three In the years following his LSD therapy Tom has not needed hospitalization
years old, he had an emotionally disturbed nurse who finally turned out to and did not have to rely on psychiatric help. He married and was able to
be psychotic. She used to maltreat him and frighten him in a very sadistic maintain a job arid take care of his two children.
way, particularly during bathing. The authenticity of Tom’s recollections
was later verified by his step-mother; she fired the nanny after having dis-
Sometimes seemingly bizarre sensations, emotions, and thoughts occurring
covered low much she had abused the child. After full and complex reliving
in the context of an adverse LSD reaction can be explained naturally and logically
' of these traumatic memories, most of the elements described above disap-
when one uncovers and identifies the underlying unconscious material. The fear of
' peared from Tom's sessions. However, the anxiety and muscular jerks per-
a male patient that his penis is shrinking can thus be traced to an emotional fixa-
sisted, despite the fact that they originally seemed to belong to the trau-
tion on a body image corresponding to the age of an unfinished childhood
matic memory involving the nanny. At this point, the anxiety in Tom’s LSD
memory. In a similar way, a female patient who is psychologically tuned into an
sessions became much more primitive and elemental; the twitches now ap-
activated memory from the preadolescent period can lose the awareness of her
peared to be associated with very unpleasant tastes and oral sensations. This
breasts from the body image, or can develop a conviction that she is losing her
gradually developed into reliving of early childhood experiences that in-
hair when she connects emotionally to -early infantile memories. Naive and
volved the application of various disinfectant solutions to the mucous mem-
childlike perception of the environment, inappropriate fears, increased depen-
branes of his mouth when he suffered from a fungus disease. The musuclar
dency needs, or doubts about bladder or bowel control are some other examples in
jerks were particularly emphasized around Tom's head and neck and he
this category. Of particular interest for psychosomatic arid internal medicine are
identified them as escape reactions associated with these medical interven-
y those instances in which, following an LSD session, an apparently somatic prob-
tions. In the intervals between these sessions, Tom showed a strong negative
‘lem turns out to be an integral part of a traumatic memory from childhood.
attitude toward hospitals and medicine; he criticized and ridiculed the
" Because of the special clinical importance of this phenomenon, I will illustrate it
medical aspects of our treatment procedures and revolted against them.
with several examples.
Following this phase, intense hunger and thirst, feelings of cold and
emotional starvation were added to his anxiety. In his LSD sessions, he was
now reliving traumatic experiences from a nursery where he was kept for Renata, a patient suffering from severe cancerophobia, relived in one of
the first seven months of his life. At this time, he craved the presence of and her sessions a sexual episode that supposedly happened when she was four
physical contact with women, and asked for the female therapist and nurses years old. In this scene, her stepfather was lying in bed and she crawled
—persons whom he previously could not stand—to be present. In this con- under the blanket with him expecting to be fondled and caressed. During
text they seemed to compensate for the frustration and emotional depriva- their play, however, he gradually directed her to his genital area and
tion which he had experienced in the nursery, where the superficial profes- abused the situation for his sexual gratification. The discovery of his erect
sional attitudes of the personnel had failed to satisfy his infantile needs. In penis was a particularly exciting and frightening aspect of this situation.
the free intervals between these sessions, Tom was haunted by the desire to While reliving a part of this episode, in which her forearm was the most
find the ideal woman; his depression was accentuated and he felt an ir- important area of contact with her step-father’s body, she suddenly
resistible urge to consume great quantities of alcohol and various drugs. developed a massive circumscribed infiltration and reddening of the skin. In
When Tom started to relive his difficult birth, during which his mother front of my eyes and within a matter of minutes this area reached the con-
had died and he himself had barely survived, he recognized that many of his sistency of shoe-leather; it became thick, hard and covered with protruding
symptoms were actually rooted on the perinatal level. His panic anxiety, ag- skin eruptions. This condition, which was diagnosed as eczema by a consul-
gression, guilt, and driving tension suddenly made sense as derivatives of the 1, tant dermatologist, persisted for ten days until the next LSD session. After
birth trauma. He now saw his massive muscular jerks and twitches as the traumatic memory had been fully relived and integrated, it disappeared
belated discharges of pent-up energies related to the “hydraulic” aspects of ‘ over several hours.
the delivery. Tom’s behavior around the birth sessions was impulsive, ruth- In another of her sessions, Renata relived a childhood scene in which
less and erratic; it was characterized by acting out of strange ambivalent she had fallen on ice while figure-skating and badly hurt her head and knee.
tendencies and conflicts between dependence and independence. Much of During the following week she experienced intense pain in the “injured”
this was expressed in the context of the transference relationship; by conven- parts of her body. She could not turn her head, was limping considerably,
tional standards Tom’s behavior during this period would be labelled and maintained a typical protective posture of her right leg. All these phe-
psychotic. nomena disappeared after the incident was filly relived.
In his sixty-fifth psycholytic session, Tom seemed to have completed the Another interesting example of a similar kind was observed during the
birth process and had his first deep trancendental experience, followed by a LSD therapy of Dana, a patient with complicated neurotic problems. In
dramatic but not lasting improvement. It took six more sessions and several one of her sessions, she started reliving a trauinatic episode which had oc-
months of unstable clinical condition before he reached a new equilibrium. curred at a time when she suffered from severe bronchitis. In this context,
 Adverse Aftereffects of LSD Psychotherapy ee AYS
192 COMPLICATIONS OF LSD PSYCHOTHERAPY

prove oneself.
she suddenly began manifesting all the typical symptoms of a bronchial in- limitations is combined with exaggerated ambitions and efforts to
to BPM II, the clinical
fection. These symptoms persisted even after the actual pharmacological ef- In contrast to the inhibited and tearless depression related
depressio n accompa nied by emo-
fects of LSD had worn off; during the following week, she continued to picture here can take the forny of an agitated
tor exciteme nt. Suicidal thoughts, fantasies and
cough excessively and complained about severe chest pain. The internist tional incontinence and psychomo
quite frequent, and follow a pattern distinctly different from that
who saw her as a consultant diagnosed bronchitis on the basis of elevated tendencies are
temperature, characteristic rales during stethoscopic examination, described for BPM II. Individuals in this state contemplate bloody and violent
window or
coughing, and production of thick phlegin. The only signs that distinguished suicides, such as throwing themselves under trains, jumping from a
cliff, hara-kiri, or shooting themselve s. (suicide II) The only suicidal fantasies
this condition from genuine bronchitis were its suelden onset at the time
in this context that do not involve blood are related to strangul ation and
when the trauniatic inemory started to cmerge and its equally abrupt ter- observed
of suffocati on are fre-
mination when tle psychological gestalt was completed. hanging. This seems to reflect the fact that high degrees
of birth. Typical physical symptom s
quently experienced in the final stages
syndrom e involve intense muscular tension, frequentl y result-
The governing influence of activated basic perinatal matrices on the post- associated with this
twitches, and jerks, pressure headaches, pains in various other
session intervals is usually much more dramatic, and is of great practical and ing in tremors,
ac-
theoretical importance. If the subject is under a strong influence from one of these parts of the body, nausea with occasional vomiting, intensification of intestinal
urination or urethral spasms, and profuse sweating .
matrices at the time that the pharmacological action of the drug is wearing off, he tivity and diarrhea, frequent
manifest ation in the sexual area is excessive augmenta tion of the
or she can experience its influence in a mitigated form for days, weeks or even A characteristic
ory relief.
months. If a deep level of a negative matrix is activated, the individual difficulties libidinal drive, for which even repeated orgasins do not bring satisfact
is sometime s associate d with
following the session can reach psychotic proportions. The consequences are quite In male subjects, this intensification of sexual tension
on; in females, with an inability to achieve
distinct and characteristic for each of the perinatal matrices. impotence? and premature ejaculati
painful
When the termination period of an LSD session is governed by BPM II and sexual orgasm, premenstrual emotional turbulence, dysmenorrhea, and
the subject stabilizes under its influence, the post-session interval is characterized genital cramps during intercour se (vaginism ).
pre-
by deep depression. Under these circumstances, individuals are vexed by various Subjects whose LSD session terininates under the influence of BPM IV
aspect of this state is a
highly unpleasant feelings, thoughts, and physical sensations. They have access sent a very different picture. The most remarkable
of previous psychopa thologic al symp-'
only to unpleasant memories and cannot see any positive elements in their entire dramatic alleviation or even disappearance
feel that they
life history. Guilt, inferiority, and shame seem to dominate their thinking about toms, and a decrease of emotional problems of all kinds. Individuals
have left the past behind and are now capable of starting an entirely new chapter
the past. Their present life appears to be unbearable and fraught with problems
in their lives. Exhilara ting feelings of freedom from anxiety, depressio n and guilt
that have no solution; they do not have any perspective on anything, and the
of perfect function ing of
future looks equally hopeless. Life is devoid of any meaning, and there is an ab- are associated with deep physical relaxation and a sense
simple and exciting, and the individua l
solute inability to enjoy anything. The world is perceived as threatening, ominous, all physiological processes. Life appears
oppressive and without colors. Suicidal ideation is not uncommon in this situation; has the feeling of unusual sensory richness and intense joy.
I is concerned, the individual can stabilize under the in-
it typically has the form of a wish to fall asleep or be unconscious, forget every- As far as BPM
inter-
thing, and never wake up again. Persons in this state of mind have fantasies about fluence of its positive or negative aspects. In the former case, the postsession
val resembleg the one described for BPM IV. However , all the feelings involved
taking an overdose of sleeping pills or narcotics, drinking themselves to death, in-
Sub-
haling domestic gas, drowning in deep water, or walking into snow and freezing. are inuch deeper and are experienced in a religious or mystical framework.
have strong feelings of
(suicide I) Typical physical symptoms accompanying this condition are headaches, jects see new dimensions in the world and in the universe,
and tend to regard ordinary things and ac-
oppression of the chest, breathing difficulties, various cardiac complaints, ringing being an integral part of creation,
or
in the ears, severe constipation, loss of appetite, and a total lack of interest in sex. tivities in everyday life—such as eating, walks in nature, playing with children,
intercou rse—as manifest ations of the divine. The experien ce of cosmic unity
Feelings of exhaustion and fatigue, drowsiness and somnolence, and a tendency to sexual
nces
spend the entire day in bed or in a darkened room are also common. has an unusual therapeutic potential and can have lasting beneficial conseque

A
Stabilization of an LSD session under the dominance of BPM III results in for the individual.
feelings of intense aggressive tension, frequently associated with strong but vague If the subject remains after an LSD session under the influence of the nega-
tive aspects of BPM I or negative transpersonal matrices, he or she experiences
apprehension and anticipation of a catastrophe. Subjects in this state liken
d with con-
themselves to “time bombs” ready to explode at any minute. They oscillate be- various forms and degrees of emotional and physical distress associate
interpret ed in a metaphys ical
tween destructive and self-destructive impulses and are afraid of hurting other ceptual confusion. These difficulties are typically
or religious terms. These unpleasa nt
people or themselves. A high degree of irritability and a strong tendency to pro- frainework—in spiritual, oceult, mystical,
“bad karma,” malefic
voke violent conflicts is typical. The world is perceived as a dangerous and unpre- conditions are attributed to the adverse forces of destiny,
In ex-
dictable place, where one has to be constantly on guard and prepared to fight and astrological or cosmobiological influences, or various evil spiritual entities.

a
the individu al
struggle for survival. Painful awareness of one’s real or imagined handicaps and treme cases this condition can reach psychotic proportions. After
 194 COMPLICATIONS OF LSD PSYCHOTHERAPY Prevention and Management of Complications in LSD Psychotherapy 195

works through and integrates the experience, he or she assumes a more tentative virus diseases and other somatic processes. On occasion, later psychotherapeutic
and metaphorical approach to such extreme interpretations. sessions, especially those that involve techniques using hyperventilation, can facili-
The four major complications of LSD sessions that are of great practical tate what the subject considers to be an LSD “flashback.” Meditation and various
relevance and should be specifically discussed are activation of preexisting symp- other spiritual practices or the individual and group exercises used in growth
toms, prolonged reactions, psychotic decampensations, and “flashbacks.” They centers can have similar effects.
can all be reduced to a common denominator, namely, the weakening of the In addition to the above factors which have a general catalyzing influence,
defense systein and incomplete resolution of the unconscious material that: was the mechanisin of “flashbacks” frequently involves an element of very specific
thns made experientially available. The weakening of resistance is most apparent psychological stress. This mechanism is of such importance that it deserves special
in those situations where the symptoms that the subject originally had are acti- emphasis. Powerful triggers for the recurrence of the LSD state are situations of
vated and intensified after a particular LSD session. In this case, no major change everyday life that involve elements similar or identical to the unconscious matrix
has occurred; the underlying matrix remains the same but its dynamic influence is or theme that remained unresolved. An exaniple of this would be a subject whose
expericnced more strongly than before. In the case of a prolonged reaction, the last LSD session, spent mainly under the influence of BPM IJ, did not end
specific defense system collapses but the material behind it is not worked through. with a satisfactory resolution. Under these circumstances a crowded, overheated,
The experience then continues not because of the persisting pharmacological ac- poorly ventilated, and noisy subway can provide an experience which is extremely
tion of the LSD, but as a result of the emotional charge of the unleashed un- close to the basic characteristics of the “no exit” situation. Driving a car in the
conscious material. The emerging unconscious theme is now too energetically rush-hour on a busy highway or use of a crowded elevator can have a similar im-
charged and too close to consciousness to be repressed and covered up again, but pact. All these situations can thus function as powerful facilitators of the content
a subject unfamiliar with the psychodynamics of this process usually tries to pre- of the second perinatal matrix.
vent it from emerging fully and completing itself. In a similar way, a subject psychologically tuned into BPM III could have a
A temporary psychotic decompensation after an LSD session can be seen as “flashback” as a result of watching a movie or TV-show involving rape, sadism
a special example of a prolonged reaction. It occurs when the unconscious and violence, or while driving a car and reaching a speed that appears dangerous.
matcrial that became activated and remained unresolved is a theme of fundamen- Sometinies the triggering stiniuli come from the external world, more or less acci-
tal relevance and carries excessive emotional charge. It may occasionally be a dentally and without active participation of the subject. Iu some other instances,
the subject is instrumental in creating a situation in everyday life that is an ap-

ee
major trauma from very early infancy; however, in most instances such an episode
involves perinatal material or some powerful negative transpersonal matrix. I proximate replica of the unresolved traumatic gestalt. The mechanisni underlying
have never seen an incident of this kind after supervised LSD sessions with persons such situations was described earlier in detail. Since this process typically involves
who showed a reasonable degree of emotional, interpersonal and social adjust- interpersonal partners and external circumstances it takes some time for it to reach
ment prior to the experience. In individuals who have serious psychiatric problems critical dimensions. The period necessary for such development would then ex-
that border on psyehosis, or have had schizophrenic episodes in the past, occur- plain the frequently long period that elapses between the drug experience and the
rence of transient adverse reactions of this depth is not uncommon. “recurrence.” Examples of this mechanism would be: recreating for oneself a “no-
The recurrences of LSD-like states days, weeks, or even months after the ac- exit” situation in everyday life, contaminating a sexual relationship by elements of
tual administration of the drug has stirred much publicity and deserves special the third perinatal matrix, reenacting an unresolved father problem in the daily
attention in this context. Careful study of the psychodynamics of the LSD reaction interaction with one’s employer.
over many years has convinced me that these episodes, popularly known as “flash- Understanding that the adverse aftereffects of LSD sessions are comprehen-
backs,” have a very similar basis to the prolonged reactions and psychotic breaks sible and lawful phenomena reflecting the basic psychodynamics of the uncon-
immediately following the sessions. The difference is that in this case the defense scious, and not capricious spin-offs of the pharmacological effects of a bizarre and
mechanisms are strong enough to cover up the activated and unresolved material unpredictable substance, suggests a general strategy and certain specific tech-
in the termination period. The experience appears to be completed, but this is true niques for their prevention and therapy.
only on the surface; the result is a very precarious dynamic balance between the
unconscious forces and the psychological resistance against them. As time passes,
any number of circumstances can disturb this problematic equilibrium, and the PREVENTION AND MANAGEMENT OF
individual starts consciously experiencing the,unfinished gestalt. Since it is a con-
tinuation of a process that started during the LSD experience, the uninformed
COMPLICATIONS IN LSD PSYCHOTHERAPY
subject will usually see it as an insidious, belated attack of the drug, rather than as
a manifestation of his or her unconscious. Less urgent episodes of this kind occur Occasional activation of the unconscious material associated with various kids
under circumstances which physiologically involve weakening of defenses, such as and degrees of emotional and psychosomatic discomfort is part of every uncover-
the periods between waking and sleep (the hypnagogic and hypnopompic state), ing process. Instances of this have been observed occasionally even in the course of
physical fatigue, or sleep deprivation. More dramatic instances are usually asso- conservative and traditional psychoanalytic treatment, and it is a common occur-
ciated with the use of drugs such as alcohol, marijuana, and psychostimulants, or rence in various experiential psychotherapies—neo-Reichian work, primal
 196 COMPLICATIONS OF LSD PSYCHOTHERAPY Prevention and Management of Complications in LSD Psychotherapy 197

therapy, Gestalt practice, encounter groups—where no psychoactive drugs are in the unconscious; this opens the way to emotional liberation, although the actual
used. Dramatic intensification of emotional or psychosomatic symptoms and inter- mechanics of it may extend over a long period of time.

Barn
personal maladjustment indicates that a patient has approached areas of impor- For patients who are properly instructed and guided, these reactions usually
tant unconscious problems. In LSD therapy, which considerably deepens and in- do not represent serious problems. They are trained in dealing with unusual states
tensifies all psychological processes, this mechanism is more apparent than in nore of consciousness and see thenias windows into their unconscious and opportunities
conservative forms of therapy, but is in no way specific to it. for self-exploration, rather than as threats to their sanity. Since the emotional
Understanding the basic dynamics of the complications that arise in LSD material usually tends to surface in the hypnagogic and hypnopompic periods, it is
psychotherapy is absolutely essential for their prevention and treatment. An im- not difficult to take some time and approach such episodes as “‘micro-sessions.” A
portant part of this work has to be done during the preparation for the first LSD short period of hyperventilation can help to activate the underlying problem and
session. The therapist has to explain clearly to the patient that intensification of facilitate its resolution through fuller experience and energy discharge. This ap-
symptoms, deep emotional turmoil, and even psychosomatic manifestations in the proach is far preferable to the usual effort to suppress and control the emerging
course of LSD therapy do not mean failure of treatment but are logical and mean- material, which prevents lasting solution and binds much of the patient’s energy.
ingful parts of the process. As a matter of fact, such phenomena frequently occur Frequently, difficult emotions and physical symptoms can disappear after half an
just before a major therapeutic breakthrough. Another important message that hour of introspective work.
has to be communicated before the drug is administered is that the incidence of This situation is more complicated if the material is so close to the surface
these complications can be considerably reduced by consistent internalization of and its affective charge so strong that it tends to emerge unpredictably under the
the LSD sessions. Full, unselective experiencing of whatever surfaces during the circumstances of everyday life. In that case, the patient should be instructed to ar-
drug sessions, and finding appropriate channels for discharging deep pent-up range for situations where it is possible to face and express whatever is emerging.
energies are of crucial importance for safe and effective psychedelic therapy. It is If this is not available, regular therapeutic sessions should be scheduled and
also essential that patients understand the function and importance of active systematic uncovering work done on the unresolved issues with the assistance of
work during the termination period on unresolved issues. Explaining the the sitters. The techniques used in this work are essentially the same as those that
rationale, basic principles, and rules for cooperation increases the chances for we described for the termination period of the LSD sessions. After a short episode
good integration of the sessions and reduces the incidence of prolonged reactions of hyperventilation that tends to unspecifically activate the underlying emotional
or “flashbacks.” structure, the sitters assist the patient by accentuating the physical sensations and
The basic principles of conducting the LSD sessions have already been de- states that he or she is already experiencing. Depending on the nature of the prob-
scribed and will be only briefly summarized here. A patient who removes the lem, they can use a combination of bioenergetic exercises or other neo-Reichian
eyeshades to avoid confrontation with difficult emotional material that is surfac- approaches, Gestalt technique, psychodrama, guided affective imagery, and deep
ing is not likely to have a smooth and clean reentry and should be prepared for massage to mobilize and work through the unfinished matrices. Stereophonic
difficulties in the post-session interval. Similarly, unwillingness to work hard on music, especially the pieces that were played in the session, can be of great help
unfinished material in the termination period of the session might mean a pro- during this work.
longed process of integration with investment of the therapist’s and patient’s time If LSD therapy is being conducted in the atmosphere of a therapeutic com-
and energy for days to come. munity, it can be very useful to engage a group of co-patients in this uncovering
Even if the above criteria are met, it is not possible to eliminate with any work. For example, the group can enact in a very convincing way the experience
certainty the belated occurrence of various emotional and psychosomatic after- of the encroaching birth canal, the atmosphere of a life-and-death struggle, or the
effects. Psychedelic experiences represent powerful interventions in the dynamics comforting and nourishing womb. On occasion, stimulating or comforting sounds
of the unconscious and it takes time to integrate them. Even a well-resolved ses- produced by the group members during this work can be very effective. Individ-
sion may be followed by later upsurges of additional unconscious material, uals in this team may also volunteer or be chosen by the patient or therapist for
because the experience might have removed an important block and made specific psychodramatic roles—surrogate mother, father, sibling, spouse, child, or
available new contents that were previously successfully repressed. employer. This approach is not only very effective for dealing with unresolved
I remember in this context a very beautiful and fitting simile which one of gestalts, but can also have a very powerful catalyzing effect on the assisting per-
my Czech patients used to describe the process. Lumberjacks floating trees down a sons. It is not infrequent that under these circumstances the intense experiences of
river occasionally encounter a situation in which the trunks form a barrier that the protagonist can trigger valuable emotional reactions in some of the helpers.
obstructs the stream. Their approach to this situation is not to remove every log The material and observations from such therapeutic events can become an im-
systematically, but to look for what is called a key-log, one piece that holds a portant addition to later group sessions. The experience of the role of helper also
strategic position. Experienced lumberjacks will approach the obstruction pad- has an important function for the self-esteem of the group members and con-
dling against the stream, find the key-log, and remove it with a hook. After this tributes to their sense of mastery. Collective efforts of this kind tend to create a
intervention, the logs start moving in a way that ultimately reestablishes the free sense of closeness, intimacy and togetherness which contribute to the social cohe-
flow of the river. This process can take days or weeks, but it is made possible by sion of the therapeutic community and its healing potential.
removing the crucial block. Similarly, LSD sessions can eliminate dynamic blocks In the rare instances where the adverse aftereffects are very intense and the
 198 COMPLICATIONS OF LSD PSYCHOTHERAPY Prevention and Management of Complications in LSD Psychotherapy 199

patients are potentially dangerous to others or to themselves, it may be necessary lessness is a necessary experiential attribute of hell; the experience of enormous
to keep them in the therapeutic facility twenty-four hours a day until these reac- physical and emotional pain where there is hope for release is not hell but
tions subside. Nurses and co-patients should be trained to assume collective purgatory. It seems that mainstream Christian theology has made the same
responsibility in these situations, and provide continuous assistance and surveil- mistake as some LSD subjects and confused psychological time with clock-time,
lance. If the non-drug work fails to bring desirable results it is advisable to shorten In spiritual systems that have a deeper understanding of consciousness, such as
Hinduism and Buddhism, one does not stay forever in hells or heavens; when
the free interval and run another LSD session as soon as possible, to complete the
one is experiencing infernal or paradisiacal states, it subjectively feels like they
unfinished gestalt. An interval of less than five to seven days tends to decrease the will last forever. Eternity should not be confused with an infinitely long period
intensity and the therapeutic efficacy of the next session, because of the biological of historical time. It is a state where linear time is experientially transcended
tolerance incurred by the previous administration of LSD. and ceases to exist.
In particularly resistant cases the therapist may decide to resort to the use of 2. This apparent paradox requires a few words of explanation. According to
other pharmacological substances. Major or minor tranquillizers should be observations from LSD psychotherapy, most cases of impotence and frigidity
avoided, since their effect is contrary te the basie strategy of any uneoveriug ap- are not based on lack of libidinal drive, but on excess of volcanic instinctual
proach and psychedelic therapy in particular. By inhibiting the process, blurring energies related to BPM III. It is unconscious fear of unleashing these forces

een
the experience, and obscuring the nature of the underlying problem, they prevent and a need to control them that interferes with the sexual act. When these ex-
its resolution. In those instances where the unconscious material is close to the sur- cess energies are discharged in a non-sexual context, they reach a level of inten-
sity which the individual can comfortably handle in a sexual situation.
face but is blocked by a barrier of intense psychological resistance, inhalation of
This understanding of sexual disturbances is supported by the clinical observa-
Meduna’s mixture (thirty percent of carbon dioxide and seventy percent of oxygen) tion that impotence and frigidity change into temporary hypersexuality in the
can be very useful. A few inhalations of this mixture can cause a brief but power- course of successful treatment along these lines.
ful activation of the underlying unconscious matrix and facilitate a breakthrough. 3. In recent years there has been a trend among surgeons to use ketamine only
A session with Ritaline (40-100 milligrams) can occasionally help in the integra- in children and old persons despite its biological safety and special advantages
tion of material from the previous LSD session, Psychedelic drugs with a certain as an anesthetic. The reason for this has been the occurrence of certain
affinity for positive dynamic systems, such as tetrahydrocannabinol (THC) or psychological states during awakening that have been referred to as emergence
methylenedioxyamphetainine (MDA) can be used with advantage. A drug that phenomena. ‘This reflects basic ignorance of the nature of the ketamine effects.
holds great promise in this indication but has not been sufficiently explored, is Since extraordinary psychedelic-type experiences are the very essence of the
ketamine (Ketalar). It is a drug approved for medical purposes, which has been ketamine action, every administration of this drug should be preceded by
specific instructions which make it clear that a very unusual type of anesthetic
used by surgeons for general anesthesia.? This anesthesia is of a dissociative type,
is being used.
which is very different from the one induced by conventional anesthetics. Under
i the influence of ketamine consciousness is not obliterated but deeply changed and
t
drastically refocused. An out-of-body state is induced in which the patient loses
y
contact with and interest in objective reality and gets involved in various cosmic
adventures, to a degree that makes surgical operations possible. Optimal dosages
i for psychedelic purposes are relatively small, 50-150 milligrams, which is about
one-twentieth to one-sixth of the standard anesthetic dose. The psychoactive effect
even in this low-dose range is so powerful that it catapults the patient beyond the
point of impasse from the previous LSD session, and can make it possible for him
or her to reach a better level of integration. This approach should be explored
with individuals who have developed long-term psychotic states as a result of un-
supervised self-experimentation with LSD.

NOTES

1. Since the deepest level of BPM U involves experiences described by many

religions as being in hell, a few references to spiritual systems seem appropriate
at this point. Hell is crossculturally defined as involving unbearable tortures
without end; it is an experience of eternal suffering. The element of hope-
THE COURSE OF
LSD PSYCHOTHERAPY
Changes in the Content of Psychedelic Sessions
Emotional and Psychosomatic Changes in the
Post-Session Intervals
Long-Term Changes in the Personality Structure
World-View, and Hierarchy
of Basic Values

The discussion of the course of LSD psychotherapy presented in this section is

based to a great extent on the observations made during a study which was con-
ducted at the Psychiatric Research Institute in Prague between the years 1960 and
1967. This was a clinical project exploring the potential of LSD for personality
diagnosis and as an adjunct to psychotherapy. The orientation in the early phases
of this study was psycholytic; however, in the course of clinical work with LSD,
many of the principles characteristic of the psychedelic approach were discovered
and assimilated into the treatment procedure. The most important of these were
increased dosage, internalization of the process, use of music, and appreciation of
the healing potential of perinatal and transpersonal experiences. The final out-
come of this development was the therapeutic method of using LSD described in
this book.
Most of the subjects in this study were psychiatric patients, although psychi-
atrists, psychologists, psychiatric nurses, scientists from various disciplines, and
artists were occasionally given serial LSD sessions outside of the therapeutic con-
text for training, insight, and inspiration. In selecting the patients for this project
‘we followed three basic criteria. We wanted to have all the major psychiatric
diagnoses represented in the study, to assess indications and contraindications of
this form of therapy and to explore whether the LSD process had specific
characteristics related to clinical diagnosis and personality structure. There was a
definite bias toward selecting patients who had severe chronic and fixated emo-
tional disorders that had lasted many years and had not responded to conventional
therapies. This emphasis seemed to provide ethical justification for subjecting pa-
tients to experimental treatment with a new, powerful and insufficiently known
201
 202 THE COURSE OF LSD PSYCHOTHERAPY
Changes in the Content of Psychedelic Sessions 203
psychoactive drug. Since high-quality feedback about the psychedelic experiences
and therapeutic results was essential for the study, we tended to select people with expanded the model of the human unconscious. It also threw light on the basic
an above-average level of intellectual functioning, a good educational back- characteristics of the transformative process facilitated by repeated administra-
ground, and a talent for introspection. tions of the drug.
We kept detailed records of each drug experience, as well as of the intervals In the following text we will discuss in detail the processes unfolding during
between the sessions. These records caine mainly from two sources—the patients the course of LSD therapy, focusing on its three important aspects:
themselves, and the therapists who were conducting LSD sessions. Additional in- a) changes in the content of psychedelic sessions;
formation was occasionally provided by the nurses and co-patients who spent b) emotional and psychosomatic changes in the post-session intervals;
some time with the LSD subjects during the late hours of the psychedelic ex- c) long-term changes in the personality structure, world-view, and hier-
perience. With the help of two colleagues who joined me later in the project, I col- archy of basic values.
lected records from the serial sessions of fifty-four patients. The dosages ranged be-
tween 150 and 450 micrograms and the overall number of LSD sessions per pa-
tient was between fifteen and one hundred-and-three. CHANGES IN THE CONTENT OF PSYCHEDELIC
The study thus involved intelligent patients with a variety of severe emo- SESSIONS
tional and psychosomatic disorders of a chronic and fixated nature. Among the
conditions we treated with serial LSD sessions were inhibited and agitated depres- In an eartier section of this book, we discussed abstract, psychodynamic, perinatal
sions, all major forms of psychoneuroses, psychosomatic diseases such as asthma, and transpersonal phenomena as being the four major categories of experiences
psoriasis and migraine headaches, various sexual dysfunctions and deviations, occurring in LSD sessions. The arrangements of the generative matrices of these
alcoholism and narcotic drug addition, character disorders, borderline psychotic experiential modalities and their interconnections are intricate and complex. They
states, and several patients with manifest schizophrenic symptoms. Later, when I cannot be reduced to any linear model, and are best understood in holonomic
was heading the psychedelic research project at the Maryland Psychiatric Re- terms.! It is, therefore, not quite accurate to talk about the unconscious as
search Center in Baltimore, I also had the opportunity to conduct serial LSD ses- stratified, and to refer to some of its manifestations as more superficial than
sions with cancer patients. The variety of subjects and circumstances made it pos- others. Yet in everyday clinical work with LSD some of these phenomena seem to
sible to draw general conclusions about the natural course of LSD psychotherapy, be generally more available than others, and in serial psychedelic sessions they
as well as the therapeutic strategies that ean influence it in a favorable way. tend to emerge in a certain characteristic sequence.
Keeping detailed records of the psychedelic experiences and of the intervals In the first few LSD sessions, especially if the dosage is kept within the range
betwcen consecutive sessions is a very important part of LSD psychotherapy. It is of 100-150 micrograms, there is usually a preponderance of abstract experiences
absolutely essential for research purposes, if one intends to draw generalized con- of various kinds. With the eyes closed, most LSD subjects have incredibly colorful
clusions and use the observations as a basis for theoretical speculation. Good and and dynamic visions of geometric designs, architectural forms, kaleidoscopic dis-
detailed records are also extremely useful in everyday clinical practice. A therapist plays, magic fountains, or fantastic fireworks. Sometimes, this can take the more
treating a large number of patients in serial LSD sessions usually forgets many complex form of interiors of gigantic temples, naves of Gothic cathedrals, cupolas
details, and even patients themselves do not remember all the sequences from their of monumental mosques, or decorations in Moorish palaces (“arabesques”). When
previous psychedelic expericnccs. Occasionally, niaterial from a much earlier ses- the eyes are open, the environment appears to be in flux or in rhythmic undulating
sion unexpectedly acquires new meaning in view of later episodes; reliable records movement. Colors are unusually bright and explosive, color contrasts much
can be of great value under such circumstances. This can becotne even morc evi- stronger than usual, and the world can be perceived in a way characterized by
dent if the patient has documented the course of his or her therapy with drawings various movements in modern art, such as impressionism, cubism, surrealism, or
and paintings. superrealism. Sometimes inanimate objects are described as coming to life; at
During my own research, careful retrospective study of the LSD records other times the entire world can appear geometrized and ornamentalized. Prob-
revealed many connections that I had missed during the actual treatment process, ably the most interesting perceptual phenomena in this group are optical illusions.
which extended over periods of months or years. While reviewing and reconstruct- Various ordinary elements of the environment may be seen transformed into
ing the unfolding of the psychedelic process of each single individual as reflected fantastic animals, grotesque faces, or exotic sceneries. Although the changes of
in the notes, I could recognize certain repetitive themes, recurrent experiential perception are most striking in the optical field, they can also iuvolve hearing, :
clusters, important underlying trends, typical stages, and characteristic turning touch, smell, or taste. Characteristic occurrences at this stage are synaesthesias, |
points. This gave valuable insights into the nature and course of the LSD where external stimuli produce responses in inappropriate sensory organs; thus |
procedure in specific individuals and allowed comparison with the significant LSD subjects ean report such extraordinary phenomena as seeing music, hearing
findings from similar data about other patients. This in turn provided a rough pain, or tasting colors.
dynamic cartography of the inner spaces made available through LSD and thus The above experiences, although fascinating from the aesthetic and artistic
point of view, seem to have very little relevance from the point of view of therapy,
 Changes in the Content of Psychedelic Sessions 205
204 THE COURSE OF LSD PSYCHOTHERAPY

tain aspects of the psychodynamic sessions represented reliving of emotionally

self-exploration, and personal growth. The most important aspects of these experi-
important events in the individuals’ lives, from early childhood, later life or even
ences can be explained in physiological terms as resulting from chemical stimula- the recent past. Most other experiences on this level could be identified, either im-
tion of the sensory organs and reflecting their anatomical structure and functional mediately or at a later date, as various derivatives of such biographical material.
characteristics. Many of them can be produced by anoxia, hyperventilation,
The deciphering of these more complex formations often occurred spontaneously
inhalation of carbon dioxide, or various physical means, such as mechanical pres- in the course of LSD therapy when they could eventually be traced back to their
sure on the eyeball, electric stimulation of the optical system and exposure to original sources. However, since these psychodynamic phenomena have a struc-
stroboscopic light or sounds of various frequencies. LSD subjects occasionally refer ture similar to dreams, they can also be subjected to further analysis by various
in this context to certain phenomena in everyday life that approximate some of techniques used in dream interpretation.
these experiences. Thus the television screen of a set that is out of tune can produce Tle understanding of the content and dynamics of LSD sessions on this level
a close replica of the visual distortion or geometrization of an image. Sinilarly, is facilitated if we think in terms of the specific memory constellations, or COEX
the illusive acoustical changes produced by LSD can be simulated by a radio systems, which were described earlier. These help to explain the otherwise puz-
receiver that is registering the noises from intermediate bands between stations. zling observation that in sequential LSD sessions the specific content tends to
Visions of geometrical patterns are so common in the low-dose LSD sessions undergo constant change, yet the overall structure of the experience, the quality of
of beginners that they were originally considered a regular and typical reaction to the emotions, and the accompanying psychosomatic symptoms can remain rela-
the drug. However, they tend to disappear from the sessions when the dose is tively stable for long periods of time. This reflects the fact that every COEX
increased or the administration of LSD repeated. This is an observation that is not system has a general theme that characterizes it, but each of the historical layers
easy to explain. There is a possibility that they actually represent a replay of the represents a concrete and specific version of this theme linked with many
sensory phenomena induced by the lack of oxygen during delivery, and thus form biographical details. Once the entire COEX system is revealed, the sequential
the most superficial level of the memory of birth. Their affinity to the third changes in the specific content of the sessions (and the corresponding illusive trans-
perinatal matrix seems to point in this direction. To prevent misunderstanding it is formations of the therapist and the setting) can be retrospectively understood as
important to emphasize that not all abstract and geometrical experiences in LSD reflecting its various historical levels. With some clinical experience, it is also
sessions belong in this category. LSD subjects can have various visions of a possible to use the knowledge of COEX systems for anticipating the approximate
geometrical nature in advanced transpersonal sessions. These two kinds of geo- nature of the experiences in their deeper layers before these are actually
metrical visions are quite different and can be easily distinguished from each manifested in the LSD process. As we discussed earlier, the concept of COEX con-
other. The advanced geometrical images are related to specific forms of the micro- stellations, and of governing dynamic systems in general, is particularly useful in
and macrocosm or represent elements of spiritual geometry. Typical visions from understanding the complications of LSD administration, such as prolonged reac-
this category represent atomic and molecular structures, cellular and _ tissue tions or recurrences.
elements, shells, honeycombs, flowers and blossoms, or various universal symbols
In our research in Prague, the content of psychodynamic sessions tended to
and complex mandalas. The rich philosophical and spiritual content of these proceed, by and large, from reliving traumatic memories of a psychological
phenomena clearly distinguish them from the abstract and aesthetic experiences nature to memories of serious diseases, operations, and accidents. This should be
described earlier. understood in statistical terms, as a trend in a large number of patients; it does not
Sometimes, the abstract sensory changes can assume a distinct emotional
mean that this development is absolutely linear or that it is mandatory for every
quality, and even a specific content. They can become sharp, dangerous, and ag- single individual or every treatment situation. At a certain stage of their LSD
gressive, with a dark red color that suggests accident, operation, murder, or in-
treatment, many patients moved from conflicts, problems, and memories of emo-
cest. Their colors might be very fecal with accompanying feelings of revulsion, tionally relevant events to reliving situations that had endangered their survival or
disgust, or shame. Some other forms and colors of abstract visions can be per- bodily integrity. Biologically threatening events and severe psychological traumas
ceived as lascivious and obscene, or very sensuous, sexually stimulating and seduc- in early infancy seem to represent a thematic link between the biographical level
tive. Similarly, warm, soft, and soothing forms and colors can be suggestive of the and the perinatal level of the unconscious. Since there is usually considerable ex-
world of the satisfied infant. Such specific qualities in the imagery always reflect periential overlap between these two realins, the transition may be gradual and
underlying emotionally-relevant biographical material. The same is true for almost imperceptible. Thus, many LSD patients who were reliving episodes of
perceptual changes in other areas, whether they occur spontaneously or as specific near-drowning, diphtheria, whooping cough, childhood pneumonia, or tonsillec-
illusive transformations of some concrete sensory input. Experiences of this kind
tomy, suddenly recognized that some of the pain, fear, and suffocation that
represent a transition from the abstract to the psychodynamic level. seemed to be related to these biographical events was actually part of the birth
In the study of psycholytic therapy in Prague most patients had, in the ini-
trauma. Similarly, other patients who were working through murderous rage
tial stages of their LSD treatment sessions, psychodynamic and abstract elements seemingly related to early oral disturbances frequently recognized that some of the
in various combinations and proportions. With the increasing number of sessions, enormous aggression which they had attributed to their infantile dissatisfaction
the abstract phenomena progressively disappeared from the content of psychedelic with the conditions of nursing was on a deeper level associated with the struggle to
experiences and the process focused on complex biographical self-exploration. Cer-
 206 THE COURSE OF LSD PSYCHOTHERAPY Changes in the Content of Psychedelic Sessions 207

be born. In the perinatal context, the tension and locking of the jaws characteriz-
ing oral aggression appeared to be a natural situation in the final stage of birth,
where the head is being pressed against the resisting walls of the birth canal. An
experienced LSD therapist can thus frequently recognize emerging perinatal
elements behind certain exeessive emotional reactions and psychosomatic
manifestations that the patient associates with various childhood memories.
When serial psychedelic sessions were continued, sooner or later every single
LSD subject transcended the biographical stage and moved fully into the perinatal
area. The number of sessions necessary for this development varied considerably
from one individual to another. By and large, in the context of the psycholytic
study conducted in Prague, subjects without scrious emotional problems spent
very little time dealing with biographical material and moved relatively quickly
to problems of dying and being born, philosophical questioning of the meaning of
human life, and discovery of the spiritual dimensions of existence. In contrast,
psychiatric patients with severe neurotic and psychosomatic problems sometimes
necded twenty to thirty sessions before they fully entered the realms of the death-
rebirth process. Retrospectively, many of them realized that their dwelling on the
psychodynamic level had been defensive in nature; they had been avoiding the
much more frightening perinatal material. This attitude was, of course, supported
and encouraged by the exclusive emphasis on biographical data implicit in the ini-
tial Freudian orientation of the therapists. The time needed for psychodynamic
work can be considerably shortened if the sitters are familiar with the perinatal
and transpersonal dimensions of the psychedelic experience and are comfortable
with them.
Once patients are fully involved in the death-rebirth process, the main focus
in many consecutive LSD sessions is on the perinatal unfolding,with all its
ramifications and nuances. In the most general terms, this process consists of a
large number of experiential sequences involving the symbolism of individual peri-
natal matrices. We have not been able to detect any universal patterns or regulari-
lies as to the order in which these matrices are confronted. Some exceptional sub-
jects have direct experiential access to elements of BPM I and _ transpersonal
phenoniena before they confront the elements of negative perinatal matrices.
More typically, the access to BPM IV and I inereases as LSD subjects
deal with the difficult aspects of BPM IE and III. In general, the perinatal sequen-
tial patterns are very individual: the factors determining them are complex and at
the present time ouly insufficiently understood. The nature and circumstances of
the actual biological birth process, and specific features of the individual's history
that reinforced and accentuated certain facets of the birth trauina seem to be of
considerable importance in this sense.
In addition to elements built into the personality structure of the subject, a
variety of external factors seem to be of potential or actual significance. These in-
clude the personality of the therapist, his or her general orientation and
therapeutic approach, and the clements of set and setting in the broadest sense.
Various unsystematie observations seem to suggest the potential relevance of
seasonal influeuces and calendrical events, such as birthdays, important anniver-
saries, Christmas, or Easter. Some interesting clues can occasionally be derived
from the subject's astrological chart and from the data on planetary transits,? and
A complex experience combining feelings of constriction with painful genital and umbilical
the most interesting area for future research may be that of possible cosmobio- sensations. It illustrates the origin of the castration complex and its roots in the birth trauma.
logical determinants of psychedelic sessions in general and the perinatal process in
 Changes in the Content of Psychedelic Sessions 9209
208 THE COURSE OF LSD PSYCHOTHERAPY

peri-
particular. While the major experiential focus in the LSD procedure is on the
several important episodes related to the individual matrices can be
natal level,
experienced in a single session. However, in each of these sequences the emphasis
se-
is on a different aspect, facet, or level of the main experiential pattern. In some
quences involving the negative matrices, the central focus is on the emotional
as depression, anxiety, guilt, anger, aggression, or revulsion. In
quality, such
others the emphasis can be on one or several psychosomatic manifestations—a
feeling of suffocation, pressures on the head and body, various physical pains,
s. In
discharge of tension in tremors, nausea and vomiting, or cardiac difficultie
can be experienc ed on dif-
addition, each of the stages of the perinatal process
ferent levels, from various superficia l symbolic allusions to sequences of a primor-
dial and elemental nature that have mind- and world-shattering dimensions.
The richness of the experiential content is augmented by the fact that the
process involves an endless variety of illustrative material from biology, zoology,
to
anthropology, history, mythology, and religion. These elements also contribute
matrices, whose emotional and physiologi cal
the content of positive perinatal
ones.
manifestations are much more uniform and simple than those of the negative
not
For these reasons, psychedelic sessions focusing on the death-rebirth process
only have great therapeutic potential, but are a source of invaluabl e scientific,
sociopolitical, philosophical, and spiritual insights.
Although LSD subjects can have several sequences of death and rebirth ina
process is
single psychedelic experience, it usually takes many sessions before this
s from their content. This
finished and the perinatal material completely disappear
ons in various non-West ern cultures
is in agreement with anthropological observati
where powerful sequences of death and rebirth are induced by drugs or various
s
non-drug methods in the context of so-called rites of passage. There are indication
that in the second half of life the episodes of unusual states of consciousn ess during
Stewart's
such rituals become less dramatic and lack the perinatal elements. Kilton
(96) description of the Senoi culture can be cited as an important confirmat ion of
this. As the perinatal process unfolds, the intensity of negative experi-
ences tends to increase and the feelings of release and liberation thereafter become
deeper and more complete.
Certain aspects of the perinatal process can be used as rough indicators of its
progression. If the LSD subject spends large periods of several consccutive sessions
feel-
in the role of the suffering victim—helpless, hopeless, and with “no-exit”
ings—it usually means that he or she is in the initial stages of the process. Increas-
ing access to aggressive feelings and an active role in the experiential sequences are
was men-
characteristic of more advanced stages of the death-rebirth process. ft
that, in the context of the third perinatal matrix, physical and emo-
tioned earlier
tional agony are intimately interwoven with intense sexual arousal. As a result of
this connection, during LSD therapy using lower dosages some of the birth agony
can be discharged and worked through in the form of orgastic sequences of painful
con-
intensity. If high dosages are used in the LSD process, the increase of sexual
in the sessions is an important indicator that the perinatal process is moving
tent
biological
into the final stage. The same is true for intimate encounters with
material such as blood, phlegm, feces, urine, or various other foul-smelling sub-
an end is
stances. Another typical sign that the death-rebirth process is coming to
The horrors of the birth trauma. Bird-like monsters encroach on the helpless and fragile of fire, in the form of concrete images of
experiential predominance of the element
fetus as it hangs from the top of the uterine cupola by its umbilical cord. Their gigantic
claws and beaks symbolize the destructive biological forces of the delivery. volcanoes, thermonuclear reactions, explosions and conflagrations, and especially
 210 TUE COURSE OF LSD PSYCHOTHERAPY Y

in the more abstract and transcendental form of the purifying and rejuvenating
fire (pyrocatharsis).
It is of critical importance for the practice of LSD psychotherapy to know
the concomitants of the experiential transition from death to rebirth intimately.
Some of the states the subject has to face in this context are so unbearable that he
or she may not be able to do it without sufficient acquaintance with this territory
on the part of, and constant encouragement and support from the sitter. If this is
not available, desperate avoidance of the frightening aspects of the critical
turning-point can become a long-term impediment or even a permanent block to
the completion of the perinatal process. The expectation of a catastrophic global
explosion, excessive degrees of suffocation, feeling an impending loss of con-
sciousness (“black-out”), a sense of bodily disintegration, and the collapse of all
reference points are the most frequent final obstacles that subjects have to face in
the death-rebirth process.
Perinatal experiences have an interesting intermediate position between the
biographically determined individual unconscious and the transpersonal realms of
the collective unconscious. The relative degree of involvement of psychodynamic
or transpersonal material in perinatal sessions is another indicator of progress. In
early phases there is considerable biographical emphasis; while LSD subjects are
dealing with traumatic childhood memories the experience occasionally deepens
into a perinatal sequence. ‘Later, the main focus shifts almost entirely to the con-

a
tent of perinatal matrices and the psychodynamic elements are usually reduced to

eee
an occasional reliving of diseases, operations, or accidents. At the same time,
various transpersonal realms are increasingly represented in the sessions, either as
illustrations and concomitants of the perinatal sequences or as independent
episodes. Quite frequently, LSD subjects experiencing various aspects of the birth
trauma report a simultaneous reliving of past-incarnation memories which involve
similar elements. Feelings of suffocation in the birth canal can thus be associated
with what feels like a nemory of being drowned or hanged in another life-time.
Sharp perinatal pains can take the form of being gored by a sword or a wild
animal in a previous incarnation, and the no-exit feelings of BPM I! can be paral-
leled by a scene of irnprisonment in a medieval dungeon. In a similar way, experi-
ences of the ego death can coincide with executions, murders, or ritual sacrifices.
Many other forms of transpersonal phenomena can tnake their first appear-
ance in connection with perinatal sequences. Various archetypal images of deities
and demons can accompany the birth experiences, as individual visions or in the
context of entire mythological sequences. Versions of the Terrible or Great
Mother, Satan, Moloch, Shiva the Destroyer, Osiris, Dionysus and Jesus Christ
seein to have specific association with individual perinatal matrices and various
aspects of the birth process. In some instances, memories from the lives of the indi-
vidual’s human ancestors, or experiences of various phylogenetic crises can occur
in the same function as described above for karmic elements. An identification Above. The anger that would be
Identification with the crucified
with persons of different races, professions, social groups, and predicaments, such an appropriate human reaction to
Christ in the context of BPM IIT.
as soldiers in wars, ambitious military leaders, revolutionaries, dictators, prisoners
Top. Jesus surrounded by the the tortures that were inflicted
in concentration camps, inmates of insane asylums, adventurers, explorers, mar- hatred of the hostile mob. upon Jesus.
tyrs, saints, and sages is quite characteristic. Similar identification may be ex- Middle. The brutal biological
perienced in regard to entire groups of people, and be accompanied by various aspects of crucifixion.
relevant insights into the dynamics of important religious, historical, and socio-

211
Vhree manifestations of the same basically perinatal symbol the sol-
theme on the psychodynamic, diers represent elements of an
perinatal and transpersonal lev- underlying transpersonal experi-
els. ence which is depicted in the last
Above. ‘Pega’, an important fan- drawing.
tasized childhood companion of Lower right. A military expedi-
the subject. tion of an ancient (African?)
Upper right. Soldiers in ancient army. The image of ‘Pega’ now
costumes are crushed between re-appears as a motif on the
two vigantic cvlincders. Ino this standard,

212 213
 Changes in the Content of Psychedelic Sessions 215

political movements. In the extreme, the death-rebirth experience can seem to

have transcended all boundaries and beeome a drama involving all of mankind.
The number of psychedelic sessions necessary for the completion of the peri-
natal process varies considerably from person to person and also depends critically
on external factors such as dosage, therapist, set and setting. For this reason, any
absolutely valid numerical estimate is impossible. In my experience, some in-
dividuals were able to work through and integrate the perinatal material in less
than ten fully-internalized high-dose LSD sessions. Others necded several scores of
psychedelic experiences in the same framework before they were able to move
fully into the transpersonal phase. I have also met a number of people who had
taken LSD on their own, in an unsupervised externalized way and in a social con-
text, and had not really even begun this process in spite of hundreds of exposures
to the drug.
If high dosages of pure LSD are used and the sessions are approached as in-
depth self-exploration, most individuals sooner or later complete the process of ego
death and rebirth. Beyond this point, all their sessions are transpersonal in nature
and represent a continuing philosophical and spiritual search. Whether the pro-
cess was originally approached as therapy or for another reason, it becomes at this
stage a cosmic adventure in consciousness aimed at solving the riddles of personal
identity, human existence, and the universal scheme.
In the program of psycholytic therapy in Prague a typical psychiatric pa-
tient with neurotic or psychosomatie problems moved successively from work on
psychodynamic issues through the process of death and rebirth to the philo-
sophical and spiritual exploration of the transpersonal phase. If we want to relate
this development to existing schools of psychotherapy, we can refer to the first
Above. The explosive energies phase as Freudian, because much of the LSD process on the psychodynamic level
and overwhelming emotions in-
volved in the final stages of the
can be understood in psychoanalytic terms. Since an important aspect of the peri-
perinatal unfolding (BPM * natal process is the reliving of the birth trauma, we can refer to it as Rankian. One
IE).
Right. The connection between of the essential characteristics of this phase is enormous release of pent-up energies
this process and the opening of through orgasm-like discharges and the dissolving of the character armor; it thus
the heart chakra. also has an important Reichian dimension. The only psychiatrist) who
systematically explored and described many of the transpersonal phenornena was
Carl Gustav Jung. Although his conceptual framework does not cover the entire
range of transpersonal experiences, it is appropriate to call the third stage Jungian.
Much of the experiential cartography of the perinatal and transpersonal areas has
also been covered by various religious and mystical systems and traditions.?
The progression through the above stages and the corresponding changes of
content can be illustrated in the series of LSD sessions of Erwin. a twenty-two-
year-old patient with an extremely severe obsessive-compulsive neurosis. Although
from the point of view of therapeutic outcome he was one of the few absolute
treatment failures, his sessions were an interesting example of the change of svm-
bolic content. They showed how the snake, a classical Freudian phallic symbol,
took on different meanings depending on the level of the psychedelic proeess. Dur-
ing his LSD therapy, Kerwin successively experienced various psychodynamic.
perinatal, and transpersonal phenomena, but all of a negative nature. He was
never able to experience the ecstatic unitive states that, according to our observa-
tions, have the greatest therapeutic potential.

Erwin was accepted into the LSD treatment program after four years
214
216 THE COURSE OF LSD PSYCHOTHERAPY Changes in the Content of Psychedelic Sessions 217

of unsuccessful psychiatric therapy with various conventional methods. His It took a long time to work through all the complicated emotions asso-
most tormenting clinical problem was a strong compulsion to conceive in his ciated with this event. They ranged from disgust, embarrassment, shame,
mind a geometrical system with two coordinate axes, and find within this and inferiority feelings to strong libidinal pleasure and a sense of triumph
system the proper location for different persons, situations and problems in related to breaking through exaggerated parental restrictions regarding
his life. When he resisted this urge, he became overwhelined by intolerable cleanliness. On this level, the image of the snake and the neurotic symptoms
fear and other highly unpleasant emotions. This activity absorbed so much had clear anal connotations: the serpentine forms represented feces and the
of his time and energy that it interfered with his everyday functioning and obsessive preoccupation with the shift of the coordinate system reflected the
frequently totally paralyzed him. Somctimes he spent hours attempting to movenients of the bowels.
find the appropriate coordinates for a certain aspect of his life, but was Later on, entirely new elements appeared in Erwin'’s LSD sessions.
never able to complete the task to his satisfaction. Shortly before his admis- The visions of the snake skin and of the serpentine loops now became
sion, he developed an alarming feeling that the center of his imaginary associated with strong erotic excitement and sexual tension. On occasion,
system was shifting to the left. This was accompanied by a sense of urgency, Erwin now saw scenes involving naked male and female bodies in sexual
tension, depression, and general insecurity. At that time he had also intercourse. These sequences finally opened into a complex reliving of a
developed various psychosomatic symptoms and tended to interpret them in classical Freudian primal scene—observation of sexual activities of his
a hypochondriacal way. He was referred to LSD therapy after several psy- parents to which he gave a sadistic interpretation. He felt that this event
chiatric hospitalizations and unsuccessful treatment with tranquilizers, took place at approximately the same time as the circus scene. The two
antidepressants, and drug-free psychotherapy. memories seemed to have a deep similarity; both of them involved a male
In the beginning, Erwin showed extreme resistance toward LSD; at and female figure with himself as an observer. The boa constrictor from the
one point, he was able to fight with full success the impact of 1500 ‘circus scene and the penis from the primal scene appeared to be symbol-
micrograms of Sandoz LSD administered intramuscularly.‘ A long series of ically equivalent. On this level, the snake was clearly a phallic symbol in
high-dose sessions was entirely uneventful; the content of most of them con- full accordance with the Freudian tradition.
sisted in massive somatization and struggle for control. After this, he When Erwin progressed to the perinatal level, many of the previously
gradually started to gain access to some recent biographical material, such described phenomena were meaningfully related to the birth agony. In this
as certain memories from his military service. Finally, in his thirty-eighth context, the snake became the symbol of the destructive female element,
LSD session, he suddenly regressed into childhood in a very convincing and crushing and smothering the baby during delivery. Erwin recalled books
realistic manner. He felt small and helpless and had various strange sensa- and films showing constrictor snakes strangulating the prey and swallowing
tions around his genital area. It seemed to him that his penis had shrunk and it. The similarity between these acts and birth or pregnancy seemed to
was as tiny as that of a child. This was associated with anxious concerns represent the associative bridge between the phallic connotation of the snake
about losing control of his bowels, and embarrassing feelings of having his symbol and its relation to the process of death and rebirth. The obsessive
pants wet and soiled. His usual obsessive urge was intensified to an enor- symptonis continued to be closely related to the movements of the snake’s
mous degree and seemed to be intimately linked to visions of moving rep- body, but now they symbolically reflected the conflicting forces during the
tilian bodies and patterns of snake skin. The shifts of various elements propulsion through the birth canal. The feelings of uncleanliness extended
within his imaginary geometrical system seemed to be perfectly synchro- from the genital and anal areas to the entire body and could be identified as
nized and at times even identical with the movements of the snakes. In these the condition of the newborn during and immediately after the delivery.
sessions, he was working through problems related to toilet training and to The problems of losing control of the bowels and bladder were now related
rebellion against parental authority. The excretory functions had a strongly to reflex urination and defecation, which occurs as a reaction to the agony
ambivalent meaning for him, being simultaneously or alternately of birth.
pleasurable and repulsive. The serpentine visions persisted even in some later sessions that had
In this context, he relived in a complex way and in full age-regression elements of a transpersonal nature. Here the snake was perceived in a vari-
an event which occurred when he was two and a half years old. His mother ety of archetypal and mythological contexts. Erwin described numerous
had taken him to a circus, and he was watching the show while sitting on visions of high priestesses attending and worshipping sacred pythons, snakes
her lap in the front row. After a performance that involved a female belly embodying the primordial forces of nature, gigantic Ouroboroses swallow-
dancer with a large boa constrictor, her male partner carried the snake ing their tails, plumed serpents, and other mysterious serpent deities.
around the arena, exhibiting it to the audience. When he approached Erwin The LSD experiences on all the levels described seemed to make
and his mother, the snake made an unexpected movement. In a sudden state perfect sense in regard to Erwin’s symptoms. Unfortunately, none of these
of panic, Erwin wet and soiled his pants while sitting on his mother’s lap. seemingly relevant connections proved to be therapeutically useful.
She was greatly embarrassed by the incident and left the circus immedi- Although Erwin frequently felt that he was coming close to the solution of
ately. The authenticity of this memory was later independently verified by his problems, the long series of psychedelic sessions failed to bring the
Erwin’s mother. desired results.
218 THE COURSE OF LSD PSYCHOTHERAPY Emotional and Psychosomatic Changes in the Post-Session Intervals 919

EMOTIONAL AND PSYCHOSOMATIC CHANGES Within a few hours of the LSD session, old psychopathological manifestations,
IN THE POST-SESSION INTERVALS which in some instances had persevered for many years, disappeared as if by
magic and were replaced by different clinical symptoms that the patient had
The changes that occur in the content of LSD sessions during the course of psyche- never had before. For a detailed discussion of the dynamics underlying these
delic therapy have their counterparts in parallel changes in the subjects’ clinical changes, see p. 277 ff. of this book. In some instances, these changes were so fun-
condition following the drug experiences. The specific dynamics of the post-session damental that the patient moved into a completely different clinical category.
intervals and the therapeutic approach to complications have been discussed in an This phenomenon is so striking and of such theoretical and practical significance
earlier section. Here we will describe certain general patterns of change associated that it deserves to be illustrated by a short clinical example:
with serial LSD sessions. We will focus our attention on the course of therapy in
the psycholytic study in Prague, before we introduced the principle of strict inter-
nalization of the sessions and active efforts at positive resolution and structuring of Richard was a twenty-six-year-old student who had suffered for more
the termination period. The use of these two principles decreases the incidence of than four years from severe unrelenting depression, and had made six
negative after-effects considerably, and thus reduces the oscillations of the clinical serious suicidal attempts, one of them with rat poison. In addition, he had
condition. frequent attacks of free-floating anxiety, excruciating headaches, agonizing
The discussion of the course of the LSD process under less-structured cir- cardiac pains and palpitations, and severe insomnia. Richard himself re-
cumstances is important for two reasons: it provides a better understanding of the lated most of these emotional problems to disturbances in his sexual life.
dynamics involved, and gives a rationale to future LSD therapists for aetive in- Although he had many friendly relationships with women, he was not able
tervention in the reentry period. Although the LSD sessions were supervised, the to approach them sexually and had never had sexual intercourse with a
lack of therapeutic intervention in the reentry period made the procedure more female. He tried to reduce his sexual tension by occasional masturbation;
like non-medical self-experimentation. The observations made in this context are however, this resulted in self-hatred and tormenting guilt feelings. At ir-
therefore also of great potential value for those professionals who practice crisis in- regular intervals, he got involved in homosexual activities, always in the
tervention and treat complications of unsupervised LSD self-experimentation. role of the passive partner. Although he could reach momentary satisfaction
Even when no active therapeutic help is offered during the termination in these situations, the feelings of guilt associated with them reached self-
period, negative aftereffects of LSD sessions are minimal in individuals who show destructive proportions. In the state of despair that followed his homosexual
reasonable emotional stability. As mentioned earlier, I have never seen in this affairs, he made several attempts at suicide and once tried to castrate him-
category aftereffects that had the form and intensity of clinical psychopathology. self by taking a large dose of estrogen hormones.
Occasionally, we observed feclings of sadness, irritability, fatigue, existential In his eighteenth LSD session, Richard completed the reliving and inte-
questioning, headaches, or “hangover” on the day following the session; such gration of a powerful negative COEX system that was functionally related
manifestations, however, always remained within the normal range. Even at a to BPM II.> This was followed by an ecstatic experience of several hours’
time when these individuals were dealing with difficult perinatal material, the duration. He felt self-assured, cured, whole and optimistic. However, dur-
negative sequelae of their LSD sessions did not interfere with their everyday func- ing the reentry period he tuned experientially into a different memory con-
tioning. In fact, to focus one-sidedly on the negative consequences of LSD sessions stellation, one associated with the third perinatal matrix. It was an unpleas-
in “normal” persons would be misleading. In most instances, one observed a dis- ant surprise for him after what he believed to be the final resolution of his
tinct enhancement of vitality, an increase of zest, a sense of elation, unusual per- illness. Disappointed, and unwilling to face the new problems, he mobilized
ceptual richness, and other distinctly positive changes for days or weeks following his defenses prematurely. He returned from his LSD session radiant, happy,
the psychedelic session. and with a sense of physical well-being; however, to our surprise, the com-
The situation was quite different in psychiatric patients with severe neurotic plex of his old symptoms was replaced by a classical hysterical paralysis of
and psyehosomatic disorders. At the time when these patients were working in his right arm. It had all the typical features of a hysterical conversion reac-
their LSD sessions on psychodynamic material, their clinical condition showed a tion, including the “belle indifférence”—a surprisingly indifferent emo-
considerable degree of variation and oscillation. After some LSD sessions, they tional attitude toward a seemingly serious and crippling symptom.
would manifest signs of very dramatic improvement; because our knowledge of The continuation of psychedelic treatinent brouglit about interesting re-
the nature and dimensions of the LSD procedure was rather limited at that time, sults. In several subsequent sessions, Richard's paralysis was lifted every
this occasionally created a false impression that the therapy was approaching a tine the LSD started taking effect. Two important areas of problems
successful termination. However, other LSD sessions were quite unexpectedly underlying his hysterical paralysis kept emerging aud had to be worked
followed by a dramatic accentuation of pre-existing symptoms. In the remaining through. The first was Richard's relationship with his father, fraught with
cases, the positive or negative changes were small and sometimes negligible. In aggression and conflicts about patricide. His father was a brutal and
addition to these oscillations in terms of alleviation or worsening of clinical symp- despotic alcoholic who physically abused both Richard and his mother. On
toms, we occasionally observed dramatic transformations of the symptoms. several occasions, his father had hurt him so seriously that Richard had to be
 220 THE COURSE OF LSD PSYCHOTHERAPY Emotional and Psychosomati

——
had a defi-
taken to a hospital. In puberty, Richard used to have violent fantasies and elemental. Much of the material that these patients were dealing with
was coming
dreams about killing his father. , nite oral emphasis. This was for me an indication that their therapy
in the belief that we just had to work
In the LSD sessions of this period, Richard repeatedly saw me as trans- to an end, and I continued the LSD sessions
,” to prevent a relapse. Accordi ng to psycho-
formed into his father. As soon as his arm and hand could move under the through a few “residua l problems
blank tablet-—-and the psychological
influenee of the drug, he would inevitably aim his fist toward my face. analysis, we are born a “tabula rasa” —a
before
However, he never completed the movement; his hand would stop several problems of our development start in the oral period; there is nothing from
much further to go. My expectat ion at that time was
inches from iny nose, withdraw, and strike again with new force. At times, birth and thus there was not
ical material would be limited and that we would
his fist would oscillate in this way for several hours in front of my face, as if that the amount of biograph
and
tossed around by contrary impulses of the Freudian id and superego. As this eventually reach a point where no new areas of problems would be detected
reliving of traumati c memorie s was frequent ly
was happening Richard kept reliving various traumatic memories involving activated by LSD. Since the
and contentl ess episodes , I expected serial administ ration of
his father, and had a number of symbolic visions related to patricide. followed by ecstatic
experien ces with a great
The second theme underlying Richard’s paralysis involved problems LSD to ultimately result in undifferentiated and unitive
correct, but
around masturbation. As he experienced strong conflict between his over- potential for healing and integration. This basic premise proved to be
was much longer and more complic ated than I had
whelming desire to masturbate and his guilt and fears associated with it, his the way to such experien ces
hand kept reaching toward the genital area and then pulling back into a expected .
and
position near his hip joint. While his hand was involuntarily oscillating back The continuation of therapy was thus a result of ignorance of the nature
it also reflected the use of an inadequ ate and
and forth, Richard had numerous experiences involving sex and punish- basic laws of the LSD process;
which underes timated the dimensio ns of the human per-
ment. Finally, he relived with intense emotions a traumatic memory of be- limited theoretical model
psychosomatic
ing caught and severely punished by his father for masturbating. sonality. The toll paid for this was much unexpected emotional and
al confusio n and a real
Both areas of conflict described above had their deeper roots in the peri- suffering on the part of my patients, and much conceptu
ce on my part. Despite all these
natal area and thus also reflected Richard's relationship with his mother. In testing of therapeutic optimism and enduran
most fascinat ing intellect ual and spiritual
these sessions, sequences of the death-rebirth struggle were closely inter- difficulties, this period became the
for me new and uncharte d areas of the human
woven with biographical material related to his relationship with his father. adventure of my life. It revealed
unsuspected situations and events, and confronted’
It took seven sessions to work through these two areas of conflict. When this unconscious, led to countless
The final out-
was completed, Richard regained full control of his hand and arm, this time me with hundreds of incomprehensible and puzzling observations.
conceptu al framewo rks, a
no new symptoms emerged and his old complaints did not return. Several come of this process was a radical break with the old
mind, and even a drastic change in my
weeks later, he had the first heterosexual intercourse of his life. much broader understanding of the human
concepts concerning the nature of reality.
l
In spite of the oscillations in their clinical condition, a general trend toward As the LSD sessions proceeded into the perinatal realms, the emotiona
ed, broaden ed and
improvement was observed in ost neurotic patients in our study. After a certain qualities and psychosomatic sensations that had to be confront
patient
number of sessions, which varied greatly from person to person, many of them deepened beyond all imaginable limits. Sooner or later, every single
ons. As the patients
temporarily reached a point where their symptoms were considerably alleviated started to experience agonies and ecstasies of cosmic proporti
my also
or even non-existent and there was a good level of overall adjustment. With a few dealt with various aspects of the death-rebirth process, a similar dichoto
lic experien ces. After some LSD ses-
exceptions, they could be discharged and continue LSD therapy on an out-patient occurred in the intervals following psychede
n of the patients would deterior ate drastical ly. On occa-
basis. sions, the clinical conditio
s and then at
This degree of improvement was probably comparable to the result of very sion, persons who came into treatment with severe neurotic symptom
showed transitor y psychotic
successful psychoanalysis or some other type of systematic long-term psycho- a certain point appeared almost cured, suddenly
ry rehospit alizatio n was necessar y in
therapy. In retrospect, from a conventional point of view this would have been a symptoms. Not infrequently, tempora
returned to their ordinary life situation and were con-
good time to terminate therapy. However, with most of our patients this did not patients who had already
on an out-pati ent basis. Less frequent ly, the LSD sessions of this
happen. For several reasons, it seemed appropriate at the time to continue LSD tinuing therapy
clinical improve-
psychotherapy beyond this point. My orthodox psychoanalytic training and back- stage terminated in deep ecstatic states and were followed by
anything observed earlier on the
ground were very important factors in the decision to continue, which eventually ment of an order qualitatively different from
were characte rized by not only a considerable
opened up for me an entirely new avenue of research into the human mind. psychodynamic level. These changes
s, but also an actively joyful approac h to existence with a
Although at this stage these patients showed a satisfactory level of sympto- reduction of symptom
matic improvement in the periods between LSD sessions, their psychedelic experi- distinctly spiritual undertone (“psychedelic afterglow”).
some of
ences still involved episodes of aggression, anxiety, guilt, and various psycho- As LSD patients come closer to the moment of the final ego death,
Deep depressi ons, aggressi ve tension,
somatic symptoms. In a way these were actually becoming more primitive and the free intervals becoine rather precarious.
 299) THE COURSE OF LSD PSYCHOTHERAPY Emotional and Psychosomatic
Y Changes
g in the Post-Session Intervals 223
\

self-destructive tendencies, and manic states are not uncommon at this stage. scenes, and sadomasochistic orgies of birth do not reappear in the sessions. How-
Although complications of this kind can be considerably decreased by active work ever, no matter how grandiose and cosmic the scale of transpersonal experi-
in the reentry period, a special treatment facility with trained personnel should be ences, ‘they are always intimately connected with the everyday life of the indi-
available when individuals with severe emotional problems reach this critical vidual. Working through negative transpersonal matrices and connecting with
phase of LSD psychotherapy. positive ones has a therapeutic influence on the subject's emotional, psychosomatic
At this time, sone of the original clinical symptoms that had been alleviated and interpersonal processes. It also provides new levels of understanding of one’s
or even eliminated by previous therapy might temporarily be accentuated or reap- own identity, the dimensions of being, human life, and existence in gencral.
pear. As the patient moves during the psychedelic process from the psycho- Although there is no more specific “archaeological” work to be done on one’s pres-
dynamic realm into the perinatal area, various psychopathological syndromes ent life history, the interpretation of its meaning changes constantly as the concep-
may gradually lose their specific characteristics and be reduced to their perinatal tual frameworks are expanded to accomodate new experiential data.
roots. Psychiatric patients who started LSD therapy with the most variegated clin- Onc aspect of everyday existence that shows particularly intimate connec-
ical problems typically show a striking convergence, and ultimately manifest in tions with the psychedelic process is the individual's dream life. In a course of
the LSD sessions and in their free intervals a quite similar symptomatology. In this psychotherapy involving serial LSD sessions, there is a clear continuity between
stage, there may be little difference between patients who started with symptoms the nature and content of the drug-induced experiences and mental activity during

ana
of claustrophobia, alcoholism, or inhibited depression; they all manifest symptoms sleep and the hypnagogic period. Dreams before the LSD session often anticipate
characteristic of an activated second perinatal matrix. Similarly, sadomasochism, the content of the psychedelic experience, and dreain life in the post-session
asthma, hysterical seizures, and agitated depression can be stripped of their periods typically elaborates on various themes from the preceding drug session.
biographically determined specific differences and reduced to typical BPM III This is particularly striking when important gestalts remain unresolved in the
phenomenology. Observations of this kind throw an entirely new light on the preceding session and much unconscious material with strong emotional charge
dynamic structure of various psychopathological syndromes and make it possible becomes experientially available.
to construct a revolutionary model of mental illness and of psychotherapy. When the emphasis in the psychedelic process is on biographical issues, the
Theoretical implications of this kind will be discussed in the next volume. dreams have the typical dynamic structure known froin Freudian psychoanalysis.
After many sequences of agony, death, and rebirth, LSD patients in the Much of their content seems to make sense in terms of the individual's emotional
psycholytic study in Prague typically reached the final experience of ego death. history, and can be easily deciphered by an interpreter who is familiar with the
This is an important turning point in LSD psychotherapy; beyond this point, ele- basic principles of dream work. When LSD patients experientially enter the
ments characteristic of BPM II, III, and IV no longer appear in the sessions or as perinatal area, the quality of their dreams changes and the Freudian approach to
determinants of the free intervals. The first perinatal matrix and various combina- interpretation is no longer adequate. Although formal analysis usually produces
tions of transpersonal matrices take over and govern the psychedelic experiences some material from the individual’s history that appears to be relevant and
from then on. From the clinical point of view, this is usually associated with thematically associated with the content of such dreams, any purely biographical
dramatic improvements over a broad spectrum of neurotic and psychosomatic interpretation remains superficial and unconvincing. The dreains of this phase are
disorders. However, full experiential shift from the perinatal into the trans- very primordial, elemental, and fraught with intense emotion. Their content is
personal arca does not mean that all negative experiences are permanently usually a more or less direct derivative of the typical themes associated with the
elimiuated from the content of LSD sessions or from the post-session intervals. The individual perinatal matrices. Thus perinatal dreams related to BPM II involve
content of purely transpersonal sessions shows the same dichotoniy as that of passive expericnces of tortures in prisons, concentration camps, and gas chambers;
biographical and perinatal experiences. The same is true for the dynamics of the frightening claustrophobic experiences in caves, underwater passages, or pro-
post-session periods; here too, the emotional and psychosomatic condition of the gressively narrowing corridors, tunnels and pipelines; and a world of meaningless
individual can be strongly influenced by positive or negative transpersonal cardboard figures, circus sideshows, and automatons or robots. More mitigated
matrices. Thus the everyday feelings, thoughts, behavior, entire world-view and forms of these dreams involve a variety of hopeless no-exit situations on different
life style can reflect elements of the oceanic bliss of the intrauterine state or the all- levels, Various aspects of BPM III generate dreams of titanic warfare or natural
encompassing horror of fetal crises; positive karmic patterns or past-incarnation catastrophes of enormous proportions; murders, accidents, bloody massacres,
tragedies; and the energy of nourishing or destructive archetypal constellations. rapes, and sadomasochistic orgies; pornographic scenes full of outrageous sexual
The fact that the subject has transcended the biographical and perinatal deviations and perversions; and an atmosphere of decay and unimaginable dirt.
levels docs not mean that from then on the content of his or her LSD sessions has Final phases of this matrix are associated with dreams of exciting adventures in
no personal significance or relevance. The biographical history is now frecly avail- inilitary expeditions, hunts, amusement parks, and particularly in colorful car-
able on the adult level without repression and emotional distortion. There is no nivals. The transition from BPM III to BPM IV is reflected in dreams about indi-
more painful reliving of individual traumatic events nor narrow emphasis on vidual and inass death, enormous fires, volcanic eruptions, atomic wars, and the
deciphering the dramas in the nuclear family and their impact on one’s life. Simi- destruction of the world. Dreams derived from ~BPM IV involve elements of divine
larly, the life-and-death struggles, the claustrophobic nightmares, scatological revelations, triumphant victories, escape from dangerous situations, loving recon-
 OF LSD PSYCHOTHERAPY Emotional and Psychosomatic Changes in the Post-Session Intervals 295
224 THE COURSE

ciliation or reunion, and joyful celebration. Heavenly realms, paradisiacal atmos-

phere, beautiful natural sccneries, and oceanic states in dreams reveal the involve-
ment of the first perinatal matrix.
The following description is an excellent example of a dream whose content
reflects perinatal dynamics. In this case the subject himself recognized its relation
to the birth process.

It was a Sunday afternoon and all my family was in the large living-
room of a house situated on a cliff overlooking the Pacific. Everyone was
enjoying themselves in our usual family holiday manner when I noticed that
a storm appeared to be gathering force outside. Suddenly, the wind and
rain acquired such power that it began to penetrate the windows; at this
point my father said in a very significant tone, “It is the Fifth Wind.” Then,
in a moment that seems magnificent even in retrospect, the entire house
began to rotate on its foundations and to fall off the cliff into the Pacific far
below. During the few seconds between the time it began its descent and the
moment of impact, I realized that all my family and myself were going to
die in the cataclysm. At the very moment that I had accepted totally my
own death and that of my loved ones, I awoke, just before the house hit the
ocean.
Upon awakening, I was left with an extraordinary exalted feeling, and
then | recognized the dream as bearing a deep resemblance to certain sensa-
tions [ had had in recent LSD sessions. In these sessions I appeared to be re-
living my birth, and the elements of accepting my death, the end of the
world, tremendous elemental forces involved in a cataclysmic explosion,
and finally the peculiar sensation that my head (perceived as much greater
than usual), the room and building I was in, and indeed the entire universe
seemed to be about to spin on its axis in the most inexplicable and awesome
manner—all these elements had appeared in various parts of the sessions
and were repeated in a beautiful fashion in the dream. Finally, I recalled training.
how, in the birth of my son, the head seemed to rotate at the culmination of A synoptic representation of a dream which the author had during his analytical
He was in a horrible dungeon, chained to a slab and exposed to various inhuman tortures.
the birth process, and the entire picture seemed to fit together —this dream of cream
These were associated with the motif of the little cup that provides unlimited amounts
seemed to represent in a symbolic manner many of the essential aspects of of wheat to anyone knowing the magic word—a theme from a popular Czech fairy tale.
the ego death. In the dream this magic cup was outside the prison, pouring out enormous quantities of
nourishing liquid. It was clear that the torments would end at the moment the cream of
Once the individual moves into the transpersonal stage of the LSD process, wheat reached the window and started flowing in. Free associations arising from this dream
this has important consequences for the nature and content of his or her dreams. included the Spanish Inquisition and the ingenious torture instruments used; the instinctual
Many of the elements and sequences, or even the entire content of certain dreams life of apes; many oral themes, including the buccal repositories of hamsters: and details
can represent transpersonal phenomena in a more or less pure form. Such dreams concerning a Czech king who spent his entire life in prison. Various concrete childhood in-
cannot be adequately interpreted in Freudian terms and the results of such eidents, involving discomfort in erogenous zones, were also recalled: the mouth being
burned by hot milk, an operation for fimosis, painful enemas, and others. The analyst conse-
analysis are bound to be superficial and inaccurate. These dreams do not show the
quently interpreted the dream as a composite formation condensing all the interferences
distortion and condensation characteristic of those that are biographically deter- with libidinal satisfaction which the analysand suffered in his early life.
mined, and have the quality of past-incarnation memories, ancestral or phylo- This explanation appeared superficial and unsatisfactory. Later the elements of the dream
genctic experiences, encounters with archetypal entities, various types of extra- reappeared in a high dose LSD session and made perfect sense in the context of the birth
sensory perception, or out-of-body travels. Recognition and acknowledgement of trauma. The dungeon is the delivering uterus and the tortures will end when the nursing
the specific nature of such dreams is essential for their correct understanding and stage is reached. Identification with the king illustrates the connection between birth and
interpretation. Because of the deep organic link between the dream life and the child-king archetype (“crowning”). Identification with monkeys and their uninhibited
psychedelic experiences, the work with dreams should be an integral part of every biological indulgence points to the unleashing of a variety of instinctual impulses (poly-
comprehensive program of psychedelic therapy. morphous perversion) in the perinatal process.
 Long-Term Changes in the Personality Structure_ oo 297
226 THE COUUSE OF LSD PSYCHOTHERAPY

Under these circumstances, one does not see the gradual unfolding of various
The above discussion focused on the course of LSD psyehotherapy for sub-
levels of the unconscious from one session to another as described for the psycho-
jects with neurotic and psychosomatic symptoms that were ‘serious enough for
lytic approach. Instead, all the categories of psychedelic phenomena can be
them to require psychiatric hospitalization. A few words should also be said about
sequentially encountered in a single LSD experience. At the beginning of a session
the individuals who were at the two extreme ends of the psychopathological spec-
the subject usually experiences a short period of an abstract nature wheu he or she
trum—“norial” persons and schizophrenic patients. Those subjects who did not
sees colors and dynamic geometrical patterns. Then the focus shifts to the psycho-
have serious emotional problems and participated in the LSD program for train-
dynamic realm, and the individual might briefly come in touch with some bio-
ing purposes or because of intellectual curiosity, basically followed the same
graphical elements related to a particular COEX system. As the LSD session cul-
general course as neurotic patients. However, this group was characterized by a
minates, he or she usually confronts deep levels of memory constellations dealing
rapid progression from abstract to perinatal experiences. These individuals did not
with survival and bodily integrity, or the material of the basic perinatal matrices.
spend much time on biographical issues and entered very quickly the realm of the
Memories of near-drowning, injuries, operations, and dangerous diseases, as well
death-rebirth process. In the perinatal sessions, the difficult experiences were
as profound encounters with death that go beyond concrete biographical events
usually limited to the time at which the drug-effect culminated, and most of the the session can
are quite common. After several sequences of death and rebirth,
reentries were pleasant or even ecstatic without any active assistance from the sit-
stabilize on the level of BPM I, or the subject can enter the transpersonal realm
ters. Negative carry-overs from the contents of the LSD sessions to the free inter-
and experience various mythological sequences, ancestral and phylogenetic mem-
vals were rare and only minimal, and no prolonged reactions or psychotic break-
ories, elements of the collective unconscious, or past-incarnation phenomena.
downs were observed in persons who had not had serious emotional problems
During reentry, when the effect of the drug is diminishing, episodes of a
prior to the administration of the drug.
psyehodynamic nature might be repeated. At this time, the insights acquired
The number of psychotic patients we treated was too small to allow any safe
earlier in the session are frequently applied to the concrete conditions and cir-
generalization. However, the LSD process in these patients had certain interesting
cumstances of one’s life. However, the fact that the subject has had experiential
characteristics which deserve to be mentioned. Those persons whom we began
access to the transpersonal level does not inean that he or slie has completed the
treating with LSD at a time when they had manifest schizophrenic symp-
death-rebirth process. It will still take a series of internalized high-dose LSD ses-
tornatology showed considerable oscillation in their elinical conditions after the
sions of a kind similar to the one described above to work through and integrate
initial sessions. Although these fluctuations were deeper and more dramatie, the
all the perinatal material and the associated psychodynamic eleiments. However,
over-all process resembled that described for the neurotic group. Just before these
if the principles of psychedelic therapy are applied, the overall time required to
patients entered the perinatal realm, their clinical condition appeared to be great-
complete this process is much shorter than in psycholytic therapy. In addition,
ly improved. Their psychotic symptoms were alleviated or had altogether disap-
there are fewer difficulties and complications in the intervals between the sessions,
peared, and they showed surprising critical insight into and psychological distance
especially when the therapeutic approach involves intense experiential work in the
from their previous difficulties. They typically displayed a variety of neurotic and
termination period and the sitters make an active effort at positive structuring of
psychosomatic complaints. Their LSD sessions and clinical symptoms in the inter-
the reentries.
vals between them seemed to be similar to those of the neurotic group, and their
perinatal process was equally stormy.
The major difference occurred after the completion of the death-rebirth
process. At this point these patients suddenly developed various degrees of what LONG-TERM CHANGES IN THE PERSONALITY
can best be described as “transference psychosis.” This condition is characterized STRUCTURE, WORLD-VIEW, AND
by recurrence of the original psychotic symptoms, but with the therapist as the HIERARCHY OF BASIC VALUES
main focus and target of all the patient’s thoughts, emotions, and behavior. I will
return to this process in more detail in a later section and illustrate it with a typ- Since we have been discussing the LSD procedure primarily in a therapeutic con-
ical clinical example, (see p. 244) When the LSD sessions were continued despite text, the question of its lasting influence on various personality characteristics is of
the deteriorating clinical condition and the persisting transference psychosis, the particular interest. Under certain circumstances even a single psychedelic experi-
patients were eventually able to reach an entirely new level of integration and ence can have profound and lasting consequences. If the subject's personality
mental functioning. A specially structured treatment unit is absolutely necessary structure has intrinsic potential for a fundamental positive or negative shift, the
for therapeutic experimentation of this kind and the therapist has to be prepared administration of LSD can catalyze and precipitate a sudden dramatic transfor-
to work for several weeks under the difficult and demanding conditions of trans- mation, On oceasion, one LSD experience has drastically changed an individual's
ference psychosis. world-view, life philosophy, and entire way of being. It has mediated a profound
spiritual opening in atheists, skeptics, and materialistically oriented scientists,
The course of LSD therapy is considerably different from the one deseribed
facilitated far-reaching emotional liberation, and caused radical changes in value
above if the therapist uses the approach outlined in this book. The use of high
systems and the basic life style.
dosages, eveshades, and stereophonic music deepens the experience considerably.
298 THE COURSE OF LSD PSYCHOTHERAPY Long-Term Changes in the Personality Structure 9299 :
AL

At the other end of the spectrum, less-fortunate individuals have been relevance. In a more concrete sense, certain fundamental approaches to problems,
deeply shattered by a single exposure to the drug and the psychedelic experience projects, and situations are, at this point, seen to be repetitions of the basic aspects
became for them the “last straw” that led to a psychotic episode. Serious emo- of one’s biological birth.
tional disturbances triggercd by ingestion of the drug and lasting months or even As the individual moves through the perinatal process, he or she discharges
years are not uncommon among persons who approach self-experimentation with and integrates enormous amounts of physical tension and negative emotions, and
LSD casually and take it under poor circumstances. This should not happen in the gains experiential access to unitive states associated with BPM I and BPM IV. This
context of supervised LSD work. Individuals with serious emotional problems that tends to change the way of being in the world and the basic approach to life. The
border on psychosis should be screened out in advance, unless the therapeutic ability to relax physically and emotionally and enjoy ordinary things in life is
team is willing and equipped to work through all the problems that might be ac- greatly enhanced. The emphasis shifts from pursuit of complicated external
tivated by the administration of the drug, and bring the therapy to satisfactory schemes to appreciation of simple aspects of existence. The individual discovers
completion. In this section, we will discuss changes that occur in the course of new ways of enjoying his or her own physiological processes and develops more
systematic and judicious long-term LSD psychotherapy following the principles respect for life in all its infinite manifestations. Deep satisfaction can now be
described in this book. derived from a number of things that have been available all along but were
Although the process of psychedelic transformation shows many individual previously ignored or barely noticed. Full participation in the process of life be-
variations, it is possible to outline certain basic trends that are reasonably constant comes more important than pursuit of any specific goal. It appears quite obvious
and predictable. In the Freudian stage of LSD psychotherapy, which involves bio- that one should be concerned about the quality of the experience of life rather
graphical self-exploration, subjects tend to discover that various aspects of their than the quantity of external possessions and achievements. Feelings of separation
life are “inauthentic.” Certain perceptions of the world, emotional reactions to and alienation are replaced by a sense of belonging or being part of the life pro-
persons and situations, and specific behavior patterns suddenly appear to be blind cess. This is typically accompanied by a definite shift from a competitive orienta-
and mechanical automaton-like processes that reflect psychological fixations from tion toward synergistic behavior patterns. ,A selfish and competitive approach to
childhood. As the traumatic material from the past is confronted and worked existence is seen as ignorant, inferior, and ultimately self-destructive. Compleinen-
through, LSD subjects free theniselves from certain idiosyncratic perceptions, in- tary and synergistic arrangements become the new ideal, to be applied on all
appropriate emotional responses, rigid value systems, irrational attitudes, and levels—in intimate relationships, working situations, large social groups and jin
maladjustive behavior patterns that are products of their early programming. This regard to the entire population of the planet.
process can also lead to elimination or alleviation of some psychopathological The old belief that “more and bigger” automatically means better, on both
symptoms and various life problems of less serious proportions. Since the life the individual and social scale, is rejected as a delusion and a dangerous fallacy.
history varies greatly from one person to another, the changes on this level can The Western life philosophy, which confuses conspicuous consumption with
take many different forms. richness of life is replaced by a new emphasis on “maximum well-being with
Perinatal experiences have a much more fundamental and uniform impact minimum consumption” and a definite shift toward “voluntary simplicity.” The
on the LSD subjects. The insights that occur in this profound confrontation with new holistic world-view quite automatically includes increased ecological
the extremes of huinan experience can drastically change one’s perception of awareness arid a need to live in basic harmony with the environment.It seems
oneself and of the world, and result in an entirely new strategy of existence. In this that the need to control and manipulate people and nature is related to the in-
process, inany individuals realize that the inauthenticity of their life is not limited fluence of negative perinatal matrices and reflects the memory of life-and-death
to certain biographically determined partial distortions, such as lack of confidence struggle with the maternal organism. Conversely, the holistic and synergistic ap-
and poor self-image, chronic problems with authority figures, or difficulties with proach to the human and natural environment seems to be related to positive
sexual partners. They suddenly see that their entire concept of existence and ap- perinatal matrices and based on the memory of a mutually satisfying and
proach to it had been contaminated by a deep, unconscious fear of death. A strong nourishing exchange with the maternal organism.
need to prove oneself, a chronic sense of dissatisfaction and inadequacy, exag- Another striking aspect of the psychedelic transformation is the development
gerated ambitions, tendencies to compare and compete, feelings of pressure and of intense interest in consciousness, self-exploration, and the spiritual quest. A
lack of time, and the “rat-race” or “treadmill” type of existence that were spontaneous inclination toward mysticism, ancient and oriental spiritual
previously considered intrinsic and inevitable aspects of life, suddenly appear in disciplines, the practice of yoga and meditation, and a fascination with mythology
an entirely different light. They seem to reflect subliminal awareness of the and religious art is particularly common. It is associated with the spontaneous
perinatal energies and their insidious influence on the ego. An individual who is emergence of a new transcendental ethic, quite similar to Maslow’s concept of
under their spell is, in a sense, still psychologically involved in the life-and-death metavalues and metamotivations. The individual seems to gain access to a value
struggle in the birth canal. This entails a peculiar paradoxical mixture of un- system that is not understandable in terms of his or her early history or cultural
conscious feelings; from one point of view, one has not yet been born, from norms, It entails a sense of compassion, tolerance, basic justice, and aesthetic ap-
another, one is afraid of death. Under these circumstances, many trivial situations \1 preciation that has a transpersonal or even cosmic quality. Successful completion
become symbolic equivalents of the birth process and are seen as having survival f
of the death-rebirth process thus results in a more joyful, interesting, and satisfac-
‘
 230 | THE COURSE OF LSD PSYCHOTHERAPY Long-Term Changes in the Personality Structure 931
\

tory way of being in the world, with a sense of belonging, meaning, natural create a utopian world free of problems, is replaced by a “transcendental realism”

—
spirituality, and synergistic participation. / which sees the dark and light side of the universe as two intrinsic and inseparable
This development involves a great conceptual expansion in many ways, but components, in the sense of the Taoist yin and yang. From this point of view, the
does not seem to influence certain basic philosophical cornerstones of the objective is not to eliminate the negative elements from life, but to develop an at-
Newtonian-Cartesian world-view. The world is still seen as objectively real and titude that would affirmatively embrace the universe as it is in its complex cosmic
material in its essence. Space is three-dimensional, time is linear and causality is dialectics. In this context, various aspects of the life process that previously would
accepted as a mandatory principle governing the course of events, although its have been considered negative appear to have multiple new dimensions and can
roots have been extended far into the transpersonal realms. Intrauterine experi- be seen from so many different points of view that they become intriguing and in-
ences, racial and phylogenetic memory, metaphysics of the DNA, archetypal dy- teresting. The ultimate reconciliation with the universe—not necessarily with its
namics, and the law of karma miglit have to be incorporated into the subject's status quo but with the unfolding cosmic process—comes from the insight that the
thinking to account for the enorinous expansion of the experiential world. A sci- totality of existence forms a unified field or network which is experientially
entifically trained individual still typically accepts at this point the Cartesian divi- available to each of us. From the point of view of an advanced LSD subject, we
sion between mind and matter and tries to find material substrates for all his or are all ramifications of the principle that has created this universe in its infinite
her LSD experiences in the structures of the central nervous system. complexity and are thus responsible for all the processes involved.
As the psychedelic process continues and the subjects explore the world of
transpersonal phenomena, many of the above attributes of the Newtonian-
Cartesian world-view become philosophically untenable. The possibility of tran-
scending the limitations of matter, time, space, and linear causality is experienced
so many times and in so many different ways that it has to be integrated into the NOTES
new world-view. Although for the practical purposes of everyday life the individ-
ual still thinks in terms of matter, linear time and causality, the philosophical 1. The holonomic theory of the universe and the human brain was developed
understanding of existence approaches that of Kashmir Shaivism, Taoism, Tantric by physicist David Bohm (13) and the neuroscientist Karl Pribram (81, 82). It
Buddhism, or modern physics. The universe ceases to be a gigantic assembly of is a revolutionary paradigm that offers the possibility of a new synthesis of such,
seemingly disparate fields as mysticism, modern consciousness-research,
material objects; it becomes an infinite system of adventures in consciousness. The
parapsychology, neurophysiology and quantum-relativistic physics. This model
new understanding has distinct holonoinic features, and the dichotomy between makes it possible to bridge the differences between the part and the whole, or
the part and the whole, experiencer and the experienced, determinism and between separate objects and undifferentiated unity. It also offers a new
free will, form and emptiness, or even existence and non-existence has been approach to the understanding of spatial and temporal characteristics of the
transcendcd. phenomenal world. Because of its importance to a comprehensive theory of the
Since much of the information in this book has been obtained in a clinical human mind, it will be discussed in detail in the next volume.
context, a few words should be said about the implications of the above trans- 2. Dr. Rick Tarnas (99), who has been systematically studying the correlations
formation for the understanding of emotional disorders and psychotherapy. The between various aspects of the process of spiritual development and major
LSD process can be viewed as therapy in the traditional sense as long as the self- planetary transits, drew my attention to the fact that the archetypal features of
exploration remains limited to the biographical areas. Once it reaches the peri- the planets Neptune, Saturn, Pluto and Uranus, as described by astrology,
natal level, it can be better described in terms of a rite of passage or spiritual show striking parallels with my descriptions of the experiential characteristics of
BPM I, BPM II, BPM III and BPM IV respectively.
transformation. Although the client is still working on emotional, psychosomatic
3. A similar understanding of the connection between various schools of
and interpersonal problems, the emphasis tends to shift toward a philosophical psychotherapy and specific levels of consciousness was recently expressed by
and spiritual quest. Many symptoms and difficulties in living disappear in the Ken Wilber (103) in his concept of spectrum psychology.
process, some of them in a psychodynamic context, others during the death- 4. This episode is described in detail in my book, Realms of the Human
rebirth process, or as a result of certain transpersonal experiences. However, as the Unconscious, p. 30. (32)
process deepens, each client without exception also has to deal with a number of 5. See the description of this memory constellation in Realms of the Human
problems that were previously latent and only emerged during the LSD pro- Unconscious, pp. 57-60. (32)
cedure. In general, the emphasis should be on a good integration of each LSD ses-
sion in the series, rather than on long-term maximalistic goals such as eliminating
all negativity from the sessions, which is unrealistic.
There are aspects of the psychedelic approach however, that are much more
important than concerns about simple symptomatic relief. The intensity and mag-
nitude of the LSD experiences are so great that they change the basic tolerance for
difficulties in life and alter the very concept of what constitutes a hardship.~The .
_simplistic approach to life, which tries to eliminate any difficult experiences and_,
INDICATIONS FOR
LSD PSYCHOTHERAPY,
THERAPEUTIC
POTENTIAL, AND
CLINICAL RESULTS
Problems in the Evaluation of Clinical Results
Depressions, Neuroses and Psychosomatic
Symptoms
Alcoholism, Drug Addiction, Character
Disorders and Sexual Deviations
Borderline Psychotic States and Endogenous
Psychoses
Emotional Distress and Physical Pain of Dying
Individuals

PROBLEMS IN THE EVALUATION OF

CLINICAL RESULTS
Disagreement about the potential and efficacy of LSD therapy has been one of the
most striking aspects of the LSD controversy. Professional literature discussing the
clinicat significance of the drug falls into three distinct categories. The first group
of publications consists of enthusiastic reports by LSD therapists according to
whom remarkable and relatively quick results have been achieved in the therapy
of emotional disorders, not only those that usually respond to conventional treat-
ment but also many that otherwise have a very poor clinical prognosis. In some
LSD studies, the success reported with chronic alcoholics, heroin addicts, subjects
with severe character disorders, criminal recidivists, and individuals dying of
cancer was quite dramatic. The second group of articles on LSD therapy involves
those studies that produced essentially negative clinical results, and tend to deny
the enthusiastic reports of the first group. Finally, the third group of clinical
reports on LSD focuses on descriptions of various deleterious aftereffects of LSD
self-experimentation. The images of LSD in professional literature thus cover a
wide range, from therapeutic panacea for psychogenic disorders to dangerous
psychosis-producing substance. Without a deeper dynamic understanding of the
nature of the LSD effect, therefore, it is difficult to draw any clear conclusions
from the published material about its clinical use.
233
 234 INDICATIONS FOR LSD PSYCHOTHERAPY
Problems in the Evaluation of Clinical Results 235
The evaluation of the therapeutic potential of LSD psychotherapy presents
many serious problems. Some of them are not specific to LSD-assisted therapy, peutic value if they have successfully confronted them in their own psychedelic
but relate to any kind of psychotherapy or to psychiatric therapy in general. These sessions.
include not only the difficulties with the accuracy and reliability of the measuring Evaluation of the therapeutic results of psychedelic therapy is further com-
instruinents, but a lack of agreenient as to what the basic indicators of therapeutic plicated by the fact that the clinical improvement is frequently associated with
change should be. Those authors who limit their efforts to symptomatic ap- profound changes in life strategy, philosophical and scientific world-view, and the
proaches tend to emphasize the reduction of emotional and psychosomatic distress basic hierarchy of values. Alleviation of severe psycliopathological symptoms can
as the najor criterion of therapeutic progress. Those who are more dynamically be accompanied by a distinct loss of interest in the pursuit of power, status, and
oriented prefer to focus on the patient's ability to solve conflicts or problems of liv- position. An orientation toward competition and achievement can be replaced by
ing and on the quality of interpersonal relationships. Some authors value more ob- one toward maximum well-being at minimum expenditure of energy and effort.
jective but less specific indices, such as changes in certain psychophysiological or Previously pragmatic and materialistic individuals can develop deep interest in
biochemical parameters. This is further complicated by various criteria which and genuine appreciation of the spiritual aspect of existence. A tendency to control
reflect contemporary societal values, such as income, professional achievement, or and dominate other people and nature might be replaced by synergistic and
residential adjustment. The difficulties in assessing psychotherapeutic results can ecological concerns. A psychiatrist who sees the present Occidental value system,
be best illustrated by the fact that researchers of the stature of Eysenck seriously based on ambition and competition, as natural, healthy, and ultimately man-
argue that there exists absolutely no scientific evidence for the therapeutic efficacy datory, may consider the above changes in a psychopathological framework and
of any psychoanalytically oriented psychotherapy. (25) describe them as showing lack of initiative, loss of interest in socially desirable
The evaluation of LSD psychotherapy presents several additional problems goals, or even development of psychotic delusional systems. This can be illustrated
of a more specific nature. This treatment modality involves much more than just by an episode which occurred during my lecture at the Harvard University School
|
administration of a powerful psychoactive substance; it is a complex process which of Medicine in 1968, after I described dramatic clinical improvements that I had
is critically dependent on many non-drug variables. The personality and approach observed in several of my patients during LSD psychotherapy. These changes
of the therapist and a variety of factors related to set and setting have to be con- followed death-rebirth experiences, feelings of unity with the whole universe, and
sidered integral parts of the treatment process. In the past, many authors ap- various transpersonal phenomena. In the discussion, one of the participants
proached LSD therapy simply as a chemotherapy, expecting therapeutic results offered the interpretation that the previously neurotic condition of these patients
from the administration of the drug alone without regard to all the extrapharma- had actually changed into psychosis, because they had now become interested in
cological factors involved. Others had various degrees of understanding of the spiritual pursuits, were seriously considering the possibility of reincarnation, and
complexity of the process and appreciation for the importance of the psycho- had become deeply interested in yoga and meditation.
therapy that precedes, accompanies, and follows the drug sessions. Unfortunately, At present, the situation in the world is quite different from what it was ten
most clinical reports about LSD therapy do not give sufficient information about years ago. The limitations and dangers of the Occidental value system are more
the degree and quality of psychotherapeutic care involved. In discussing the than obvious. Criticisms of the one-sided orientation toward unlimited industrial
therapeutic results achieved with the use of LSD it is essential to realize that all growth come from many different directions, the failures of competitive politics
the drug can do is to bring previously unconscious material into consciousness; the and technocracy are beginning to overshadow the successes, and ecological con-
outcome of this process depends critically on the way this material is dealt with sciousness is gaining ground in view of the impending environmental disaster. The
and integrated. There is nothing inherently beneficial or detrimental about the ef- criteria of sanity are changing rapidly; according to Abraham Maslow and
fect of the drug per se. other humanistic and transpersonal psychologists, feelings of oneness with the
The state of mind and level of consciousness of the therapist is also an imipor- universe or otlier mystical experiences need not be considered psychopathological
tant variable in the treatmeut process. His or her ability to remain calm and sup- phenomena. They can occur in healthy individuals and are conducive to self-
portive in the face of various extraordinary experiences and unusually intense actualization and self-realization. Oriental systems of thought and spiritual prac-
emotions, and
tices are attracting increasing numbers of mature and well-educated individuals
the degree of open-mindedness, tolerance, and permissiveness
maintained towards the entire spectrum of psychedelic phenomena are factors who cannot be easily dismissed as ambulatory schizophrenics. Transpersonal psy-
critical to therapeutic success. The role of the therapist in the process is so vital chology and psychiatry, a recently developed discipline that represents an attempt
that it is impossible for him or her to make an objective evaluation of the efficacy to integrate spirituality and mysticism into modern psychology and psychiatry, is
of LSD psychotherapy without critically assessing his or her role in it. For this gaining wider and wider acceptance among professionals.
reason, specialized training of the therapist, which includes first-hand experiences Many theoretical physicists are coming to the conclusion that the mystical
of psychedelic states of consciousness, is an important element in LSD psycho- world-view is perfectly compatible with the philosophical implications of modern
therapy. It is easier for LSD therapists to tolerate, encourage, and appreciate science, particularly relativity theory and quantum physics.! It is quite possible, if
certain unusual experiences of a perinatal or transpersonal nature that have thera- the present trend continues, that individuals resisting mysticism will in the near
future be considered evolutionary throwbacks. At present, however, the theory
236 INDICATIONS FOR LSD PSYCHOTHERAPY Depressions, Neuroses and Psychosomatic Symptoms 237

and practice of mainstream psychology and psychiatry is based on the Newtonian their content to consciousness, making it available for introspective analysis and
mechanistic model of the universe and on the Cartesian dichotomy between mind working through.
and matter. Perceptual and cognitive congruence with the Newtonian-Cartesian Despite the fact that LSD psychotherapy can be beneficial over a very
world-view and agreement with the present Occidental value system are used as broad spectrum of emotional and psychosomatic disorders, it should not be con-
important criteria of sanity. This fact cannot be ignored in evaluating the results sidered an easily available psychiatric panacea. It is a highly demanding and
of psychedelic therapy. specialized procedure, and requires a rigorous training of the therapist. The
Because of the above factors, I will present my personal view of the poten- course of LSD treatment is not always equally smooth and safe, nor is its outcome
tial of LSD psychotherapy, rather than a balanced synopsis of the clinical liter- always predictable and successful. There are certain patients who require a large
ature on the subject. Although I will occasionally refer to the work of others, the number of LSD sessions, and for whom the therapeutic progress is slow and pain-
statements in the following sections should be seen in the context of the thera- ful. For reasons that are still insufficiently understood, there appears to be a small
peutic philosophy and practice described in this volume. percentage of severely disturbed individuals who show very limited therapeutic
In general, LSD psychotherapy is indicated in those conditions that have a gain despite large numbers of psychedelic sessions and a great investment of time
psychological rather than organic basis, and are a result of learning in its most and energy. In some others, the process is not limited to the time of the phar-
general sense. That does not necessarily exclude disorders with clear physical macological action of the drug and the intervals between the sessions are difficult
manifestations, as long as psychogenic factors have played an important role in or even potentially dangerous. ‘
their development. This definition of the indications for psychedelic therapy is Clinical conditions in which LSD psychotherapy has been successful fall into
rather loose and leaves much space for individual therapeutic experimentation. four major categories: 1) depressions, neuroses, and psychosomatic symptoms; 2)
Whether a certain disorder is considered psychogenic or somatogenic depends on alcoholism, drug addiction, character disorders, and sexual deviations; 3) border-
the level of development of medical science in general and on the degree of line states and endogenous psychoses; 4) emotional distress and physical pain of
understanding of a specific disease in particular. Since medical opinion concerning the dying, particularly cancer patients.
the nature and genesis of various disorders is seldom unanimous, the diagnosis of a
problem as functional or organic will frequently also reflect the personal AND PSYCHOSOMATIC
DEPRESSIONS, NEUROSES,
philosophy of the clinician.
There are conditions for which the degree of agreement among different re-
SYMPTOMS
searchers will be very high. Psychological factors are clearly of great importance
in the genesis of various psychoneuroses, such as anxiety or conversion hysteria In general, the less serious the clinical problem, the quicker and more dramatic
and obsessive-compulsive neurosis. Similarly, in character disorders, alcoholism, are the results and the safer the treatment procedure. The best candidates for
drug addiction, and various sexual dysfunctions and deviations, the psychogenic LSD psychotherapy seem to be subjects who have a good intellect and adequate
component seems to be unquestionable. Bronchial asthma, peptic ulcers, psoriasis, interpersonal and professional adjustment, but-lack zest for life and a sense of
and ulcerous colitis are traditionally considered to be of psychosomatic origin. The meaning. Although they might appear to be highly successful by the standards of
opinions of clinicians about the ratio of psychogenic and somatogenic factors in the society that surrounds them, they cannot connect emotionally with their
various depressions, borderline psychotic states and so-called endogenous psy- achievements and enjoy tllem. These symptoms would fall into the category of
choses such as schizophrenia and manic-depressive disease, vary considerably. In what Victor Frankl calls noogenic depression. A single high-dose psychedelic ses-
some other conditions only a minority of researchers consider psychological factors sion with LSD is frequently enough to change this situation dramatically. The
to be of any relevance; cancer and collagenous diseases are important illustrations selective accentuation of negative aspects of the world and the basically pessimistic
of these. philosophy of existence associated with this condition can be dissipated within a
Fortunately, the nature of the LSD reaction seems to offer help in those few hours. These previously almost-depressed individuals typically emerge from a
cases where the therapist experiences uncertainty. One or two exploratory psyche- successfully integrated LSD session with elevated mood, joyful appreciation of ex-
delic sessions will usually make it clear for the client and the therapist whether the istence, enhanced self-esteem and self-acceptance, and greater capacity for mean-
disorder has an important psychological component or not. Emotional and physi- ingful human relationships. Their inner life is enriched, they are more open, and
they show an increased appreciation of beauty in nature and art. In addition,
cal symptoms of psychogenic origin tend to be accentuated by the effect of LSD,
and the content of the psychedelic experience will bring relevant insights into the many of them are able to apply various insights from their psychedelic sessions in
a creative way in their professional lives.
psychodynamic, perinatal, and transpersonal roots of the problem. During the in-
itial experiences, the patient also usually gets a clear feeling about the possibility Various forins of depression seem to respond unusually well to LSD psycho-
of influencing the disorder by psychotherapeutic work in the LSD sessions. As I therapy. In general, depression is the most changeable psychiatric syinptom, one
mentioned earlier, one of the most remarkable aspects of the effect of LSD is its which shows great fluctuations even without any specific treatinent. Two dif-
ability to detect dynamic structures with intense emotional charge and bring ferent kinds of changes of depression can occur as a result of psychedelic sessions,
 938 INDICATIONS FOR LSD PSYCHOTHERAPY Depressions, Neuroses and Psychosomatic Symptoms ; 239

and it is important to distinguish between them. A single LSD session, well re- these cases. On occasion, it is possible to use the same approach in cases where the
solved and integrated, can totally dispel clinical depression, occasionally even a traumatization was prolonged and chronic. We should mention in this context a
deep one that has lasted for months. However, that does not mean that the depres- unique LSD program for victims of the Nazi regime conducted by A. Bastians and
sion has been permanently cured and cannot recur; the patient may have a relapse his team at the University of Leiden in Holland. These researchers have reported
as a result of various psychological or physiological factors. success in working through delayed traumatic consequences of incarceration in
This can best be illustrated by the influence of LSD on so-called periodic de- former inmates of a concentration camp (the so-called “concentration camp
pressions. A patient suffering from this disorder has regular attacks of depression syndrome”). (7)
following a rather rigid pattern, in terms of occurrence of symptoms at certain Sexual experiences and behavior can be deeply influenced by the LSD pro-
times of the year and the specific duration of the episodes. A single LSD adminis- cess. The intensity, depth and completeness of the sexual orgasm and the ease with
tration can frequently terminate a deep periodic depression that according to the which it occurs seems to be closely related to the process of letting go of psycho-
usual recurrent pattern would have lasted several more weeks or months. How- logical defenses. Many problems in this area can be traced back to unconscious
ever, this does not necessarily change the general course of the disorder, and the confusion between the pattern of genital orgasim and that of the total physical
next episode of depression might appear on the usual date and last the expected release that characterizes the orgasm of birth. As LSD subjects learn to let go in
period of time. Systematic work in sequential LSD sessions is necessary to change the death-rebirth process, their orgasmic ability increases considerably; this im-
the complex underlying dynamic structure and influence the overall pattern of provenient of sexual experiences can be observed in botli males and females. In
the disease. those individuals who did not have any major psychopathological symptoms prior
Most neurotic disorders tend to respond well to LSD psychotherapy; how- to the LSD session, the same effect can usually be observed after one or several
ever, even with the powerful catalyzing effect of the drug one should not expect high-dose psychedelic experiences. Sexual neuroses, such as frigidity, vaginal
therapeutic magic and overnight cures. Various psychoneuroses require long-term spasms (vaginism), genital pain during intercourse, impotence and premature
psychedelic sessions. In general, most authors seem to agree that the prognosis is ejaculation frequently respond well to LSD psychotherapy; however, effective
best in those cases where anxiety and depression are important components. treatment of these disorders usually requires serial administrations of the drug and
Psychiatric patients who suffer from free-floating anxiety or anxiety neuroses, as experiential confrontation of the roots of these disorders on the perinatal level.
well as those whose anxiety is bound in the forin of various phobias, respond well A wide variety of psychogenic physical probleins have in the past been
to psychedelic treatment. Conversion hysteria usually presents greater difficulties, favorably influenced by LSD psychotherapy; this applies equally to organ-
but LSD therapy is frequently successful with this disorder. As in conventional neurotic manifestations, symptoms that have the dynamic structure of hysterical
psychoanalysis, anxiety and conversion hysteria might present special problems in or pregenital conversions, and psychosomatic diseases. Painful conditions of
terms of transference and countertransference. Monosymptomatic neuroses are not various kinds, such as ordinary or migraine headaches, severe menstrual cramps,
necessarily easier to treat than those that have rich, ramified, and complicated gastric or intestinal spasms, pains in the neck muscles or in the lumbar area, and
clinical pictures. Frequently, a single torpid syinptom condenses problems from even arthritic pains without a detectable organic basis can be traced back to their
many different areas and levels in the patient, and a great number of LSD sessions origins and worked through in the course of LSD therapy. Neurotic disorders of
might be necessary to resolve this. various organs, such as cardiac dysfunction, gastric distress, breathing difficulties,
Although success in treating obsessive-compulsive neurotics has occasionally excessive sweating, muscular tremors, constipation or diarrhea, and menstrual ir-
been reported,’ in my experience they seem to have the dimmest prognosis of all regularities often disappear in the course of LSD treatment. Far-reaching im-
the patient categories. Less debilitating obsessive-conipulsive states have been suc- provements of myopia, which occurred as an unexpected side-effect during LSD
cessfully influenced by long-term systematic LSD therapy, but severe cases of this psychotherapy with two neurotic patients in Prague, suggest that in some cases of
category belonged to our most painful failures. Usually much higher dosages have this disorder there is a substantial component of psychogenic muscular tension that
to be used to overcome the excessive resistances of these patients and a large can be resolved by psychedelic treatment. Pregenital conversions, such as
number of sessions is necessary for any therapeutic progress. However, it is con- psychogenic asthma, various muscular tics, and stammering are usually relatively
ceivable that these therapeutic failures reflect our limited understanding and in- resistant to LSD therapy, which may be related to an underlying obsessive-
adequate technique, rather than an intrinsic aspect of this emotional disorder. The compulsive personality structure. However, the situation is far from hopeless, and
fact that the psychological resistances of these patients are intimately linked to the patients with these disorders have on occasion been successfully treated with serial
problem of control of the anal sphincter might be one of the important variables. LSD sessions. An especially interesting indication for LSD psychotherapy seems to
Traumatic emotional neuroses resulting from singular major traumas, such be psoriasis; dramatic improvements even in severe cases have been independently
as war situations, natural catastrophes, or mass accidents, have in the past been reported by several therapeutic teams. Clearing of various skin disorders, par-
the best indications for drug-assisted abreactive therapy. (narcoanalysis) or hyp- ticularly various eczemas, are rather common observations in psychedelic treat-
notic interventions (hypnoanalysis). LSD can be used with great success for these ment.
disorders because of its unique properties as an abreactive agent. A single high- In some patients, LSD psychotherapy can lead to dramatic improvement of
dose LSD session can frequently alleviate or remove very debilitating symptoms in certain recalcitrant physical problems that are traditionally considered organic in
 _ Alcoholism, Drug Addiction, Character Disorders and Sexual Deviations 24]
240 INDICATIONS FOR LSD PSYCHOTHERAPY

origin; certain chronic infections such as cystitis, bronchitis, and sinusitis are it. An interesting and unexpected research finding was the dramatic improvement
examples of this. A possible therapeutic mechanism is suggested by the fact that in some patients in the control group who received only 50 micrograms of LSD on
such physical changes immediately follow the resolution and integration of a a double-bind basis, as compared to 450 micrograms for the experimental group.
psychological gestalt in which the corresponding area is meaningfully involved. In our original thinking the dosage of 50 micrograms was considered to be an ac-
The experience of Tanya described in a later section can be mentioned here as an tive placebo, the therapeutic effect of which should be negligible. In reality,
a
illustration of this. (p. 288) This suggests that the infectious agent is just one ele- several patients in the low-dose group had quite significant experiences, while
few of the individuals in the high-dose category had uneventful psychedeli c ses-
ment in the development aud perpetuation of the condition, and possibly even a
secondary one. A much more important factor seems to be decreased vitality of sions. The interested reader will find a more detailed description of this study in a
the organ or tissue, which accounts for the ineffective defense against the bacterial paper by the Spring Grove team entitled The Experimental Use of Psychedelic
invasion. It is not difficult to see how psychological factors could play an impor- (LSD) Psychotherapy. (77)
tant role in this situation. One of the possible mechanisms could be, for example, The above results of the Spring Grove team are in sharp contrast with the
psychogenic constriction of the afferent vessels resulting in limited blood supply to outcome of an extensive controlled study conducted by Ludwig, Levine and Stark
and reduced immunobiological resources in the afflicted area. It is interesting that (59) at the Mendola State Hospital in Madison, Wisconsin. The authors randomly
during the session immediately preceding the clinical improvement of a physical assigned the 176 alcoholic patients who had volunteered for this project to one of
problem of this kind, LSD subjects usually report that a block has been removed the following four groups: 1. “psychedelic therapy” with LSD, 2. hypnodelic
and free flow of blood and energy established in the afflicted area. This is typ- treatment with LSD, 3. administration of LSD alone, and 4. no specific therapy
ically associated with an invigorating feeling of pleasant warmth, and tingling at all (milieu therapy). In addition, half of each group was offered Antabuse
sensations. medication after the completion of the experiment. The results of this study were
devastatingly negative; the authors did not find significant differences between
any of the groups, and the overall remission rate was extremely low. After six
ALCOHOLISM, DRUG ADDICTION, CHARACTER months between 70 and 80 percent of the patients in all the categories were drink-
DISORDERS, AND SEXUAL DEVIATIONS ing, and after a year this number ranged between 80 and 90 percent. Even the in-
troduction of Antabuse did not make any difference in this context.
Many of the emotional and psychosomatic disorders described above are, by and This study met the formal criteria of contemporary medical research so well
large, within the range of indications for traditional analytically oriented psycho- that it received the Hoffheimer Award from the American Psychiatric Association.
therapy. The use of LSD as an adjunct in these cases will intensify, deepen, and For this reason the negative results of this project deserve special attention; they
accelerate the therapeutic process. However, LSD psychotherapy ean be success- can be used to demonstrate some of the basic principles emphasized in this book.
fully applied in some diagnostic categories which are outside the realm of the In the following text I will refer to an incisive critique that Charles Savage pre-
traditional indications for dynamic psychotherapy. Many clinical studies of sented in March 1971 at a staff-meeting of the Maryland Psychiatric Research
psychedelic therapy lave reported dramatic results in chronic alcoholics. Unfor- Center, of which he was Associate Director. He pointed out that very serious defi-
tunately, in a great majority of them the evaluation was bascd on clinical impres- ciencies could be detected in this study, which on the surface appeared to be
sions. Like most results reported in psychoanalytic literature, these are open to methodologically sound and meticulously designed. In the past, substantial claims
questioning and criticism from the point of view of rigorous research for fast and dramatic therapeutic success in alcoholism have only been made for
methodology. the psychedelic model; no LSD therapist has ever indicated that one psycholytic
In a large, controlled study conducted by our team at the Maryland Psychi- session with LSD can have a profound effect on alcoholic patients. Ludwig and
atric Research Center, 135 hospitalized alcoholics were randomly assigned to his associates were familiar with the essential characteristics of psychedelic
either high-dose (450 micrograms) or low-dose (50 micrograms) LSD treatment. therapy, as evident from the accurate definition given in their book. However, in
After six months, an independent evaluation team rated fifty-three percent of the the actual study they rejected the psychedelic model, while pretending to test it,
high-dose group as “essentially rehabilitated,” as compared to thirty-three percent and neglected many of the elements that psychedelic therapists consider man-
of the low-dose group. In statistical terms this difference had only five chances out datory for therapeutic success. The therapists engaged in this project were thirteen
of one hundred of being coincidental. Differences between high- and low-dose residents and state hospital psychiatrists who were not committed to the work and
groups were no longer as great after eighteen months, with 54 percent of the high- performed it as a peripheral activity. None of them had personally explored the
dose patients considered greatly improved versus 47 percent of the low-dose psychedelic or hypnotic state; they were not experienced in either LSD therapy or
patients. hypnotherapy and had only a superficial “crash-course” in both. The preparation
The overall results of this study were quite impressive, considering that the for the LSD session was limited to one two-hour session, half of whic was spent
patients were volunteers selected from the population of the Alcoholic Rehabilita- on measurements of suggestibility. The ex-post justification that the authors gave
tion Unit of a state mental hospital, and that most of them had only one high-dose for this drastic condensation of the preparatory work was that none of the patients
LSD session and several hours of drug-free psychotherapy preceding and following became psychotic. This fact might be used as an illustration of the safety of LSD,
 242 INDICATIONS FOR LSD PSYCHOTHERAPY Alcoholism, Drug Addiction, Character Disorders and Sexual Deviations 943

but certainly does not prove that the procedure was adequate for therapeutic pur- sions, in these two categories quite striking improvements may frequently be ob-
poses. Although the dosages they used were in the lower range of those used in served after a single LSD experience. It was mentioned earlier that this might be
psychedelic therapy, (3 micrograms per kg.) the approach was essentially psycho- related to the ease with which many alcoholics and drug addicts achieve tran-
lytic. There was continuous verbal exchange, which is known to increase the pa- scendental states of mind. In the Spring Grove program, the number of sessions
tient’s resistance and interferes with deep regression. The therapists attended the per patient was limited by the research design. All heroin addicts and most
patients for only three hours of the session and left them alone for the remaining alcoholics received only one LSD session; sonie alcoholic patients had two or,
hours of the drug action. The mystical experiences that are considered of utmost quite exceptionally, three sessions. There is good reason to believe that much
importance in the psychedelic inodel were reported by only 8.4 percent of the pa- better clinical results could have becn achieved if the research design had been less
tients, as compared to the 78 percent of the Spring Grove study. Charles Savage rigid. In a more open-ended situation in Prague, where it was possible to ad-
concluded that the project reflected a strong bias in the authors. At a time when minister serial LSD sessions without any limitations, we observed in several in-
LSD was popular, Levine and Ludwig (58) had reported positive results using the stances not only lasting abstinence but deep positive restructuring of the alcoholic’s
hypnodelic technique with addicts, a group generally much more difficult to treat or addict’s personality.
than alcoholics. When LSD fell out of favor and the positive results became Another category of difficult patients with poor prognosis that can occasion-
politically unwise, they obtained negative results. Unconsciously or consciously ally be reached by LSD-assisted psychotherapy should be inentioned in this con-
they built into their study a number of antitherapeutic elements that guaranteed a text. There are indications that certain individuals with asocial, antisocial, and
therapeutic failure. The use of inexperienced and unmotivated therapists, defec- criminal tendencies can benefit from LSD treatment. Several aspects of the
tive preparation, antimystical orientation, violation of the basic rules of psychedelic process seem to make it possible to achieve positive results with these
psychedelic therapy, and a critical lack of human support and care can be men- subjects. The most serious obstacle to effective psychotherapy of sociopathic
tioned here as important elements. LSD can best be described as a facilitator, and individuals under normal circumstances is their inability to form, develop and
in the above study it seems to have facilitated mediocrity, however brilliantly maintain relationships. This interferes significantly with the treatment process,
reported and adumbrated with elegant statistical techniques. since a strong emotional connection with the therapist is considered an important
On the basis of encouraging results with alcoholics, the team at the Mary- element of therapeutic change. It is well-known that during psychoanalysis just

—
land Psychiatric Research Center carried out a study of LSD psychotherapy with the sharing of intimate personal material tends to result in development of a trans-
heroin addicts. All volunteers for this program were male addicts serving a sen- ference relationship in most subjects. This factor is much more powerful in

Las
tence in Maryland correctional institutions, mostly for theft, robbery, and in- psychedelic therapy; merely sitting in an understanding and supportive way in a
volvement in illegal drug traffic. Those who were interested in participating in the person’s LSD sessions will automatically result in formation of a strong emotional
study were recommended by the research staff for an early parole hearing by the tie. This bond can be positive, negative, or distinctly ambivalent, but the patient
Board of Parole and Probation. Only individuals who had been granted parole cannot easily avoid some sort of response. Although this is just a prerequisite for
were accepted into the research program. One half of the volunteers had one high- effective therapy and not necessarily a therapeutic element per se, it is an essential
dose psychedelic session after an average of twenty-three hours of intensive condition for the successful treatment of individuals with sociopathic traits. In
psychological preparation, while the other half participated in a regular program addition, the LSD experience provides effective channels for the discharge and
of non-drug therapy at the out-patient clinic, which lasted a comparable amount integration of enormous amounts of aggression and destructive feelings underlying
of time. The assignment of patients to the experimental and control group was antisocial activities. Experiential access to the areas of transcendental feelings and
done on a random basis. Both groups were required to remain in regular contact connection with the system of metavalues seems to be even more important in this
with the outpatient clinic after treatment and give samples of urine for chemical context. As a result, criminal behavior is often taken out of the narrow context of a
!
analysis. The results of this experimental treatment program were reported by two revolt against human society and can suddenly be seen as violation of the cosmic
members of the Spring Grove team, Charles Savage and Lee McCabe (93). Eleven order.
of the thirty-four patients in the LSD group did not return to narcotics during the Several LSD therapists occasionally described good results in individual pa-
six-month follow-up period, while only one control subject showed a comparable tients with antisocial tendencies in the context of larger clinical studies involving a
improvement. At the one-year follow-up, eight LSD patients were still abstaining broad range of diagnostic categories. In several instances, researchers conducted
as compared to none in the control group. Although not dramatic in absolute special studies focusing on antisocial and criminal populations. Arendsen-Hein (4)
terms, this has to be considered a very promising result for this extremely difficult treated twenty-one severely-critninal psychopaths with regular LSD sessions using
category of patients. Short-term follow-up studies of narcotic addicts indicated dosages of 50-450 micrograms. After a period of ten to twenty weeks of therapy,
that typically 94-97 percent of the patients return to drug use within a few weeks twelve were clinically improved and two greatly improved.
following conventional treatments. In the early sixties, a team of Harvard psychologists leaded by Timothy
One aspect of psychedelic therapy with alcoholics and heroin addicts Leary initiated a research program of psychedelic therapy with recidivists at the
deserves special notice. While successful treatment of psychoneuroses and psycho- Concord State Prison in Massachusetts. (55) The drug used in this project was not
somatic disorders usually requires a whole series of therapeutic psychedelic ses- LSD, but the closely related psilocybin, the active psychedelic principle from the
 244 INDICATIONS FOR LSD PSYCHOTHERAPY Borderline Psychotic States and Endogenous Psychoses 245

Mexican sacred mushrooms Psilocybe mexicana. The unique aspect of this neurotics, particularly obsessive-compulsive patients. However, this statement is
research was that the psychologists ingested the drug along with the convicts, al- conditional and needs clarification and specification. LSD work with severely dis-
though a non-drugged “ground control” and supervising psychiatrist were always turbed individuals is a very demanding and intense process which requires special
present. The result of this study, in which over two hundred psychedelic sessions preparation and training. It should not be attempted by anyone who has not had
were run with men incarcerated for their antisocial behavior, was a statistically sufficient experience of LSD sessions with “normal” and neurotic individuals. The
significant reduction in new erimes committed by the group that had had psilo- intervals between the sessions may be characterized by dramatic cxteriorization or
cybin experiences. Several years ago, Walter Huston Clark carried out an in- intensification of various psychotic symptoms. In certain critical stages of the psy-
formal follow-up study, with quite iipressive results. At least one interesting chedelic process the inner experiences and behavior of the client can be almost
attempt has been made to integrate LSD therapy into a complex therapeutic entirely focused on the therapist, in the sense of a “transference psychosis.” A
regime under the conditions of maximum security. The results of this experiment special treatment unit with trained personnel and 24-hour-a-day supervision is an
conducted at the Maximum Security Division of the Mental Health Center at absolute necessity for this undertaking.
Penetanguishene, Ontario, have been reported by G.J. Maier, D.L. Tate, and The deepest roots of schizophrenic symptomatology can always be found in
B.D. Paris. (61) the various perinatal matrices and in negative transpersonal experiences. A
Favorable clinical results have occasionally been described in patients with therapist sharing the complicated journey triggered in the psychotic patient by
various sexual abnormalities that are usually very unresponsive to conventional LSD has to remain grounded and centered during the entire process, which might
psychotherapy or therapy in general. Among them, individuals showing sadistic turn out to be a wild emotional and conceptual roller-coaster. Because of its im-
and masochistic tendencies seem to have the most favorable prognosis. Once the portance, not only to the LSD therapy for schizophrenia but also for the basic
psychedelic process reaches the perinatal level, powerful channels become avail- understanding of the dynamics of psychosis, 1 will illustrate this process with the
able for discharge and integration of enormous amounts of aggressive and self- story of Milada.
destructive impulses. Experiences of the death-rebirth sequences offer unique op-
portunities for the resolution of the intimate perinatal link between sexuality and Milada was a 38-year-old psychologist who for many years before start-
aggression which underlies sadomasochism. Some other sexual deviations that can ing LSD treatment had suffered from a complicated neurotic disorder in-
respond to psychedelic therapy include fetishism, exhibitionism, and coprophilia. volving a variety of obsessive-compulsive, organ-neurotic, and hysterical
Although favorable results have occasionally been reported for male and female conversion symptoms. She started systematic psychoanalytic treatment, but
homosexuality, it is difficult to make any generalized statements in this area four months later had to be hospitalized because she developed acute
because of the heterogeneity and complexity of the problems involved. The prog- psychotic symptoms. An important part of her clinical symptomatology was
nosis of patients in this category is critically dependent on the nature of their prob- an erotomanic delusional system. Milada was convinced that her employer
lem, their own attitude toward their sexual behavior, and the motivation for was deeply in love with her and she herself felt irresistible affection and sex-
therapy. A positive outcome can be expected only when the individual considers ual attraction toward lim. She sensed a strange erotic and spiritual com-
the deviation to be a problem, has a strong intrapsychic conflict about it, and munion existing between them which they shared intrapsychically, beyond
shows an active interest in treatment. the facade of their rather formal social interaction. Several weeks later she
Character disorders of various kinds, sometimes even severe and compli- started hallucinating the voice of her imaginary lover. In these hallucina-
cated cases, can be considered for LSD therapy if a well-equipped facility with tions, she heard him describe in detail his passionate feelings for her, pro-
trained personnel is available. Usually, a few exploratory sessions will give the mise a beautiful shared life in the future, and give her advice or specific sug-
therapist a sufficient indication of the prognosis for a particular individual. In the gestions. During the evening and night hours Milada experienced powerful
course of the LSD therapy of character disorders that were originally symptom- sexual sensations which she interpreted as intercourse at a distance, magical-
free, one can frequently observe temporary manifestations of various neurotic and ly performed by her “lover.” Although in actual sexual situations she had
psychosomatic symptoms in the free intervals between the sessions. always been frigid, during these episodes she experienced orgastic feelings of
cosmic proportions.
Milada’s hospitalization became unavoidable when she started acting
BORDERLINE PSYCHOTIC STATES AND under the influence of her delusions and hallucinations. One day in the
ENDOGENOUS PSYCHOSES morning she left her husband, made an attempt to move into her employer's
apartment with her children, and got into a physical fight with his wife.
Psychiatric patients with borderline and manifest psychotic conditions need not She referred to his “voice,” which allegedly had told her that divorces had
necessarily be excluded from psychedelic therapy. Although clinical experiences of been arranged for both of them and that they could now live together. After
the treatment of schizophrenic and other psychotic states with LSD are rather lim- many months of unsuccessful tregtment with a variety of tranquilizers and
ited, it is possible to make certain general conclusions. By and large, the prognosis antidepressants, as well as individual and group psychotherapy, she was
in psychotic individuals seems to be much better than in certain severely defended selected for psycholytic therapy with LSD.
246 INDICATIONS FOR LSD PSYCHOTHERAPY

After twelve LSD sessions, the psychotic symptoms completely disap-

peared and Milada developed full insight in regard to her irrational behav-
ior in the past. In more than thirty subsequent sessions she worked on a
variety of complicated neurotic and psychosomatic problems, reliving
traumatic memories from different periods of her life and tracing her pre-
sent problems to their emotional sources in her unhappy childhood. Mach
time was spent on her complicated marital situation.. Her husband was
cruel, insensitive and physically abusive; he was emotionally immersed in
the pursuit of a political career and provided no eniotional support for her.
Both of their children were showing signs of serious emotional disturbances
that required professional assistance.
Then the LSD sessions moved into the perinatal realin and Milada ex-
perienced the entire spectrum of experiences characteristic of the death-
rebirth process. The emotions and physical sensations associated with the
reliving of her difficult birth, during which her twin brother had died, were
so abysmal that she referred to these sessions as a “psychological
Hiroshima.” When she finally completed the birth process and experienced
the final ego death, 1 expected a marked improvement, as was the case in
most neurotic patients. However, to my great surprise I witnessed a sudden
and complete reappearance of the original psychotic symptomatology,
which Milada had not shown for many months. The only difference was
that this time | became the main target of all the psychotic phenomena; in
the process of LSD psychotherapy she had developed a_ transference
psychosis.
At this point Milada believed herself to be under my hypnotic influence
and felt in constant rapport with me, in the LSD sessions as well as during The experience, during a trans-
personal session, of elements of
the free intervals. She experienced a mutual exchange of thoughts and even
the collective unconscious. The
verbal communication. It was interesting that in some of these hallucinated patient became a member of an
interviews we “continued psychotherapy.” Milada “discussed” various ancient culture that she could
aspects of her life with me and carried out activities suggested by my not identify by name, historical
illusory voice, such as several hours of bathing and physical training every period or geographical location.
day and exercises iu feminine housework. In these hallucinated conversa- However, she was able to draw
tions 1 told her that I had decided to drop the therapeutic game and become and paint in its artistic style.
her lover and husband; | also allowed her to use my last name instead of her
husband's name. She was repeatedly assured of iny love, was told that her
divorce was already arranged, and asked to move with her children into my
apartment. It was clear from the context of her LSD sessions that this
wishful magical thinking was a transference phenomenon reflecting her
early symbiotic relationship with her mother. Among other things Milada
talked about the “hypnogamic sessions” she was getting from me in the
evening and night hours. Sexual sensations and hallucinations of intercourse
were interpreted by her as deliberate lessons in experiencing sex that I had
decided to give her in order to accelerate therapy.
At one point, Milada spent many hours a day in bizarre postures that
resembled catatonia; however, it was always possible to bring her out of
them by talking to her. She would then resume a normal posture, answer
questions, and logically explain her behavior. Her emotional and psycho-
somatic condition at this time was dependent on the position of her body. In
some postures she experienced ecstatic bliss, oceanic feelings and a sense of
247
 Borderline Psychotic States and Endogenous Psychoses 951

cosmic unity; in others, deep depression, nausea, and metaphysical anxiety.

She herself related this phenomenon to the situation during her intrauterine
existence where she had to compete physiologically and mechanically with
her twin brother.
On the basis of previous experiences with other patients, I continued
with regular weckly administrations of LSD despite her persisting psy-
chotic symptoms. These sessions consisted almost entirely of negative ex-
periences of a transpersonal nature. There was an important emphasis on
reliving unpleasant intrauterine memories, which she related to the emo-
tional stresses and illnesses of her mother during pregnancy, various em-
bryonal crises, and the mechanical discomfort of being twins in a uterus.
She also had some negative karmic sequences and archetypal experiences of
a demonic nature.
In the final phase of treatment a most unusual phenomenon occurred:
suddenly the LSD had a distinctly paradoxical effect. Under the influence of
LSD Milada appeared normal and regained insight and critical judgment;
when the effect of the drug was wearing off, the symptoms of transference
psychosis recurred. Finally, in her ninetieth session she experienced for
several hours profond ecstatic feelings, with cosmic unity as the prevailing
pattern. To my surprise, she emerged from this session without the previous
psychotic and neurotic symptoms and with a completely restructured
personality.
According to her own description, she was now able to experience her-
. self and the world in a way completely different than ever before. She had
zest for life, a new appreciation of nature and art, a totally transformed at-
Archetvpal demonic entities en-
titude toward her children, and the ability to give up her previous unrealis-
visioned during transpersonal ses-
sions.
tic ambitions and fantasies. She was able to resume her job and perform it
Above. A stylized dragon of cos- adequately, obtain a divorcee from her busband, and live independently
mice proportions representing the while taking care of her two children. To my knowledge, she has not needed
principle of metaphysical evil. any in- or out-patient psychiatric care during the more than twelve years
Right. An image of a winged since the termination of her LSD treatment.
demonic creature that sereens the
source of divine light and prevents In several other schizophrenic patients whom I treated with LSD therapy,
the subject from reaching and the process was similar but less involved and dramatie than the one described
uniting with it.
above.? Kenneth Godfrey, an American psychiatrist also attempted this difficult
task and reported successful treatment of psychotic patients with serial LSD
sessions. (31)
Even under the best circumstances, patients with marked paranoid ten-
| dencies should not be treated by LSD psychotherapy as long as they include the
| therapist into the paranoid system and see him or her as one of the persecutors. A
‘, good therapeutic relationship with a foundation of basic trust seems to be the
single most important element for successful psychedelic treatment. Informed con-
sent, active interest, and good cooperation are necessary conditions for a smooth
course of therapy. This is very difficult to achieve with paranoid patients: even in
milder cases, it requires long and intense drug-free work. If LSD is administered
1 to a paranoid patient, he or she tends to experience the session in total
1 psychological isolation and blame all the emotional and psychosomatic distress on
ov
the therapist. The extraordinary nature and scope of the psychedelic experiences

250
 259“a INDICATIONS FOR LSD PSYCHOTHERAPY Emotional Distress and Physical Pain of Dying Individuals 253

can, under these circumstances, not only powerfully reinforce and justify the con- complex study of the effects of psychedelic therapy on cancer patients in relation
viction of the therapist’s evil intentions, but magnify his or her image in the pa- to their emotional condition, physical pain, concept of death, and attitude toward
tient’s eyes into a malefic figure of cosmic proportions. dying was carried out by the team of the Maryland Psychiatric Research Center.
Psychotic conditions of the manic-depressive type can also be treated by The initiator and original head of this research project was Walter Pahnke; after
LSD psychotherapy, although special problems might be encountered in this cate- his death 1 assumed medical responsibility and completed it in cooperation with
gory of paticnt. A single LSD session can frequently cause a complete remission of William Richards. In this program, over one hundred cancer patients were
the depressive or manic episode. In a similar way, a single administration of the treated over the years with psychedelic therapy using LSD and a similar short-
drug can change the phase of the disease, turning depression into mania or vice acting substance, DPT (dipropyltryptamine). Positive changes were observed
versa. In this sense, the effect of LSD is comparable to that of electroshock quite consistently in several different areas. Many patients showed a definite
therapy. Within the conceptual framework presented in this book such changes alleviation of various emotional symptoms, such as depression, general tension,
can be understood as COEX or BPM transmodulations—chemically triggered sleep disturbances, and psychological withdrawal. LSD therapy also had a strik-
shifts in the dynamic governing systems influencing the patient's ego. It seems that ing, although not predictable, effect on severe physical pain. In some patients who
in manic-depressive disorders LSD can precipitate such changes much more easily had not responded to analgesics or narcotics, pain was alleviated or even com-
and more frequently than in other diagnostic categories. This may be because pletely eliminated for periods of weeks or months after a single LSD session. The
lability and periodicity are typical and intrinsic characteristics of this disease. most remarkable changes were observed in the patients’ concepts of death and
The COEX or BPM transmodulations should not be mistaken for a cure of attitudes toward dying. Those patients who had perinatal or transpersonal expe-
the disease. There is always a possibility that another depressive or manic phase riences tended to show a marked decrease in fear of death. Their understanding of
will recur in the future when the dormant negative systems become activated by the process of dying tended to shift in the direction of ancient or non-Western
various physical triggers, specific psychological stresses, or physiological changes belief systems according to which consciousness or some form of existence con-
within the organism. However, in some cases it seems possible to influence the tinues beyond the time of biological annihilation.
psychological roots and basic underlying mechanisms of this disorder by syste- I mentioned earlier that the psychedelic transformation observed after LSD
matic intrapsychic work in serial LSD sessions. This procedure has its special risks, sessions with a transcendental emphasis involves drastic changes in the hierarchy
the main one being the possibility of triggering deep depressions with suicidal ten- of values. Having experienced death and rebirth and/or feelings of cosmic unity,
dencies after some of the sessions. As with borderline psychotic conditions and LSD subjects tend to put less emotional emphasis on the past and future and show
schizophrenic psychoses, LSD psychotherapy of manic-depressive disorders should an increased appreciation of the present. Preoccupation with the dismal prospects
be carried out on an in-patient basis, or a suitable facility should at least be for the future is replaced by concern about the best possible utilization of each
available at all times for temporary hospitalization if the condition of the client re- day. The ability to draw satisfaction from simple and ordinary things in life is ac-
quires it. companied by acute awareness of the ultimate futility of anxious pursuit of status,
power and possessions. It is not difficult to understand that the above changes in
values and life strategy can make the situation of the terminally ill more tolerable.
EMOTIONAL DISTRESS AND PHYSICAL PAIN Psychological work with the patients and their families also seemed to have a
OF DYING INDIVIDUALS positive influence on the survivors. It not only eased their reaction to dying and to
the death of their relative, but helped them to cope with their grief and integrate
Probably the most interesting and promising indication for LSD psychotherapy is the loss in a constructive way.
its use in seriously ill people who are facing death. Although this approach has According to the clinical ratings, approximately thirty percent of the cancer
been most systematically explored in cancer patients, it is applicable to persons patients showed dramatic improvement in the above areas after a single LSD
with other life-threatening diseases. The use of psychedelic therapy in this session and an additional forty percent showed a moderate degree of positive
indication has been discussed in detail in a previous volume‘ and will only be change. In the remaining thirty percent there were no manifest differences, posi-
briefly described here. tive or negative, from pre- to post-session measurements. The results of DPT-
The original suggestion that psychedelic therapy could be useful for persons psychotherapy were similar, although less striking and consistent.
with terminal diseases came independently from the American pediatrician of Of all the indications for LSD psychotherapy, its use for work with the
Russian origin, Valentina Pavlovna Wasson, and the writer and philosopher dying seems to be the most interesting and least controversial or problematic. The
Aldous Huxley. Wasson came to this conclusion on the basis of her experience with possibility of alleviating in a relatively short time the emotional and physical
the Mexican sacred mushrooms, and Huxley as a result of his psychedelic sessions distress of persons facing the ultimate crisis of human life should be of great in-
with mescaline and LSD. The pioneering clinical work with cancer patients was terest to all of us. Most of the objections raised against the use of LSD are of little
conducted in the early sixties at the Chicago Medical School by Eric Kast who was relevance here, certainly those concerning heredity and chromosomes. In addi-
primarily interested in the possibility of using LSD as an analgesic. A systematic tion, recent research showing the possible role played by psychological factors in
 254 INDICATIONS FOR LSD PSYCHOTHERAPY

cancer, as well as some of our own observations on the subject, seem to suggest
that at least for some cancer patients, LSD psychotherapy could become a factor
contributing to healing, and not only a preparation for death.

NOTES

1. The interested reader will find detailed information about the recent
convergence of quantum-relativistic physics, mysticism, and modern
consciousness-research in books by Itzak Bentov (11), Fritjof Capra (18), Nick
Herbert (37), Larry Le Shan (56), Kenneth Pelletier (78), Bob Toben (101),
and Arthur Young (105).
2. An example of dramatic and lasting success in a severe case of compulsive
neurosis was published in Scandinavia by E. Brandrup and T. Vangaard (16).
On page 185 I described striking improvements in a patient with an obsessive-
compulsive neurosis that had resisted Freudian psychoanalysis for eighteen
years. Unfortunately, our research design did not allow for more than three
sessions and the therapy could not be completed.
3. The condensed story of another of these patients, Michael, is presented in
my first book, Realms of the Human Unconscious (32), pp. 66 and 235.
4. Stanislav Grof and Joan Halifax: The Human Encounter With Death (34).
The bibliography of this book gives all the specific references to original papers
in this area.
NON-THERAPEUTIC
USES OF LSD

Administration of LSD to Creative Individuals

Drug-Induced Religious and Mystical
. Experiences
Role of LSD in Personal Growth and
Self-Actualization
Use of LSD in the Development of Paranormal
Abilities

TRAINING SESSIONS OF MENTAL HEALTH

PROFESSIONALS
The extraordinary value of LSD for the education of psychiatrists and psychol-
ogists became evident at a very early stage of its research. In his pioneering paper,
published in 1947, Stoll emphasized that an auto-experiment with this drug gives
professionals a unique opportunity to experience first-hand the alien worlds which
they encounter in their everyday work with psychiatric patients. During the
“model psychosis” phase of LSD research, when the psychedelic state was consid-
ered a chemically-induced schizophrenia, LSD sessions were recommended as
reversible journeys into the experiential world of psychotics which had a unique
didactic significance. The experience was recommended’ for psychiatrists, psychol-
ogists, nurses, social workers, and medical students as a means of acquiring insights
into the nature of mental illness. Rinkel (85), Roubiéek (90) and other researchers
who conducted didactic experiments of this kind reported that a single LSD ses-
sion can dramatically change the understanding that mental health professionals
have of psychotic patients, and result in a more humane attitude toward them.
The fact that the “model psychosis” concept of the LSD state was eventually
rejected by most researchers did not diminish the educational value of the psy-
chedelic experience. Although mental changes induced by LSD are obviously not
identical with schizophrenia, the ingestion of the drug still represents a very

257
 258 NON-THERAPEUTIC
Administration of LSD to Creative Individuals 259
USES OF LSD

special opportunity for professionals and students to experience many states of LSD session in their professional work, life philosophy, religious feelings, their
mind that occur naturally in the context of various mental disorders. These emotional and physical condition, and interpersonal adjustment. Although we
involve perceptual distortions in the optical, acoustic, tactile, olfactory, and have much anecdotal evidence of the value of this training program, the data
gustatory areas; quantitative and qualitative disturbances of the thought-pro- from the pre- and post-session psychological testing and from the follow-up ques-
cesses; and abnormal emotional qualities of extraordinary intensity. Under the in- tionnaires has not yet been systematically processed and evaluated.
fluence of LSD it is possible to experience sensory illusions and pseudohiallucina- As I have emphasized earlier, LSD training sessions are an essential
tions, retardation or acceleration of thinking, delusional interpretation of the qualification for every LSD therapist. Because of the unique nature of the
world, and an entire gamut of intense pathological emotions such as depression, psychedelic state it is impossible to reach a real understanding of its quality and
manic mood, aggression, self-destructive craving, and agonizing feelings of inferi- dimensions unless one directly experiences it. In addition, the experience of con-
ority and guilt, or conversely, ecstatic rapture, transcendental peace and serenity, fronting the various areas in one’s own unconscious is absolutely necessary for
and a sense of cosmic unity. The psychedelic experience can also become a source developing the ability to assist other people with competence and equanimity in
of revelatory aesthetic, scientific, philosophical, or spiritual insight. their process of deep self-exploration. LSD training sessions are also highly recom-
Autoexperimentation with LSD does not exhaust its didactic potential. mended for nurses and all other members of the staff in psychedelic treatment
Another learning experience of great value is participation in the sessions of other units who come in close contact with clients in unusual states of consciousness.
subjects. This offers an opportunity for young professionals to observe an entire
range of abnormal phenomena and be exposed to and become familiar with ex-
treme emotional states and unusual behavior patterns. This occurs under specially ADMINISTRATION OF LSD TO CREATIVE
structured circumstances, at a convenient time, and in the context of an existing INDIVIDUALS
relationship with the experient. All these factors make this a situation better suited
for learning than the admission ward or emergency unit of a psychiatric hos- One of the most interesting aspects of LSD research is the relationship between the
pital. In a more specific way, sitting in LSD sessions has been recommended as psychedelic state and the creative process. Professional literature on the subject
an unequaled training for future psychotherapists. The intensification of the reflects considerable controversy. Robert Mogar (71), who reviewed the existing
relationship with the sitters that is characteristic of LSD sessions presents a rare experimental data on the performance of various functions related to creative.
opportunity for a novice professional to observe transference phenomena and work, found the results inconclusive and contradictory. Thus soine studies focus-
learn to cope with them. The use of LSD in the context of a training program for ing on instrumental learning demonstrated impairment during the drug experi-
future psychotherapists has been discussed in a special paper by Feld, Goodman, ence, while others indicated a definite enhancement of the learning capacity.
and Guido. (26) Conflicting results have also been reported for color perception, recall and recog-
An extensive and systematic study of the didactic potential of LSD sessions nition, discrimination learning, concentration, symbolic thinking, and perceptual
was conducted at the Maryland Psychiatric Research Center. In this program, up accuracy. Studies using various psychological tests specifically designed to measure
to three high-dose LSD sessions were offered to mental health professionals for creativity usually fail to demonstrate significant improvement as a result of LSD
training purposes. Over one hundred persons participated in this program be- administration. However, how relevant these tests are in relation to the creative
tween 1970 when it began, and 1977 when it was ended. Most of these individuals process and how sensitive and specific they are in detecting the changes induced
were interested in the psychedelic experience because it was closely related to their by LSD reinains an open question. Another important factor to consider is the
own professional activities. Some of them actually worked in crisis intervention general lack of motivation in LSD subjects to participate and cooperate in formal
units or with patients who had problems related to psychedelic drug use. Others psychological testing procedures while they are deeply involved in their inner
were practitioners of various psychotherapeutic techniques and wanted to com- experiences. In view of the importance of set and setting for the psychedelic expe-
pare LSD psychotherapy to their own particular discipline— psychoanalysis, rience, it should also be mentioned that many of the above studies were conducted
psychodrama, Gestalt therapy, psychosynthesis, or bioenergetics. A few were in the context of the “model schizophrenia” approach, and thus with the intention
researchers involved in the study of altered states of consciousness, the dynaraics of of demonstrating the psychotic impairment of performance.
the unconscious, or the psychology of religion. A small group consisted of profes- The generally negative outcome of creativity studies is in sharp contrast to
sionals who were specifically interested in becoming LSD therapists. They usually the everyday experience of LSD therapists. The work of many artists— painters,
spent several months with us, attending staff meetings, watching videotapes of musicians, writers, and poets—who participated in LSD experimentation in
LSD therapy practice, or guiding psychedelic sessions under supervision. They various countries of the world has been deeply influenced by their psychedelic ex-
then had the opportunity to undergo their own LSD sessions as part of the training periences.' Most of them found access to deep sources of inspiration in their un-
schedule. All the participants in the LSD program for professionals agreed to conscious mind, experienced a striking enhancement and unleashing of fautasy,
cooperate in pre- and post-session psychological testing, and complete a follow-up and reached extraordinary vitality, originality and freedoin of artistic expression.
questionnaire six months, twelve months, and two years after the session. The
In many instances, the quality of their creations improved considerably, not only
questions in this follow-up form focused on changes which they observed after the according to their own judgment or the opinion of the LSD researchers, but by the
 260 NON-THERAPEUTIC USES OF LSD Administration of LSD to Creative Individuals 261

standards of their professional colleagues. At exhibitions which chronologically and LSD had a profound significance in the life, art and philosophy of Aldous
show the artist's development, it is usually easy to recognize when he or she had a Huxley. Many of his writings, including Brave New World, Island, Heaven and
psychedelic experience. One can typically see a dramatic quantum jump in the Hell, and The Doors of Perception have been directly influenced by his
content and style of the paintings. This is particularly true of painters who, prior psychedelic experiences. Some of the most powerful poems by Allen Ginsberg
to their LSD experience, were conventional and conservative in their artistic were inspired by his self-experimentation with psychedelic substances. The role of
expression. hashish in the French art of the fin de stécle could also be mentioned in this con-
However, most of the art in the collections of psychedelic therapists comes text. The Canadian-Japanese architect Kiyo Izumi was able to make unique use of
from subjects who were not professional artists, but had LSD sessions for thera- his LSD experiences in designing modern psychiatric facilities. (40)
peutic, didactic, or other purposes. Frequently, individuals who did not show any Since LSD mediates the access to the contents and dynamics of the deep
artistic inclinations at all prior to the LSD experience can create extraordinary unconscious—in psychoanalytic terms, to the primary process—it is not par-
pictures. In most instances, the intensity of the effect is due to the unusual nature ticularly surprising that psychedelic experiences can play an important role in the
and power of the material that emerges from the depths of the unconscious, rather creative development of artists. However, many observations from psychedelic
than the artistic abilities. It is not uncommon, however, for even the technical research indicate that LSD can also be of extraordinary value to various scientific
aspects of such drawings or paintings to be far superior to previous creations by disciplines that are traditionally considered domains of reason and logic. Two im-
the same subjects. Some individuals actually pursue in their everyday life the new portant aspects of the LSD effect seem to be of particular relevance in this context.
skills they discover in their psychedelic sessions. In exceptional cases, a genuine ar- First, the drug can mediate access to vast repositories of concrete and valid infor-
tistic talent of extraordinary power and scope may emerge during the LSD pro- mation in the collective unconscious and make them available to the experient.
cedure. One of my patients in Prague, who had loathed drawing and painting all According to my observations, the revealed knowledge can be very specific, ac-
her life and had to be forced to participate in art classes at school, developed a curate, and detailed; the data obtained in this way can be related to many dif-
remarkable artistic talent within a period of several months. Her art eventually ferent fields. In our relatively limited LSD training program for scientists, rele-
found enthusiastic acceptance among professional painters and she had successful vant insights occurred in such diverse areas as cosmogenesis, the nature of space
public exhibitions. In instances like this, one has to assume that the talent already and time, sub-atomic physics, ethology, animal psychology, history, anthro-
existed in these individuals in a latent form, and that its expression was blocked by pology, sociology, politics, comparative religion, philosophy, genetics, obstetrics,.
strong pathological emotions. The affective liberation through psychedelic psychosomatic medicine, psychology, psychopathology, and thanatology.?
therapy had allowed its free and full manifestation. The second aspect of the LSD effect that is of great relevance for the creative
It is interesting that the LSD experience tends to enhance appreciation and process is the facilitation of new and unexpected syntheses of data, resulting in un-
understanding of art in individuals who were previously unresponsive and indif- conventional problem-solving. It is a well-known fact that many important ideas
ferent. A characteristic observation from psychedelic research is the sudden devel- and solutions to problems did not originate in the context of logical reasoning, but
opment of interest in various movements in modern art. Subjects who were in- in various unusual states of mind—in dreams, while falling asleep or awakening,
different or even hostile toward non-conventional art forms can develop deep in- at times of extreme physical and mental fatigue, or during an illness with high
sight into suprematism, pointilism, cubisin, impressionism, dadaism, surrealism, fever. There are many famous examples of this. Thus, the chemist Friedrich
or superrealism after a single exposure to LSD. There are certain painters whose August von Kekulé arrived at the final solution of the chemical formula of
art seems to be particularly closely related to the visionary experiences induced by benzene in a dream in which he saw the benzene ring in the form of a snake biting
LSD. Thus many LSD subjects develop deep empathic understanding of the paint- its tail. Nikola Tesla constructed the electric generator, an invention that revolu-
ings of Hieronymus Bosch, Vincent van Gogh, Salvador Dali, Max Ernst, Pablo tionized industry, after the complete design of it appeared to him in great detail in
Picasso, René Magritte, Maurits Escher, or H. R. Giger. Another typical conse- a vision. The design for the experiment leading to the Nobel prize-winning dis-
quence of the psychedelic experience is a dramatic change of attitude toward covery of the chemical transmission of nerve impulses occurred to the physiologist
music; many LSD subjects discover in their sessions new dimensions in music and Otto Loewi while he was asleep. Albert Einstein discovered the basic principles of
new ways of listening to it. A number of our patients, who were alcoholics and his special theory of relativity in an unusual state of mind; according to his de-
heroin addicts with poor educational background, developed such deep interest in scription, most of the insights came to him in the form of kinaesthetic sensations.
classical music as a result of their one LSD session that they decided to use their We could mention many instances of a similar kind where a creative indi-
meager financial resources for buying a stereo set and starting a record collection vidual struggled unsuccessfully for a long time with a difficult problem using logic
of their own. The role of psychedelics in the development of contemporary music and reason, with the actual solution emerging unexpectedly from the uncon-
and their impact on composers, interpreters, and audiences is so obvious and well- scious in moments when his or lier rationality was suspended.’ In everyday life
known that it does not require special emphasis here. events of this kind happen very rarely, and in an elemental and unpredictable
Although the influence of LSD on artistic expression is most evident in the fashion. Psychedelic drugs seem to facilitate the incidence of such creative solu-
fields of painting and music, the psychedelic experience can have a similar fertiliz- tions to the point that they can be deliberately programmed. In an LSD state, the
ing effect on some other branches of art. Visionary states induced by mescaline old conceptual frameworks break down, cultural cognitive barriers dissolve, and
 208
USES OF LSD
Drug-induced Religious and Mystical Experiences
262 NON-THERAPEUTIC

hemp Cannabis indica and sativa have been used in Asia and Africa for many cen-
the material can be seen and synthesized in a totally new way that was not possi-
turies under different names—hashish, charas, bhang, ganja, kif—in religious
ble within the old systems of thinking. This mechanism can produce riot only strik-
ceremonies and folk medicine. They have played an important role in Brahman-
ing new solutions to various specific problems, but new paradigms that revolu-
ism, have been used in the context of Sufi practices, and represent the principal
tionize whole scientific disciplines.
sacrament of the Rastafarians. Religio-magical use of psychedelic plants was
Although psychedelic experimentation had been drastically curbed before cultures, among the Aztecs, Mayans, Olmecs,
widespread in the Pre-Columbian
this avenue could be syste:natically explored, the study of creative problem-solving
and other Indian groups. The famous Mexican cactus Lophophora williamsti
conducted by Willis Harman and James Fadiman (36) at the Stanford Research
(peyote), the sacred mushroom Psilocybe mexicana (teonanacatl), and several
Institute brought enough interesting evidence to encourage future research. The
varieties of morning glory seeds (ololiugui) were among the plants used. Ritual use
drug used in this experiment was not LSD but mescaline, the active ingredient of
of peyote and the sacred mushroom still survives among various Mexican tribes;
the Mexican cactus Anhalonium Lewinii, or peyote. Because of the general sim-
the peyote hunt and other sacred ceremonies of the Huichol Indians and healing
ilarity of the effects of these two drugs, comparable results should be expected
rituals of the Mazatecs using the mushrooms can be mentioned here as important
with the use of LSD; various accidental observations from our LSD training pro-
examples. Peyote was also assimilated by many North American Indian groups
gram for scientists and from the therapeutic use of this drug seem to confirm this.
and about one hundred years ago became the sacrament of the syncretistic Native
The subjects in the Harman-Fadiman study were twenty-seven males engaged in a
American Church. South American healers (ayahuascheros), and preliterate
variety of professions. The group consisted of sixteen engineers, one engineer-
Amazonian tribes such as the Amahuaca and the Jivaro use yagé, psychedelic ex-
physicist, two mathematicians, two architects, one psychologist, one furniture
tracts from the “visionary vine,” the jungle liana Banisteriopsis caapi. The best
designer, one commercial artist, one sales manager, and one personnel manager.
known African hallucinogenic plant is Tabernanthe iboga (eboga), which in
The objective of the study was to ascertain whether under the influence of 200
smaller dosages serves as a stimulant and is used in large quantities as an initiatory
milligrams of mescaline these individuals would show increased creativity and
drug. In the Middle Ages, potions and ointments containing psychoactive plants
produce concrete, valid, and feasible solutions to problems, as judged by the
and animal ingredients were widely used in the context of the Witches’ Sabbath
criteria of modern industry and positivistic science. The results of this research
and the black mass rituals. The most famous constituents of the witches’ brews
were very encouraging; many solutions were accepted for construction or pro-
were the deadly nightshade (Atropa Belladonna), mandrake (Mandragora of-
duction, others could be developed further or opened new avenues for investiga-
ficinarum), thornapple or “jimson weed” (Datura Stramonium), henbarte
tion. The mescaline subjects consistently reported that the drug induced in them a
(Hyoscyamus niger), and toad skin. Modern cheinical analysis has detected in the
variety of changes which facilitated the creative process. It lowered inhibitions
skin of toads (Bufo bufo), a substance called bufotenine (or dimethylserotonin)
and anxieties, enhanced the fluency and flexibility of ideation, heightened the
which has psychedelic properties. The psychedelic plants mentioned above repre-
capacity for visual imagery and fantasy, and increased the ability to concentrate
sent only a small selection of those that are most famous. According to
on the project. The administration of mescaline also facilitated empathy with peo-
ethnobotanist Richard Schultes of the Botanical Department of Harvard Uni-
ple and objects, made subconscious data more accessible, strengthened the moti-
versity, there exist more than one hundred plants with distinct psychoactive
vation to obtain closure and, in some instances, allowed immediate visualization
properties.
of the completed solution.
The ability of psychedelic substances to induce visionary states of a religious
It is obvious that the potential of LSD for enhancing creativity will be di-
and mystical nature is documented in many historical and anthropological
rectly proportional to the intellectual capacity aud sophistication of the experient.
sources. The discovery of LSD, and the well-publicized occurrence of these ex-
For most of the creative insights, it is necessary to know the present status of the
periences in many experimental subjects within our own culture, has brought this
discipline involved, be able to formulate relevant new problems, and find the
issue to the attention of scientists. The fact that religious experiences could be trig-
technical means of describing the results. If this type of research is ever repeated,
gered by the ingestion of chemical agents instigated an interesting and highly con-
the logical candidates would be prominent scientists from various disciplines:
troversial discussion about “chemical” or “instant mysticism.” Many behavioral
nuclear physicists, astrophysicists, geneticists, brain physiologists, anthropologists,
scientists, philosophers, and theologians became involved in fierce polemics about
psychologists and psychiatrists.‘ and authenticity. The
the nature of these phenomena, their meaning, validity,
opinions soon crystallized into three extreme points of view. Some experimenters
saw the possibility of inducing religious experiences by chemical means as an op-
DRUG-INDUCED RELIGIOUS AND
portunity to transfer religious phenomena from the realm of the sacred to the
MYSTICAL EXPERIENCES laboratory, and thus eventually to explain them in scientific terms. Ultimately,
there would be nothing mysterious and holy about religion, and spiritual ex-
The use of psychedelic substances for ritual, religious, and magical purposes can
periences could be reduced to brain physiology and biochemistry. However, other
be traced back to ancient shamanic traditions and is probably as old as mankind.
researchers took a very different stance. According to them, the mystical
The legendary divine potion soma, prepared from a plant of the same name whose
phenomena induced by LSD and other psychedelic drugs were genuine and these
identity is.now lost, played a crucial role in the Vedic religion. Preparations from
264 NON-THERAPEUTIC USES OF LSD Drug‘Induced Religious and Mystical Experiences 265

substances should be considered sacraments because they can mediate contact

with transcendental realities. This was essentially the position taken by the
shamans and priests of psychedelic cultures where visionary plants such as soma,
peyote and teonanacatl were seen as divine materials or as deities themselves. Yet
another approach to the problem was to consider LSD experiences to be “quasi-
religious” phenomena which only simulate or superficially resemble the authentic
and genuine spirituality that comes as “God's grace” or as a result of discipline,
devotion, and austere practices. In this framework, the seeming ease with which
these experiences could be triggered by a chemical entirely discredited their
spiritual value.
However, those who arguc that LSD-induced spiritual experiences cannot
be valid because they are too easily available and their occurrence and timing
depend on the individual's decision, misunderstand the nature of the psychedelic
state. The psychedelic experience is neither an easy nor a predictable way to God.
Many subjects do not have spiritual elements in their sessions despite many expo-
sures to the drug. Those who do have a mystical experience frequently have to
undergo psychological ordeals that are at least as difficult and painful as those
associated with various aboriginal rites of passage or rigorous and austere religious
disciplines.
Most researchers agree that it is not possible to differentiate clearly between
spontaneous mystical experiences and “chemical mysticism” on the basis of phe-
nomenological analysis or experimental approaches.® This issue is further com-
plicated by the relative lack of specific pharmacological effects of LSD and by the
fact that some of the situations conducive to spontaneous mysticism are associated
with dramatic physiological and biochemical changes in the body.
Prolonged fasting, sleep deprivation, a stay in the desert with exposure to
dehydration and extremes of temperature, forceful respiratory maneuvers, exces-
sive emotional stress, physical exertion and tortures, long monotonous chanting
and other popular practices of the “technology of the sacred” cause such far-
reaching alterations in body chemistry that it is difficult to draw a clear line be-
Ap experience of unfulfilled religious longing. Groups of people are striving to cross treach-
tween spontaneous and chemical mysticism.
crous, swampy’ waters in imperfect boats in order to reach a deity on the horizon. However,
The decision whether chemically induced experiences are genuine and
they all sink and drown before reaching their desired goal.
authentic or not thus lies in the domain of theologians and spiritual masters.
Unfortunately the representatives of different religions have expressed a wide spec-
trum of conflicting opinions; it remains an open question who should be con-
sidered an authority in this area. Some of these religious experts made their interest for theologians, ministers, and students of religion. Within a few hours,
judgments without ever having had a psychedelic experience and can hardly be individuals gain profound insights into the nature of religion, and in many in-
considered authorities on LSD; others have made far-reaching generalizations on stances their purely theoretical understanding and formal belief is vitalized by a
the basis of one session. Serious differences of opinion exist even among deep personal experience of the transcendental realms. This opportunity can be
leading representatives of the same religion—Catholic priests, Protestant particularly important for those ministers who profess a religion, but at the same
ministers, Rabbis, and Hindu saints—who have had psychedelic experiences. At time harbor serious doubts about the truth and relevance of what they preach.
present, after thirty years of discussion, the question whether LSD and other Several priests and theologians who volunteered for our LSD training program at
psychedelics can induce genuine spiritual experiences is still open. Negative opin- the Maryland Psychiatric Research Center were skeptics or atheists who were in-
ions of individuals like Meher Baba or R. C. Zaehner stand against those of volved in their profession for a variety of external reasons. For them, the spiritual
several Tibetan Buddhist masters, a number of shamans of the psychedelic cul- experiences they had in their LSD sessions were important evidence that spiritual-
tures Walter Clark, Iluston Smith, and Alan Watts. . ity is a genuine and deeply relevant force in human life. This realization liberated
Whether the experiences produced by LSD are genuine mystical revelations them from the conflict they had had about their profession, and from the burden
or just very convincing simulations thereof, they are certainly phenomena of great of hypocrisy. In several instances, the relatives and friends of these individuals
 266 NON-THERAPEUTIC USES OF LSD Role of LSD in Personal Growth and Self-Actualization

The sacred event of delivery is inextricably connected with genitals, sexuality, aggression,
A series of drawings illustrating the relation between spiritual pathology and the biological defecation and urination. :
birth trauma. The first four show images of the most sacred Christian theme—crucifixion— In the final picture the conflict is resolved. The figure of ‘Purified Christ’ rises above the
contaminated by what the patient calls “obscene biology”. During her session she realized realm of “obscene biology”, separating from it. However, the patient's hands are reaching
that this confusion reflected not only specific childhood experiences, but particularly the for the Black Sun which is a symbol of inner reality even bevond Christ, the divine that
biologica) trauma of birth. transcends all forms and limitations.
268 NON-THERAPLUTIC USES OF LSD Use of LSD in the Development of Paranormal Abilities 269

reported that their sermons following the LSD session showed unusual power and can move them in the direction of self-realization or self-actualization. This pro-
natural authority. cess seems to be comparable in every way to the one that Abraham Maslow
Spiritual experiences in psychedelic sessions frequently draw on the symbol- described for individuals who had spontaneous “peak experiences.”
ism of the collective unconscious and can thus occur in the framework of cultural The official anti-drug propaganda is based on a very superficial understand-
and religious traditions other than the experient’s own. LSD training sessions are ing of the motivations for psychedelic drug use. It is true that in many instances
therefore of special interest for those who study comparative religion. Ministers the drug is used for kicks or in the context of juvenile rebellion against parental
affiliated to a specific church arc sometimes surprised when they have a profound authority or the establishment. However, even those who take LSD under the
religious experience in the context of an entirely different creed. Because of the worst circumstances frequently get a glimpse of the drug's real potential, and this
basically unitive nature of the psychedelic experience, this usually does not dis- - can become a powerful force in future use. The fact that many people take LSD in
qualify their own religion but places it in a broader cosmic perspective. an attempt to find a solution to their emotional dilemmas or from a deep need for
philosophical and spiritual answers should not be underestimated. The craving for

a
contact with transcendental realities can be more powerful than the sexual urge.
ROLE OF LSD IN PERSONAL GROWTH Throughout human history countless individuals have been willing to take enor-
AND SELF-ACTUALIZATION mous risks of various kinds and to sacrifice years or decades of their lives to
spiritual pursuits. Any reasonable measures regulating the use of psychedelic drugs
During the years of intensive LSD research, the major focus was on basic psycho- should take these facts into consideration.
pathological investigation, psychiatric therapy, or some quite specific uses, such as "Very few serious researchers still believe that experimentation with pure
enhancement of artistic expression or mediation of a religious experience. Rela- LSD represents a genetic hazard. Under proper circumstances the psychological
tively little attention was paid to the value that psychedelic experiences could have dangers that represent the only serious risk can be reduced to a minimum. In my
for the personal development of “normal” individuals. In the mid-sixties, this issue opinion, there is no scientific evidence that precludes the creation of a network of
emerged in an clemental and explosive fashion in a wave of massive non- facilities in which those who are seriously interested in psychedelic self-exploration
supervised self-experimentation. could engage in it with pure substances and undcr the best circumstances. Many of
In the atmosphere of national hysteria that ensued, the pros and cons were these would be subjects who are so deeply motivated that they would otherwise be
discussed in a passionate, over-emphatic, and ultimately confusing way. The LSD serious candidates for illegal self-experimentation involving a much higher risk.
proselytes presented the drug quite uncritically as an easy and safe panacea for all The existence of government-sponsored centers of this kind would have an in-
the problems that beset human existence. Psychedelic self-exploration and per- hibiting effect on the immature motivations of people for whom the present strict

te
sonality transformation were presented as the only viable alternative to sudden prohibitions represent a special challenge and temptation. An additional advan-

a
annihilation in a nuclear holocaust or slow death among industrial waste prod- tage of this approach would be the opportunity to accumulate and process in a
ucts. It was recommended that as many people as possible should take LSD under systematic way all the valuable information about psychedelics that is otherwise
any circumstances and as frequently as they could in order to accelerate the ad- lost in elemental and chaotic unsupervised experimentation. This would also
vent of the Aquarian Age. LSD sessions were seen as a rite of passage that should remedy the existing absurd situation in which almost no serious professional
be mandatory for everybody who reached their teens. research is being conducted in an area where millions of people have been ex-
Failure to warn the public about the dangers and pitfalls of psychedelic ex- perimenting on their own.
perimentation and to give instructions for minimizing the risks resulted in a large
number of casualties. Apocalyptic newspaper headlines describing the horrors of
LSD “bummers” and drug-related accidents ignited a witch-hunting response in USE OF LSD IN THE DEVELOPMENT
legislators, politicians, educators, and many professionals. Ignoring the data from OF PARANORMAL ABILITIES
almost two decades of responsible scientific experimentation, the anti-drug propa-
ganda switched to the other extreme and presented LSD as a totally unpredictable Much historical and anthropological evidence and numerous anecdotal observa-
devil’s drug that represented a grave danger to the sanity of the present generation tions from clinical research suggest that psychedelic substances can occasionally
and the physical health of generations to come. facilitate extrasensory perception. In many cultures visionary plants were ad-
At present, when the emotional charge of this controversy has subsided, it ministered in the context of spiritual healing ceremonies as means to diagnose and
seems possible to take a more sober and objective view of the problems involved. cure diseases. Equally frequent was their use for other magical purposes, such as
Clinical evidence strongly suggests that “normal” people can benefit most locating lost objects or persons, astral projection, perception of remote events,
from the LSD process and are taking the least risk when participating in a precognition, and elairvoyance. Most of the drugs uses! for these purposes have
supervised psychedelic program. A single high-dose LSD session can frequently be been mentioned earlier in connection with religious rituals. They include the resin
of extraordinary value for those persons who do not have any serious clinical prob- or leaves of hemp (Cannabis indica or sativa) in Africa and Asia; fly-agaric
lems. The quality of their lives can be considerably enhanced and the experience mushrooms among various Siberian tribes and North American Indians; the plant
 270 NON-THERAPEUTIC USES OF LSD Use of LSD in the Development of Paranormal Abilities 271

Tabernanthe iboga among certain African ethnic groups; the snuffs cohoba The most interesting paranormal phenomena occurring in psychedelic ses-
(Anadenanthera peregrina) and epend (Virola theidora) of South America and the sions are out-of-the-body experiences and the instances of traveling clairvoyance
Caribbean; and the three basic psychedelics of the Pre-Columbian cultures—the and clairaudience. The sensation of leaving one’s body is quite common in drug-
peyote cactus (Lephophora williamsti), the sacred mushrooms teonanacail (Psilo- induced states and can have various forms and degrees. Some persons experience
cybe mexicana) and ololiuqui or morning glory seeds (Ipomoea violacea), Of themselves as completely detached from their physical bodies, hovering above
special interest seems to be yagé, a brew prepared from the jungle creeper Bant- them or observing them from another part of the room. Occasionally, the subjects
steriopsis caapi and other “vines of the dead” used by South Atmerican Indians in can lose the awareness of the actual physical setting altogether and their con-
the Amazon valley. Harmin, also called yageine or banisterine, one of the active sciousness moves into experiential realms and subjective realities that appear to be
alkaloids isolated from the Banisteriopsis plant, has actually been referred to as entirely independent of the material world. They may then identify entirely with
telepathine. The psychedelic states induced by the extracts of these plants seem to the body images of the protagonists of these scenes, be they persons, animals, or
be especially powerful enhancers of paranormal phenomena. The most famous ex- archetypal entities. In exceptional cases the individual may have a complex and
ample of the unusual properties of yagé can be found in the reports of McGovern, vivid experience of moving to a specific place in the physical world, and give a
(69) one of the anthropologists who described this plant. According to his descrip- detailed description of a remote locale or event. Attempts to verify such extra-
tion, a local medicine man saw in remarkable detail the death of the chief of a sensory perceptions can sometimes result in amazing corroborations. In rare in-
faraway tribe at the time when it was happening; the accuracy of his account was stances, the subject can actively control such a process and “travel” at will to any
verified many weeks later. A similar experience was reported by Manuel Cordova- location or point in time he or she chooses. A detailed description of an experience
Rios (53) who accurately saw the death of his mother in his yagé session and was of this kind illustrating the nature and complexity of the problems involved has
later able to verify all the details. All psychedelic cultures seem to share the belief been published in my book Realms of the Human Unconscious, p. 187. (32)
that not only is extrasensory perception enhanced during the actual intoxication Objective testing by the standard laboratory techniques used in parapsycho-
by sacred plants, but the systematic use of these substances facilitates development logical research has generally been quite disappointing and has failed to dem-
of paranormal abilities in everyday life. onstrate an increase of extrasensory perception as a predictable and constant
Much anecdotal material collected over the years by psychedelic researchers aspect of the LSD effect. Masters and Houston (65) tested LSD subjects with the
supports the above beliefs. Masters and Houston (65) have described the case of a use of a special card deck developed in the parapsychology laboratory at Duke
housewife who in her LSD session saw her daughter in the kitchen of their home University. The deck contains twenty-five cards, each of which has a geometrical
looking for the cookie jar. She further reported seeing the child knock a sugar symbol: a star, circle, cross, square, or wavy lines. The results of the experiments
bowl from a shelf and spill sugar on the floor. This episode was later confirmed by in which LSD subjects attempted to guess the identity of these cards were
her husband. The same authors also reported an LSD subject who saw “a ship statistically nonsignificant. A similar study conducted by Whittlesey (102) and a
caught in ice floes, somewhere in the northern seas.” According to the subject, the card-guessing experiment with psilocybin subjects reported by van Asperen de
ship had on its bow the name “France.” It was later confirmed that the France Boer, Barkema and Kappers (6) were equally disappointing, though an interesting
had indeed been trapped in ice near Greenland at the time of the subject’s LSD finding in the first of these studies was a striking decrease of variance; the subjects
session. The famous psychologist and parapsychological researcher Stanley actually guessed closer to mean chance expectation than predicted mathe-
Krippner (49) visualized, during a psilocybin session in 1962, the assassination of matically. Unpublished findings of Walter Pahnke’s parapsychological research at
John F. Kennedy which took place a year later. Similar observations were the Maryland Psychiatric Research Center suggest that the statistical approach to
reported by Humphrey Osmond, Duncan Blewett, Abram Hoffer, and other this problem might be misleading. In this project, Walter Pahnke used a modified
researchers. The literature on the subject has been critically reviewed in a synoptic version of the Duke University cards in the form of electronic keyboard panels.
paper by Krippner and Davidson. (50) The LSD subject had to guess the key that had been lit on a panel in an adjacent
In my own clinical experience, various phenomena suggesting extrasensory room either manually or by a computer. Although the results for the entire group
perception are relatively frequent in LSD psychotherapy, particularly in ad- of LSD subjects were not statistically significant, certain individuals achieved
vanced sessions, They range from a more-or-less vague anticipation of future strikingly high scores in some of the measurements.
events or an awareness of remote happenings to complex and detailed scenes in the Some researchers voiced objections to the uninteresting and unimaginative
form of vivid clairvoyant visions. This may be associated with appropriate sounds, approach to the study of parapsychological phenomena represented by repetitive
such as spoken words and sentences, noises produced by motor vehicles, sounds of card guessing. In general, such a procedure does not have much chance in the
fire engines and ambulances, or the blowing of horns. Some of these experiences competition for the subject's attention as compared to some of the exciting subjec-
can later be shown to correspond in varying degrees with actual events. Objective tive experiences that characterize the psychedelic state. In an attempt to make the
verification in this area can be particularly difficult. Unless these instances are task inore appealing, Cavanna and Servadio (19) used emotionally-loaded
reported and clearly docuinented during the actual psychedelic sessions there is a materials rather than cards; photographic color prints of incongruous paintings
great danger of contamination of the data. Loose interpretation of events, distor- were prepared for the experient. Although one subject did remarkably well, the
tions of memory, and the possibility of déja vu phenomena during the perception overall results were nonsignificant. Karlis Osis (73) adininistered LSD to a num-
of later occurrences are a few of the major pitfalls involved. ber of “mediums” who were given objects and asked to describe the owners, One
 NON-THERAPEUTIC USES OF LSD Use of LSD in the Development of Paranormal Abilities 273
972

medium was unusually successful, but most of the others became so interested in NOTES
the aesthetic and philosophical aspects of the experience, or so caught up in their
1. The interested reader will find comprehensive discussion of this subject in
personal problems, that they found it difficult to maintain concentration on the
Robert Masters’ and Jean Houston's excellent book Psychedelic Art (66). The
task. influence of LSD and psilocybin on the creativity of professional painters has
By far the most interesting data emerged from a pilot study designed by also been uniquely documented in the book Experimental Psychoses (90) by the
Masters and Houston (65) who used emotionally charged images with sixty-two Czech psychiatrist, J. Roubiéck. Osear Janiger’s unpublished collection of
LSD subjects. The experiments were conducted in the termination periods of the professional paintings done under the influence of LSD also deserves to be
sessions, when it is relatively easy to focus on specific tasks. Forty-eight of the indi- mentioned in this context.
viduals tested approximated the target image at teast two times out of ten, while 2. Some concrete examples of relevant insights of this kind are described in my
five subjects made successful guesses at least seven times out of ten. For example, book Realms of the Human Unconscious. (32)
one subject visualized “tossed seas” when the correct image was a Viking ship in a 3. Many additional examples of this phenomenon can be found in Arthur
storm. The same subject guessed “lush vegetation” when the image was rain Koestler’s book The Act of Creation. (48)
the image was an Arab on a camel, “the
4, The interested reader will find more information on the subject in Stanley
forests in the Amazon, “a camel” when
Krippner’s synoptic paper Research in Creativity and Psychedelic Drugs. (51)
Alps” when the picture was the Himalayas, and “a Negro picking cotton in a 5. The most interesting study of this kind was Walter Pahnke’s (75) Good
field” when the target was a plantation in the South. Friday experiment conducted in 1964 in the Harvard Chapel in Cambridge,
The study of paranormal phenomena in psychedelic sessions presents many Massachusetts. In this study, ten Christian theological students were given 30
technical problems. In addition to the problems of getting the subject interested milligrams of psilocybin, and ten others who functioned as a control group
and keeping his or her attention on the task, Blewett (12) also emphasized the received 200 milligrams of nicotinic acid as placebo. The assignment to the two
rapid flow of eidetic imagery that interferes with the ability of the subject to groups was done on a double-blind basis. They all listened toa two-and-a-half-
stabilize and choose the response that might have been triggered by the target. hour religious service that consisted of organ music, vocal solos, readings,
The methodological difficulties in studying the effect of psychedelic drugs on prayers, and personal meditation. The subjects who were given psilocybin rated
extrasensory perception or other paranormal abilities and the lack of evidence in very high on the mystical experience questionnaire developed by Pahnke,
whereas the response of the control group was minimal,
the existing studies cannot, however, invalidate some quite extraordinary observa-
tions in this area. Every LSD therapist with sufficient clinical experience has col-
lected enough challenging observations to take this problem seriously. I myself
have no doubt that psychedelics can occasionally induce elements of genuine ex-
trasensory perception at the time of their pharmacological effect. On occasion, the
occurrence of certain paranormal abilities and phenomena can extend beyond the
day of the session. A fascinating observation that is closely related and deserves at-
tention in this context is the frequent accumulation of extraordinary coincidences
in the lives of persons who had experienced transpersonal phenomena in their
psychedelic sessions. Such coincidences are objective facts, not just subjective
interpretations of perceptual data; they are similar to the observations that Carl
Gustav Jung described in his essay on synchronicity. (44)
The discrepancy between the occurrence of parapsychological phenomena
in LSD sessions and the negative results of specific laboratory studies seems to
reflect the fact that an increase in ESP is not a standard and constant aspect of the
LSD effect. Psychological states conducive to various paranormal phenomena and
characterized by an unusually high incidence of ESP are among the many alter-
native mental conditions that can be facilitated by this drug; in other types of LSD
experiences the ESP abilities seem to be on the same level as they are in the every-
day state of consciousness, or even further reduced. Future research will have to
assess if the otherwise unpredictable and elemental incidence of paranormal
abilities in psychedelic states can be harnessed and systematically cultivated, as it
is indicated in shamanic literature.
EFFECTIVE
THERAPEUTIC
MECHANISMS
OF LSD THERAPY
Intensification of Conventional Therapeutic
Mechanisms
Changes in the Dynamics of Governing Systems
Therapeutic Potential of the Death-Rebirth
Process
Therapeutic Mechanisms on the Transpersonal
Level

"
The extraordinary and often dramatic effects of the LSD process on various emo-
tional and psychosomatic symptoms quite naturally give rise to questions about
the therapeutic mechanisms involved in these changes. Although the dynamics of
some of these transformations can be explained along conventional lines, the
majority appear to involve processes as yet undiscovered or unacknowledged by
traditional psychology and psychiatry. This does not mean that these phenomena
have never been encountered or discussed before. Descriptions of some of these
mechanisms are found in the religious literature describing spiritual healing and
its effects on emotional or psychosomatic illnesses. Anthropologists may also
recognize elements that occur in shamanic practices, aboriginal rites of passage,
and various healing ceremonies.
It has already been mentioned that LSD does not have any intrinsic thera-
peutic properties related simply to its pharmacological effects. It is necessary to
structure and approach the experience in a specific way to make the emergence of
unconscious material therapeutic rather than destructive. Analysis of the observa-
tions from LSD psychotherapy suggests that the therapeutic changes that take
place are very complex and cannot be reduced to a single common denominator.
The LSD experience appears to involve a variety of factors on many different
levels; each has distinct therapeutic potential and can be utilized for effective
treatment and personality change. In the following text we will briefly discuss the
most important mechanisms of this kind operating in LSD sessions. The richness of
opportunities for deep dynamic shifts and transformations that is characteristic of
psychedelic states seems to make LSD a very special adjunct to psychotherapy.

275
 Changes in the Dynamics of Governing Systems
276" EFFECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY 277
‘ (ern.
playing, can reinforce the impact of the original traumatic situation rather than
INTENSIFICATION OF CONVENTIONAL act in a corrective manner. The demanding and often difficult task of the therapist
THERAPEUTIC MECHANISMS is somewhat facilitated by the fact that the patient under the influence of LSD
is
Usually Tess defensive and more open. As a result, he or she may often accept and
The only factors of therapeutic change available in the initial stages of a psycho- Fee peyeh ethan erpretations that would be impossible or untimely in drug-
lytic series are the mechanisms that have been described in the context of tradi-
tional psychotherapeutic schools. However, even in superficial psychedelic cxperi-
Suggestibility is usually markedly enhanced and a therapist who uses su
ences these mechanisms are greatly intensified. Under these circumstances the gestion in psychotherapy can take advantage of this fact; however, this ap roach
defense systems are considerably weakened and psychological resistance decreases. should be used with utmost caution. In my experience any departure from ‘honest
The emotional responses of the subject are dramatically enhanced and one may and open interaction with the client,
observe powerful abreaction and catharsis. Represscd unconscious material, in- or use of various devices and plo i
ultimately harmful to therapeutic progress.
cluding early childhood memories, becomes easily available, and this may result me
not only in enhanced recall but in genuine age-regression and vivid, complex
reliving of emotionally relevant memories as well. Unconscious material also fre- CHANGES IN THE DYNAMICS
quently apears in the form of various symbolic phenomena with a structure simi- OF GOVERNING SYSTEMS
lar to dreams. The emergence of this material and its integration are associated When the dosage is increased or the LSD sessions repeated, new and powerful
with emotional and intellectual insights into the psychodynamics of the patient's mechanisms come into action and become available in addition to the above
symptoms and maladjustive interpersonal patterns. Many therapeutic changes on deeper levels can be explained as resulting from a
The therapeutic potential of the reliving of emotionally important episodes
chemical intervention in the dynamic interplay of unconscious constellations that
from childhood seems to involve two important elements. One of them is a deep have the function of governing systems. The most important of these are the
release of pent-up energies and their peripheral discharge in the form of emotional systems of condensed experience (COEX systems), which organize material of bio-
and physical abreaction. The second is conscious integration of the content that is
graphical nature, and the basic perinatal matrices (BPM’s), which have a similar
now devoid of affective charge. This is made possible by the double orientation or role in relation to the experiential repositories related to the death-rebirth process.
dual role that individuals can assume in the LSD state, either simultaneously or in The essential characteristics of these two categories of governing systems were
an alternating fashion. On the one hand, they experience full and complex age- described in detail earlier. We could also talk about transpersonal dynami
regression to early life periods when the traumatic events took place; on the other matrices; however, because of the richness and looser organization of trans or.
hand, they also have access to the position corresponding to their chronological sonal realms it would be difficult to describe them in a comprehensive way i.
age at the time of the LSD session. In this way, it becomes possible to reevaluate
According to the nature of the emotional charge, we can distinguish nega-
from an adult point of view the relevance of events that were once overwhelming tive governing systems (negative COEX
for the immature organism. The replay of early biographical events is thus expe-
systems, BPM II, BPM III negative
aspects of BPM I, and negative transpersonal matrices) and positive overnin
rienced by a subject who represents an interesting hybrid between a naive, emo- systems (positive COEX systems, positive aspects of BPM I, BPM IV and positive
tionally totally involved child and a more-or-less detached adult observer. transpersonal matrices). The general strategy of LSD therapy is reduction of the
This dual role is also reflected in the therapeutic relationship. The subject emotional charge attached to negative systems and facilitation of experiential ac-
can perceive the therapist and interpret objective reality in a way that reflects un- cess to positive ones. A more specific tactical rule is to structure the termination
resolved material from the past. However, on another level, he or she can also
period of each individual session in a way that facilitates completion and integra-
maintain adequate reality-testing and study in detail the origin and mechanism of tion of the material that was made available that day. The manifest clinical con
these distortions. The transference relationship is typically intensified and is expe- dition of an individual is not a global reflection of the nature and overall amount
rienced in a vivid pictorial form. As indicated in an earlier chapter, the distortions of the unconscious material; it is dependent on a specific selective focus and tunin
of the therapeutic relationship are frequently exaggerated to the point of carica- which makes certain aspects of the material experientially available. Individuals
ture, so that the transference nature of the phenomena becomes obvious to both who are tuned into various levels of negative psychodynamic, perinatal or
the patient and the therapist. The intensification of the relationship produced by transpersonal governing systems perceive theinselves and the world in a pessimistic
the drug not only facilitates the transference analysis, but also offers numerous way and experience emotional or psychosomatic distress.
opportunities for corrective emotional experiences. It is essential that the therapist sons who are under the influence of positive dynamic governing systems are in a
Conversely, those per-
remain understanding, unperturbed, and consistently supportive, without regard state of emotional well-being and optimal psychosomatic functioning. The specific
<< to the nature of the emerging material and the patient's behavior. This can qualities of the resulting states depend in both instances on the nature of the ac-
_have a very powerful therapeutic impact on the patient who frequently has fan- tivated material. For a detailed discussion of the influence of COEX systems
‘tasies of disapproval and rejection, or even catastrophic expectations about the BPM’s, and various transpersonal matrices on LSD subjects, see the chapter on
therapist's reaction to certain aspects of his or her experience. Any departure from post-session intervals. (pp. 218-27)
this approach, unless explicitly designed and agreed upon as therapeutic role-
278 EEEECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY Therapeutic Potential of the Death-Rebirth Process
279
a

Changes in the governing influence of dynamic matrices can occur as a flashlight could be perceived at a particular time. Similarly, only those un-
result of various biochemical or physiological processes inside the organism, or as a conscious contents that are in the spotlight of conscious awareness can actually be
reaction to a number of external influences of a physical or psychological nature. fully experienced.
LSD sessions seem to represent a deep intervention in the dynamics of the govern- An issue that deserves special consideration at this point is the relative thera-
ing systems and their functional interplay. Detailed analysis of the phenom- peutic significance of negative and positive experiences in LSD sessions. The prob-
enology of LSD experiences indicates that in many instances sudden clinical im-_, lem whether the emphasis in LSD psychotherapy should be on reliving conflicts!
provement during therapy can be explained as a shift from the psychological and traumatic memories or on achieving transcendental experiences has been one i
dominance of a negative governing system to a state where the individual is under of the most controversial issues between psycholytic and psychedelic therapists.
the selective influence of a positive constellation. Such a change does not necessar- According to my experience, working through the traumatic material and experi{
ily mean that all the unconscious material underlying that particular psycho- encing ecstatic states are both important and integral parts of the healing process. 1
pathological state has been worked through. It simply indicates an inner dynamic Moreover, these two aspects of LSD psychotherapy seen to be mutually inter- |
shift from one governing system to another. This situation can be referred to as related in a dialectic fashion. Energetic reduction of negative systerns and working
transmodulation: it can occur on several different levels. A shift among memory through of problematic areas opens the way to deep positive episodes. Conversely
constellations involving autobiographical material can be called COEX trans- if LSD subjects experience profound transpersonal states in the initial psychedelic

Peeweres
=—
modulation. Because of the functional interrelatedness between the COEX systems sessions, this has a very beneficial influence on the future course of therapy. They
and the BPMs, most reexperiencing of traumatic childhood memories represents transcend the narrow personal framework and see their probleins in a cosmic con-
partial and mitigated reliving of a certain facet of the birth trauma. Similarly, \
text. This results in a generally optimistic attitude that is of great help in dealing
positive childhood experiences can be viewed as partial restitution of the pleasant with the negative psychodynamic and perinatal material when it emerges during
post-natal or intrauterine condition. A comparable dynamic shift from one domi- treatment. An individual who has experienced transcendental states has a strong
nant perinatal matrix to another can be referred to as BPM transmodulation. A feeling of cosmic identity and knows the.ultimate goal of the treatment. The LSD;
transpersonal transmodulation then involves governing functional systems in the process is seen as work on the barrier that separates him or her from the Self, and 4a
transindividual realms of the unconscious. not just a blind digging in the cul-de-sac of the individual unconscious. A;
A typical positive transmodulation has a biphasic course; it involves intensi-_ simultaneous emphasis on both aspects of the process with eucouragement of its
fication of the dominant negative system and a sudden shift to the positive. . spontaneous course, seems to be the best solution to this therapeutic dilemma.
However, if a strong positive system is easily available it can dominate the LSD However, positive experiences are of fundainental significance to the therapeutic
experience from the very beginning of the session, and the negative system recedes outcome, and every concept of LSD treatment that underestimates them is depriv-
into the background. A shift from one dynamic constellation to another does not ing itself of a powerful therapeutic principle.
necessarily indicate clinical improvement: There is a possibility that a poorly ‘
resolved and integrated session will result in negative transmodulation—a shift
from a positive system to a negative one. This situation is characterized by a sud- THERAPEUTIC POTENTIAL OF THE
den occurrence of psychopathological symptoms that were not manifest before the DEATH-REBIRTH PROCESS
session. Another interesting possibility is a shift from one negative system to
another that is also negative in nature. The external manifestation of this intra- The therapeutic changes associated with experiences on the psychodynamic level
psychic event is a_remarkable qualitative change in psychopathology from one seem to be of relatively minor significance compared to those that result from
clinical syndrome to another. Occasionally, this transformation can be so dra- perinatal sequences. The everyday clinical practice of LSD psychotherapy brings
matic that the patient moves into a completely different diagnostic category; a repeated evidence of the powerful healing potential of the death-rebirth process.
clinical illustration of this phenomenon was given earlier in this book (p. 219). Al- The discovery of this potent therapeutic mechanism, as yet unrecognized and ye
though the resulting condition might appear on the surface to be entirely new, all unacknowledged by Western science, represents one of the most surprising find-
its essential elements existed in a potential form in the patient’s experiential ings of my LSD research.
repositories before the dynamic shift occurred. It is thus important to realize that, Experiential sequences of dying and being born can result in dramatic
in addition to working through unconscious material, the LSD procedure can also. alleviation of a variety of emotional and psychosomatic problems. Negative peri- i
involve dramatic shifts of focus that change its experiential relevance, natal matrices are an important repository of emotions and physical sensations of
I would like to mention in this context an interesting metaphor which one of extraordinary intensity; they function as a potential experieutial source of many
my patients used to illustrate her concept of this process. She described the human psychopathological syndromes. Such crucial symptoms as anxiety, aggression,
unconscious as a dark storage house, full of various objects of all kinds, some of depression, fear of death, feelings of guilt, a sense of inferiority, helplessness, and
them ugly, others beautiful. The LSD process appeared to her to involve not only general emotional tension seem to have deep roots on the perinatal level. Many
removing junk and garbage, but also changing the direction of a flashlight illumi- aspects of these phenomena and their interrelations make sense if considered in the
nating the inside space. Only those of the stored objects that were illumined by the context of the birth trauma. Similarly, I lave also frequently been able to trace a
'
 THERAPEUTIC MECHANISMS OF LSD THERAPY Therapeutic Potential of the Death-Rebirth Process . 281
, 280 EFFECTIVE

diminution of various painful emotions or sensations, emotional indifference

client’s preoccupation with various physiological functions or biological material,
to toward one’s past or future, loosening of the body boundaries, and a fluid, undif-
strange hypochondriacal complaints, and a variety of psychosomatic symptoms
This was particula rly true for or- ferentiated state of consciousness. However, many essential characteristics of the
certain aspects of the death-rebirth process.
on, unitive state are uot reproduced in the experience of intoxication by alcohol or
dinary or migraine headaches, neurotic feelings, lack of oxygen and suffocati
vomiting, various dyskinesias or muscular tensions, narcotics. Instead of inducing a state of cosmic consciousness in its totality, these
cardiac distress, nausea and
drugs produce its caricature; however, the rescinblance is close enough to mislead
pains, and tremors in different parts of the body.
the individual involved and seduce him or her into systeinatic abuse. Repeated
A rather common observation in psycholytic therapy was that patients who
continued administrations then lead to biological addiction and irreversible physical, emo-
had moved beyond the psychodynamic level altogether in their process
| to have difficult LSD experiences and a number of clinical problems in their tional, and social damage.
were After experiences of ego death and cosmic unity, abuse of alcohol or nar-
everyday life. It became evident that certain psychopathological symptoms
level and would not disappear unless and until the underly- cotics, and suicidal tendencies, are seen as tragic inistakes caused by an unrecog-
rooted in the perinatal
to confront nized and misunderstood spiritual craving for transcendence. The presence of
ing material was thoroughly worked through. Thus it was necessary
to reach a lasting resolution strong feelings of this kind, improbable as it might seem in view of the behavior
the “no-exit” matrix experientially in order
. “
—of claustrop hobia or an inhibited depressio n. patterns and life style of narcotic addicts and alcoholics, can be illustrated by
——not just a temporary remission
of an agitated depressio n were found in the death-, statistics from psychedelic therapy. In the Spring Grove research, alcoholics and
Similarly, the deep roots
heroin addicts had the highest incidence of mystical experiences of all the groups
rebirth struggle of the third perinatal matrix.
studied, including neurotics, inental health professionals, and individuals dying of
Suicidal urges often disappeared completely when patients worked through
d the cancer.
and integrated the perinatal material. Several individuals who had complete
ently reported that their previous suicidal tenden- Malignant aggression, impulsive. behavior. aud sadomasochistic tendencies
death-rebirth process independ
ence. also have importaut roots on the perinatal level. Activation of the destructive and
cies had actually been unrecognized cravings for the ego death and transcend
self-destructive potential in the individual is one of the most important aspects of
Since this insight was not available to them at the time, they focused
a close the death-rebirth struggle. Scenes of unbridled aggression and mass destruction, as
psychologically on a situatjon in objective reality that bore for them well as sadomasochiistic orgies, are standard components of the perinatal unfold-
e of
resemblance to the ego death, namely, physical destruction. The experienc
or greatly reduce suicidal tendencie s and ing.! In this context, enormous amounts of destructive energy are mobilized and
psychological death tends to eliminate
e and self-dest ructive impulses are consumed in the discharged; the result is a dramatic reduction of aggressive feelings and ten-
ideation. Powerful aggressiv
ial sequences of the death-reb irth process. In addition, dencies. The experience of rebirth is typically associated with a sense of love, com-
many dramatic experient
existence passion, and reverence for life.
after completing the process of the ego death individuals consider human
Consciou sness is seen as supraord inated to Perinatal elements also play an important role in the dynamics of various
in a much broader spiritual framework.
s on the material plane appear absurd and ineffectiv e anxiety states and phobias, hysterical conversion symptoms, and certain aspects of
matter and drastic maneuver
es in individua l developm ent. No matter how difficult the obsessive-compulsive neuroses. Many sexual disorders and deviations seem to be
as a remedy for difficulti
suicide anchored on the perinatal level and can be logically explained from certain aspects
life situations and circumstances may be froin an objective point of view,
be a solution. and facets of the birth trauma. This is true for impotence, frigidity, menstrual
somehow no longer appears to
cramps, painful vaginal spasms during intercourse (dyspareunia), indulgence in
In our work with alcoholics and heroin addicts we made some interesting
ls. and preoccupation with biological material in a sexual context sucb as eating feces
observations that were quite similar to those concerning suicidal individua
and heroin addiction can be seen as and drinking urine (coprophilia and urolagnia), clinical sadomasochism, and
From a certain point of view, alcoholism
a long period of time; the underlyin g dynamics of certain cases of fetishism and homosexuality.
suicidal behavior extended over
ed Many important aspects of the schizophrenic process seem to represent peri-
suicide and addiction have much in common. LSD patients who had experienc
attitude toward natal elements in a more-or-less pure form. Here these deep unconscious contents
profound feelings of cosmic unity frequently developed a negative
The in- are not mitigated and modified by later biographical material, as is the case in
the states of mind produced by intoxication with alcohol and narcotics.
the nature of their addiction resemble d those of most of the disorders mentioned above. Thus the episodes of diabolic tortures, ex-
sights of these patients concerning
s. After they had discovere d and experienc ed feel- treme physical and mental suffering that seems endless, a deep sense of the absur-
persons with suicidal tendencie
really dity of existence, or visions of a monstrous world of cardboard characters and
ings of cosmic unity in their sessions, they realized that the state they had
ion. They recognize d a automatons described by many psychotic patients indicate the involvement of
been craving for was transcendence and not drug intoxicat
between the alcohol or heroin intoxica- BPM II. Sequences involving death, dismemberment, annihilation of the world,
certain superficial similarity and overlap
for cosmic catastrophes, distortions of the aggressive and sexual impulses, preoccupa-
tion and the unitive feelings evoked by LSD, and began to see that their desire
these two condition s. The elements that the tion with biological material, and experiential focus on the birth-sex-death triad
these drugs was based on confusing
rance or are characteristic of BPM III. Messianic delusions, identification with Christ, and
transcendental state has in common with these intoxications are disappea
( 282 | EFFECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY

experiences of rebirth or of recreation of the world are associated with the transi-
tion from the third to the fourth perinatal matrix. Facilitation and completion of
the death-rebirth process is associated with the disappearance of many of the
above psychotic symptoms.
The perinatal area of the unconscious thus scems to represent a universal,
undifferentiated matrix for a number of different psychopathological and psycho-
somatic symptoms and syndromes. Whether or not pathology develops and what
specific form it takes depends on the quality and nature of the individual's post-
natal life. This explains why experiences of death and rebirth may be associated
with dramatic improvements in a wide varicty of clinical conditions and prob-
lems. The therapeutic mechanisms available on this level are much more powerful
than any known to traditional psychiatry and psychotherapy. The profound
changes observed seem to involve a combination of two important therapeutic fac-
tors. The first one is release and discharge of enormous amounts of pent-up emo-
tions and physical sensations associated with BPM TL and III, which provide
energy for clinical symptoms. The second is the healing potential of unitive
ecstatic states experienced in the context of BPM LV and I. These experiences have
such a profound influence on clinical symptoms of various kinds, on the personal-
ity structure, hierarchy of values, and world-view that they deserve special note.
| believe that the expericntial content of the perinatal matrices cannot be
reduced to the memory of biological birth, However, one way of approaching this
new therapeutic principle is to focus on the biological aspects ol the perinatal
process. Whether or not an actual causal link can be established, experiences of
oceanic ecstasy and cosmic union seem to be deeply related to the undifferentiated
state of consciousness that an infant experiences in the symbiotic interaction with
the maternal organism during undisturbed intrauterine existence and nursing. The
association of the feelings of cosmic unity with good womb and good breast
experiences offers some clues for the understanding of their far-reaching healing
potential. It is a well-established fact of developmental psychology that the blissful
egoless states a child experiences during the carly period of ils life are very impor-
tant for his or her {future emotional development, stability, and mental health.
The experiences of cosmic unity induced in an adult by LSD or by various
non-drug techniques seem to be in this sense equivalent to good womb and good
breast experiences. They satisfy fundamental psychological and biological needs in
the individual and facilitate emotional and psychosomatic healing. The experience
of melted ecstasy can thus be seen as a retroactive intervention in the individual's
history and an anachronistic satisfaction of basic infantile needs. However, as im-
portant as the above incchanism night be, it reflects only one relatively superficial
facet of the experience of cosmic unity. To overemphasize the biological side of
this phenomenon would be to neglect its philosophical and spiritual dimensions.
An individual who has a transcendental experience develops an entirely new A unique series of paintings from being, the divine Self. It is sym-
image of his or her identity and cosmic status. The materialistic image of the uni- transpersonal sessions represent- bolized by the Black Sun which,
ing insights into the nature of unlike the sol niger of alchemy,
verse in which the individual is a meaningless speck of dust in the vastness of the
reality and the relationships be- is associated with transcendental
cosmos is instantly replaced by the mystical alternative. Within the new world- tween the ego, the Self and the bliss. The red stripes represent the
view, the very creative principle of the universe is expcrientially available to the universe. suffering which must be endured
individual and, in a certain sense, is commensurate and identical with him or her. Above. ‘Through Suffering to the in order to realize one's real
This is a drastic change of perspective and it has far-reaching consequences for Black Sun’, the manifestation of nature.
every aspect of life. the innermost core of the human
283
—ge
 at

The Black Sun is here depicted Self and the universal Self. The The process of creation and its erates the infinite richness of
as the ultimate source of creative insight shows a similarity to the relationship to the individual as form. In this case the created ele-
eriergy in the cosmos. In combi- Hindu concept of the relationship well as the universal Self. The ments are related to the vegetable
nation with the preceding paint- connecting Jiva with Atma- stream of creative cosmic ‘energy- kingdom: blossoming trees, flour-
ing this gives rise to the idea of Brahina and is especially striking consciousness’ emanates from its ishing meadows and aquatic
the ‘Beyond Within’, the essential as the subject was not fainiliar source, the Black Sun, and gen- plant forms.
identity between the individual with Indian philosophy.

284 285
 Therapeutic Mechanisms on the Transpersonal Level ‘287

In the cultural history of mankind, experiences of this kind have been

described in different frameworks for centuries or even millenia. They may occur
spontaneously in certain individuals under special circumstances, or be facilitated
by various spiritual procedures designed specifically for this purpose. Despite the
fact that both the existence of these experiences and their beneficial impact on ex-
perients have been known for such a long time, they have hardly ever been men-
tioned in the context of modern psychotherapy or therapy in general, Until the
publication of Abraham Maslow’s work, the only framework available in
psychiatry for “peak experiences” was that of schizophrenic symptomatology. The
healing potential of ecstatic states is of such paramount significance, however,
that it suggests an entirely new orientation in psychiatric therapy. We should
carefully study the characteristics of these states and develop new methods for
their facilitation and induction.

THERAPEUTIC MECHANISMS ON THE

TRANSPERSONAL LEVEL

Observations from LSD psychotherapy provide ample evidence that transpersonal

experiences are more than just curious phenomena of theoretical interest. In many
instances, specifie clinical symptoms are anehered in dynamic structures of a
transpersonal nature and cannot be resolved on the level of psychodynamic or
even perinatal experiences. In order to eliminate a specific emotional, psycho-
somatic, or interpersonal problem, the patieut sometimes has to experience dra-
matic sequences of a clearly transpersonal nature. Many unusual and interesting
observations clearly indicate the need to incorporate transpersonal aspects and ap-
proaches into everyday psychotherapeutic practice.
To the surprise of both patient and therapist, seemingly bizarre and
unexplainable experiences sometimes have a dramatic impact on certain clinical
symptoms and problems. Since the therapeutie process frequently leads into unex-
plored and uncharted territories, it requires considerable open-mindedness and an
adventurous spirit in both the client and the therapist. A therapist who adheres
rigidly to conventional paradigms and is unaware of and closed to unfamiliar
levels of consciousness will generally be less effective with patients whose problems
have a strong transpersonal emphasis. He or she will not encourage them to have
experiences that would resolve their symptoms, or might even implicitly and ex-
plicitly discourage them from entering transpersonal realms. Such an approach, in
addition to being therapeutically less effective, also fails to meet the intense
spiritual needs of these patients and give them sensitive guidance.
In some LSD patients difficult emotional symptoms that had not been
The process of cosmic creation the glowing magma. She related resolved on the psychodynamic or perinatal level disappeared or were mitigated in
through volcanic activity. The it to a primordial, intermediate connection with various embryonal experiences. Reliving attempted abortions,
patient, who in the perinatal state between consciousness and maternal diseases or emotional crises during pregnancy, and fetal experiences of
process had experienced the de- matter out of which all forms being unwanted (“rejecting womb”) can be of great therapeutic value. Particular-
structive power of volcanoes, was emerge and into which they even- ly dramatic instances of therapeutic change have been observed in connection
now appreciating the creative, tually return. with past-incarnation experiences. Sometimes these occur simultaneously with
mountain-forming potential of
perinatal phenomena, at other times they are independent thematic gestalts. The
subject experiences a sequence set in another country and/or a different historical
period, usually with deep emotional involvement and dramatic abreaction. This is
286
288 EFFECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY
Therapeutic Mechanisms on the Transpersonal Level ~ 289

SESE Pe
associated with a strong sense of reliving an episode from a previous incarnation.
A particular emotional, interpersonal or psychosomatic problem is felt to be a
meaningful part of a karmic pattern, and disappears when this gestalt is com-
pleted. In some instances this may be accompanied by independent synchronistic
changes in the lives and specific attitudes of people whom the subject denoted as
protagonists in the karmic scene. The following cpisode is a geod illustration of
this unusual phenomenon:

Tanya, a 34-year-old teacher and divorced mother of two children, was

undergoing LSD psychotherapy for depressions, anxiety states, and a prone-
ness to fatigue. One of her LSD sessions brought an unexpected solution
to a severe physical problem which had been considered purely or-
ganic in nature. For the previous twelve years she lad been suffering from
chronic sinusitis with occasional acute flare-ups because of colds or allergies.
The sinus troubles had started shortly after her wedding and represented a
severe inconvenience in her life. The major manifestations were headaches
and strong pains in the cheeks and teetli, low-grade fevers, heavy nasal clis-
charge, and bouts of sneezing and wheezing. On many occasions she was
awakened by a coughing attack; some mornings these symptoms lasted three
to four hours. Tanya had numerous tests for allergies and was treated by
many specialists with antihistamines, antibiotics, and flushing of the sinuses
with disinfectant solutions. When all this failed to bring any therapeutic Tanya's experience of a previous incarnation. Above her the dark figures of the crowd form
results, the doctors suggested an operation of the sinuses, which Tanya a circle against the night sky and the full moon.
declined.
In one of her LSD sessions, Tanya was experiencing suffocation, conges-
tion and pressure on her head in the context of the birth experience. She
nections Tanya made, convincing though they were on the subjective level,
recognized that some of these sensations bore a close resemblance to the
obviously did not constitute proof of the historical validity of the episode
symptoms associated with her sinus problems; however, they were greatly and of a causal link between the event and her sinus problems. Nor could
amplified. After many sequences that were clearly of a perinatal nature, the her conviction that she was dealing with a karmic pattern be considered evi-
experience opened fully into a reliving of what appeared to be a past- However, to the astonishment of
dence for the existence of reincarnation.
incarnation memory. In this context, the experiences of oppression, choking
everybody concerned, this experience cleared the chronic sinus condition
and congestion that had earlier been part of the birth trauma became symp-
that had plagued Tanya for a period of twelve years and had proved com-
toms of drowning. Tanya felt that she was tied to a slanted board and was pletely refractory to conventional medical treatment.
slowly being pushed under water by a group of villagers. After dramatic
emotional abreaction associated with screaming, violent choking, coughing,
It is interesting to note that this mechanism is not limited to psychedelic
and profuse secretion of enormous amounts of thick, greenish nasal dis-
states. Many similar observations have been reported by therapists who utilize
charge, she was able to recognize the place, circumstances and protagonists.
non-drug techniques, such as hypnosis, gestalt practice or primal therapy. Dennys
She was a young girl in a New England village who had been accused
Kelsey and Joan Grant (45) induce a hypnotic trance in their subjects and suggest
by her neighbors of witchcraft, because she was having unusual experiences
that they go back in time to find the source of their emotional or physical prob-
of a spiritual nature. A group of villagers dragged her one night to a nearby
lems. Without special programming, many of their subjects relive past-
birch-grove, fixed her to a board, and drowned her head-first in a cold
incarnation memories under these circumstances and resolve their symptoins in
pond. In the bright moonlight, she was able to recognize among her execu-
this context.
tioners the faces of her father and husband in her present lifetime. At this
One of their clients should be mentioued here because the mechanism in-
point, Tanya could see many elements of her current existence as approx- volved bears a elose resemblance to what I have observed many times during LSD
imate replicas of the original karmic scene. Certain aspects of her life, in-
psychotherapy. She suffered from a severe phobia of bird wings and feathers that
cluding specific patterns of interaction with her husband and her father, had resisted conventional psychological treatment for vears. Her difficult symp-
suddenly appeared to make sense, down to the most specific details.
tom was resolved after she relived with a dramatic abreaction a scene that had a
This experience of the New England drama and all the intricate con- past-incarnation experiential quality. She experienced herself in a male form, as a
 THERAPEUTIC MECHANISMS OF LSD THERAPY Therapeutic Mechanisms on the Transpersonal Level 991
290 EVPFECTIVE

Persian warrior who had been wounded by an arrow and was dying on the battle- months he had had little sleep, drank much coffee, and smoked two packs of
field. As he lay there approaching his terminal agony, vultures were gathering cigarettes a day. During the convalescence period following a heart attack,
around him, awaiting his death. They kept jumping toward him and pecking at he acquired Ernst Haeckel’s book Art Forms in Nature, (35) a collection of
him, while hitting his face with their wings. The patient found the roots of her plates depicting various animal forms in the evolutionary pedigree. He was
phobia of bird feathers in this horrifying experience; discharge of the emotional astounded when, looking through the book, he recognized many of the
energy together with the new insight freed her permanently from the tedious forins that had represented such an important part of his LSD sessions. In
symptom. an instant he received insights into the nature of the process that he never
Emmett Miller (70) has occasionally made similar observations using a hyp- completed. As a twin, he had to face special problems related to symmetry
notice technique which he calls selective awareness. There are psychologists and during his embryological development. [lis experiences of different stages of
psychiatrists in the United States who specialize in regressing their clients to the his embryological development were associated in the LSD sessions with
past-incarnation level to find the roots of individual and interpersonal problems. corresponding animal forms in accordance with Haeckel’s biogenetic law.?
Many past-incarnation experiences have been described in the context ofauditing In this context, he recognized that the heart as an asymmetrical organ pre-
sents special problems during embryogenesis. It was on this level, in the
realm of the basic geometry of nature, that Arthur found the deepest roots
memories emerge spontaneously in life; ‘they can have the same bene- of his life-long interest in matlematics, syminetry, and geometrical forms.
ficial consequences if they are allowed to reach completion. This raises a question
as to how many opportunities for effective therapeutic intervention have been In some instances, LSD patients recognized that some of their symptoms,
missed by Cartesian-Newtonian psychiatrists whose patients reported access to attitudes, and behavior were manifestations of an underlying archetypal struc-
karmic levels. The importance of transpersonal experiences for the therapeutic ap- .ture, Full experiential identification with the various archetypal entities can lead
proach to schizophrenia was illustrated earlier in this book by the history of to the resolution of such problems. Occasionally, the energy forms involved have
Milada. (see p. 245) such an alien quality that the behavior of the LSD subjects resembles what
Ancestral experiences can sometimes play a role similar to past-incarnation anthropologists have ascribed to spirit possession. In such cases the therapeutic
memories. In some instarices symptoms disappear after patients relive what they procedure can have many of the characteristics of exorcism as it was practiced in
feel are memories from the lives of their ancestors. I have also seen patients iden- the medieval church, or the expulsion of evil spirits in aboriginal cultures. Such
tify certain intrapsychic problems as internalized conflicts between the families of situations can be very demanding for both patient and therapist. The following
their ancestors and resolve them on this level. Some psychopathological and story is the most drainatic example of this phenomenon I have ever witnessed; the
psychosomatic symptoms can occasionally be traced back to elements of plant or fact that the patient had amnesia during most of the process distinguishes it from
animal consciousness. Thus, the complex and seemingly bizarre sensations of a other similar episodes.
female patient were resolved when she recognized them as states of vegetable con-
sciousness and allowed herself to identify with the experience of being a tree. In While working at the Maryland Psychiatric Research Center, I was in-
another patient, unusual physical feelings and symptoms of a severe hay fever vited to a staff conference at the Spring Grove State Hospital. One of the
were amplified by the effect of the drug and became authentic sensations of being psychiatrists was presenting the case of Flora, a 28-year-old single patient
an animal of another species. To illustrate the complexity and fascinating dimen- who had been hospitalized by then for more than eight inonths in a locked
sions of the problems in question I would like to describe a case that does not in- ward. All available therapy, including tranquillizers, antidepressants,
volve a clear therapeutic outcome but provides most interesting insights. psychotherapy, and occupational therapy, had been tried but failed, and
she was facing transfer to the chronic ward. Flora had one of the most com-
I was recently contacted by Arthur, a 46-year-old mathematician who plicated combinations of symptoms and probleins I have ever encountered
had had LSD experiences in the past for didactic purposes and as a means of in my psychiatric practice. When she was sixteen years old, she was a mem-
finding the roots of his neurotic symptoms. Much of the work he had done ber of a gang that conducted an armed robbery and killed a night watch-
in his sessions focused on problems of embryonal development and birth. He man. As driver of the get-away car, Flora spent four years in prison and was
had to face special complications in these areas owing to the fact that he had then placed on parole for the rest of her sentence. During the stormy years
a twin sister. In many of his LSD sessions he had visions and experiences of that followed, she became a multiple drug addict. She was an alcoholic and
creatures with complex geometrical organization. He felt very emotionally a heroin addict, and frequently used high doses of psychostimulants and
involved in these experiences, although they were strange and did not make barbiturates. Her severe depressions were associated with violent suicidal
any sense. He could not understand why he spent so much time on these tendencies; she frequently had impulses to drive her car over a cliff or col-
bizarre and incomprehensible forms. lide with another automobile. She suffered froin hysterical vomiting which
Several years later, long after he had discontinued the LSD sessions, he occurred easily in situations where she became emotionally excited. Prob-
overexerted himself while working on an involved project. For many ably the most agonizing of her complaints was a painful facial cramp, “tic
 EFFECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY Therapeutic Mechanisms on the Transpersonal Level 293
292

doloreux,” for which a Johns Hopkins neurosurgeon had suggested a brain ficult for me to control my fear and a tendency to enter into what I felt
operation consisting in severing the nerves involved. Flora was a lesbian and would be an active combat with the presence. I found myself thinking fast,
had severe conflicts and guilt about it; she had never had a heterosexual trying to choose the best strategy for the situation. At one point, I caught
intercourse in her life. To further complicate the situation, she was court- myself thinking that we should have a crucifix in our therapeutic armamen-
committed because she had severely wounded her girlfriend and rooin-mate tarium. My rationalization for this idea was that this was obviously an
while trying to clean a gun under the influence of heroin. : archetype that was manifesting and the cross could, under these circum-
At the end of the Spring Grove case conference, the attending psychi- stances, be a specific archetypal remedy.
atrist asked Dr. Charles Savage and me if we would consider LSD psychio- It soon became clear to me that my emotions, whether of fear or aggres-.
therapy. We found this an extremely difficult decision, especially because sion, were making the entity more real. I could not help thinking of scenes
this was at the time of the national hysteria concerning LSD. Flora had a from science fiction stories involving alien entities that fed on emotions.
criminal record already, she had access to weapons, and had severe suicidal Finally, I realized that it was essential for me to remain calm and centered.
tendencies. We werc well aware that the atinosphere was such that if we I decided to put myself into a meditative mood, while I held Flora’s
gave her an LSD session, whatever happened after that point would auto- cramped hand and tried to relate to her in the form in which I had known
matically be blamed on the drug, without regard to her past history. On the her before. At the same time, I tried to visualize a capsule of light envelop-
other hand, everything else had been tried without success and she was fac- ing us both, which intuitively seemed to be the best approach. The situation
ing a lifetime in a chronic ward. Finally, we decided to take the chance and lasted over two hours of clock-time; in terms of the subjective time-sense
accept her into the LSD program, feeling that her desperate situation these were the longest two hours I have ever experienced outside of my own
justified the risk. psychedelic sessions.
Flora’s first two high-dose LSD sessions were not much different from After this time, Flora’s hands relaxed and her face returned to its usual
many others J had run in the past. She faced a number of situations from form; these changes were as abrupt as the onset of the peculiar condition. I
her stormy childhood and repeatedly relived sequences of the struggle in the soon discovered that she did not remember anything of the two hours
birth canal. She was able to connect her violent suicidal tendencies and preceding. Later, in her write-up, she described the first hours of the session
‘painful facial cramps to certain aspects of the birth trauina, and to dis- and continued with the period following the “possession state.” I seriously
charge large amounts of intense emotion and physical tension. Despite this, questioned if I should discuss the time covered by her amnesia with her and
the therapeutic gains seemed to be minimal. decided against it. There did not seem to be any reason to introduce such a
In her third LSD session, nothing extraordinary happened during the macabre theme into her conscious mind.
first two hours; her experiences were similar to those of the previous two ses- To my great surprise, this session resulted in an astounding therapeutic
sions. Suddenly, she started complaining that the painful cramps in her face breakthrough. Flora lost her suicidal tendencies and developed new appre-
were becoming unbearable. Before our eyes, the facial spasms were gro- ciation for life. She gave up alcohol, heroin and barbiturates and started
tesquely accentuated and her face froze into what can best be described as a zealously attending the meetings of a small religious group in Catonsville.
mask of evil. She started talking in a deep, male voice and everything about For most of the time she did not have any facial cramps; the energy under-
her was so different that I could not see any connection between her present _lying them seemed to have exhausted itself in the “mask of evil” that she
appearance and her former self. Her eyes had an expression of indescribable maintained for two hours. The occasional recurrence of the pain was of
malice and her hands were spastic and looked like claws. negligible intensity and did not even require medication. She started experi-
The alien energy that took control over her body and voice introduced menting with heterosexual relations and eventually married. Her sexual
itself as the devil. He” turned directly to me, ordering me to stay away adjustment was not good, however; she was capable of intercourse, but
from Flora and give up any attempts to help her. She belonged to him and found it painful and not very pleasant. The marriage ended three months
he would punish anybody who dared to invade his territory. What followed later and Flora returned to lesbian relationships: this time, however, with
was explicit blackmail, a series of dismal descriptions of what would happen much less guilt. Her condition was so improved that she was accepted as a
to me, my colleagues, and the program if I would not obey. It is difficult to taxi driver. Although the following years had their ups and downs, she did
describe the uncanny atmosphere which this scene evoked; one could almost not have to return to the psychiatric hospital that could have become her
feel the intangible presence of something alien in the room. The power of permanent home.
the blackmail was further increased by the fact that it involved certain con-
‘crete information to which the patient in her everyday life could not have The above discussion and the two examples given represent only a small
access. sample of the observations I have made during twenty years of LSD research
I found myself under considerable emotional stress which had which suggest that transpersonal experiences can be of great therapeutic value.
metaphysical dimensions. Although I had seen similar manifestations in Whatever the therapist’s professional and philosophical opinion of the nature of
some LSD sessions, they were never so realistic or convincing. It was dif- transpersonal experiences, he or she should be aware of their therapeutic potential
294 ° EFFECTIVE THERAPEUTIC MECHANISMS OF LSD THERAPY Therapeutic Mechanisms on the Transpersonal Level 2935

and support clients if their self-exploration takes them into transpersonal realms. should be willing to support and validate the process as long as it does not involve
These observations from LSD _ psychotherapy regarding effective physical danger to the client or to others. Ultimately it does not seem to make any
mechanisms of therapeutic change clearly indicate that none of the existing difference which form the experience takes if the client is true to his or her process
psychological sclwols covers the entire spectrum of and provides an adequate ex- and surrenders to it fully. It can be a childhood memory, birth sequence, karmic
planatory framework for all the processes involved. Some of the major psyclio- constellation, phylogenetic episode, or demonic manifestation. The therapist
therapeutic orientations offer useful formulas in the area of the unconscious on should be sufficiently open-minded to encourage the client to follow the energy
which they focus. Thus Freudian psychoanalysis is of great help while the LSD flow, regardless of the specific content of the process. Completion of the experien-
sessions concentrate on the biographical level. The Rankian framework, with putial gestalt brings therapeutic results, whether or not the process has been intellec-
some important modifications, is relevant for understanding the biological aspects tually understood. After the process is completed, the therapist and the client can
of the death-rebirth process. The Reichian and neo-Reichian approaches give im- make attempts to put the events of the session into a theoretical framework.
portant theoretical and practical clues for dealing with the physical and energetic Depending on the nature and level of the experience, the system that offers the
aspects of the biographical or perinatal levels. Jungian psychology has explored best maps might be Freudian psychoanalysis, Rank’s psychology, the theoretical
and mapped many important experiential realms of the transpersonal domain. Yet constructs of C. G. Jung, Tibetan Buddhism, alchemy, Kabbalah, or some other
each of the above systems is only partially applicable to the psychedelic process, ancient cartography of consciousness, the mythology of a particular culture, or a
and a rigid adherence to any conceptual framework is ultimately antitherapeutic. particular spiritual system. However, the intellectual processing should be con-
In this matter, psychology and psychotherapy can learn an important lesson from sidered an interesting academic exercise that is not essential for therapeutic pro-.
modern physics. Recently, theoretical physicist Geoffrey Chew (20) has for- gress. Although on the surface this might be seen as intellectual anarchy breeding
mulated a revolutionary approach which he calls the “bootstrap” philosophy of conceptual chaos, it has a deep logic of its own and can be meaningfully related to
nature. In this view, the universe is seen not as a gigantic clockwork, an assembly a new model of the universe and of human nature. Discussion of this issue has to
of objects interacting with each other following the principles of Newtonian be reserved for the next volume.
mechanics, but as an infinitely intricate web of interrelated events. None of the
properties of any part of the web is fundamental; they all follow from the proper-

he
ties of the other parts, and the overall consistency of their interrelation determines
the structure of the entire web, The way in which various disciplines divide reality
NOTES
is ultimately arbitrary, and all scientific theories are only more or less useful
approximations.
1. The possible socio-political implications of this observation have been
In the field of consciousness research the closest parallel to Geoffrey Chew’s discussed in detail in my paper, “Perinatal Roots of Wars, Totalitarianism and
philosophy is the concept of spectrum psychology, formulated by Ken Wilber. Revolutions.” (33)
(103). It suggests that various existing schools accurately describe different levels 2. Ernst Haeckel’s biogenetic law states that during its individual development
or bands of consciousness but are not applicable to the psyche in its totality. It is (ontogeny) the organism repeats in a condensed way the history of the species
essential for effective LSD psychotherapy to approach the process of self- (phylogeny).
exploration from the point of view of spectrum psychology and in the spirit of
“bootstrap” philosophy. Theoretical models of any kind are only approximate and
useful organizations of data about a certain realm available at a certain time.
They should not be mistaken for accurate and exhaustive descriptions of the
world. To function as a facilitator of scientific progress rather than a hindrance, a
conceptual framework has to be tentative and flexible; it should respond or even
yield to new observations. Reality is always larger and more complex than the
most elaborate and encompassing theory. If the therapist confuses a theoretical
system with the “truth” about reality, this will sooner or later interfere with the
therapeutic process and create a serious impasse in the treatment of patients whose
therapeutic need is for experiences that the system does not include or allow.
My present opinion is that emotional and psychosomatic symptoms indicate
blockage of energy and ultimately represent potential experiences in a condensed_
form, trying to emerge. 1 believe the role of a therapist should be to help mobilize.
the energy and facilitate free experiential flow. He or she should not have any con-
ceptual or emotional investment in the nature of the resulting experience and
 EPILOGUE: *
THE FUTURE
OF LSD PSYCHOTHERAPY
In the preceding sections of this book I have tried to express and illustrate my
belief that LSD is a unique and powerful tool for the exploration of the human
mind and human nature. Psychedelic experiences mediate access to deep realms of
the psyche that have not yet been discovered and acknowledged by mainstream
psychology and psychiatry. They also reveal new possibilities and mechanisms of
therapeutic change and personality transformation. The fact that the spectrum of
the LSD experience appears puzzling to most professionals and cannot be ac-
counted for by the existing theoretical frameworks does not mean that the effects
of LSD are totally unpredictable. The safe and effective use of this drug requires a
fundamental revision of the existing theory and practice of psychotherapy. How-
ever, it is possible to formulate basic principles for LSD-assisted psychotherapy
which maximize its therapeutic benefits and minimize the risks.
It is very difficult at this point to predict the future of LSD psychotherapy.
The fact that it can be used safely and effectively does not automatically mean
that it will be assimilated by mainstream psychiatry. This issue is complicated by
many factors of an emotional, administrative, political and legal nature. How-
ever, we should clearly differentiate between the future of LSD psychotherapy
and its contribution to the theory and practice of psychiatry. I mentioned earlier
in this volume that LSD is a catalyst or amplifier of mental processes. If properly
used it could become something like the microscope or the telescope of psychiatry.
Whether LSD research continues in the future or not, the insights that have been
achieved in LSD experimentation are of lasting value and relevance.
The theoretical formulations and practical principles that LSD psycho-
therapy has discovered or validated include a new, expanded cartography of the
human mind, new and effective therapeutic mechanisms, a new strategy of
psychotherapy, and a synthesis of spirituality and science in the context of the
transpersonal approach. In addition, the recent rapid convergence between mys-
ticism, modern consciousness research and quantum-relativistic physics suggests
that psychedelic research could contribute in the future to our understanding of
the nature of reality.
It is true that psychedelic experimentation has its dangers and pitfalls. But
ventures into unexplored areas are never without risk. Wilhelm Conrad Roentgen,
the discoverer of x-rays, lost his fingers as a result of his experiments with the new
form of radiation. The mortality-rate of the early pilots who paved the way for
j
297
 298: LSD PSYCHOTHERAPY Epilogue: The Future of LSD Psychotherapy 299

ae
today’s safe jet travel was allegedly 75 percent. The degree of risk is directly pro- We should also mention important social forces that might play a role in the
portional to the significance of the discovery, and its potential; thus the invention future changes of policy toward psychedelic research. Many of the young persons
of gun powder involved a different level of risk from the developinent of nuclear who are in or will be moving into various positions of social relevance—as
energy. LSD is a tool of extraordinary power; after more than twenty years of lawyers, teachers, administrators, or mental health professionals —had intense ex-
clinical research I feel great awe in regard to both its positive and negative poten- posure to psychedelics during their student years. Those individuals who had expe-
tial. Whatever the future of LSD psychotherapy, it is important to realize that by riences themselves, or had the opportunity to observe the process in close friends
banning psychedelic research we have not only given up the study of an in- and relatives, will have formed an independent image and will not be dependent
teresting drug or group of substances, but also abandoned one of the most prom- on second-hand sources for information. Elements of sanity in the new marijuana
ising approaches to the understanding of the human mind and consciousness. laws in many states may be the first fruits of this development. The fact that
The present prospects for systematic LSD research and its extensive use in ritualized and responsible use of psychedelics received social sanction in some an-
psychotherapy look rather grim. It is difficult at this point to say whether or not cient societies and pre-industrial countries and was meaningfully woven into the
the situation will change, though there are indications that the general climate social | fabric represents a somewhat hopeful precedent.
might become more favorable in the years to come.
One of the major problems in LSD psychotherapy was the unusual nature
and content of the psychedelic experience. The intensity of the emotional and
physical expression characteristic of LSD sessions was in sharp contrast to the con-
ventional image of psychotherapy, with its face-to-face discussions or disciplined
free-associating on the couch. The themes of birth, death, insanity, ESP, cosmic
unity, archetypal entities, or past-incarnation memories occurring in psychedelic
states were far beyond the conventional topics of psychotherapy which empha-
sized biographical data.. An average professional at that time felt reluctance
toward or even fear of the experiential realms of this kind because of their associa-
tion with psychosis. At present, intense emotional outbursts, dramatic physical
manifestations, and various perinatal and transpersonal experiences are much
more acceptable to and less frightening for many therapists because they. can .be_
encountered quite routinely in the context of the new experiential therapies, such as
Gestalt practice, encounter groups, marathon and nude marathon sessions, primal
therapy, and various neo-Reichian approaches. Many modern therapists value
and encourage various dramatic experiences which in the framework of classical
analysis would be seen as dangerous acting-out and considered a reason for discon-
tinuation of treatment or even psychiatric hospitalization. Some modern ap-
proaches to schizophrenia actually encourage deep experiential immersion into the
process instead of its chemical inhibition. For new therapists of the above orienta-
tion, psychedelics would naturally be the next step to help accelerate and deepen’
the process. ,
LSD entered the scene at the time of the psychopharmacological revolution,
when new tranquillizers and antidepressants had their early triumphs and
generated excessive hope for easy chemical solutions to most of the problems in
psychiatry. At present much of the original enthusiasm in this area has tapered
off. While appreciating the humanization of the mental hospitals and pacification
of psychiatric wards which has brought their atmosphere close to that of general
hospitals, it is becoming increasingly obvious that tranquillizers and antidepres-
sants are, by and large, only symptomatic remedies. They do not solve the prob-
‘lems and in more serious cases lead to a life-long dependence on maintenance
medication. In addition, there is an increasing number of professional papers that
emphasize the dangers of inassive use of these drugs—irreversible neurological
symptoms of tardive dyskinesia, degenerative ‘changes in the retina, or actual
physiological addiction with a withdrawal syndrome.
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 Crisis Intervention

to
the problem I will briefly review the most pertinent data here and apply them
the area in question.

THE NATURE AND DYNAMICS OF

APPENDIX: PSYCHEDELIC CRISES
Crisis Intervention in Situations Understanding the dynamics of psychedelic experiences is absolutely necessary for
a
Related to Unsupervised Use effective crisis intervention. A difficult LSD experience, unless it results from
gross abuse of the individual, represents an cxteriorization of a potentially patho-
of Psychedelics genic matrix in the subject's unconscious. If properly handled, a psychedelic crisis
has great positive potential and can result in a profound personality trans-
formation. Conversely, an insensitive and ignorant approach can cause psycho-
logical damage and lead to chronic psychotic states and years of psychiatric
hospitalization.
Since the mid-sixties, when experimentation with LSD and other psychedelics Before discussing the difficult experiences that occur in psychedelic sessions,
moved from psychiatric institutes and clinics to private homes and public places, their causes, and the principles of crisis intervention, we will summarize our
the role of mental health professionals in regard to these substances has been dras- previous discussions about the nature and basic dynamics of the LSD process. LSD
tically redefined. Instead of being in the forefront as experimenters and research- does not produce a drug-specific state with certain stereotypical characteristics; it
ers they have become the rescuers and undertakers called upon to deal with the can best be described as a catalyst or amplifier of mental processes that mediates
casualties of the psychedelic scene. This development has contributed considerably access to hidden recesses of the human mind. As such, it activates deep repositories
it
to the present attitudes of most professionals toward these drugs; the primary of unconscious material and brings their content to the surface, making
focus of psychiatrists and psychologists has shifted from the therapeutic potential available for direct experience.
of psychedelics to their dangers. In the highly emotional atmosphere created by A person taking the drug will not experience an “LSD state” but a fantastic
sensational publicity, professionals have allowed their image of LSD to be shaped: journey into his or her own mind. All the phenoinena encountered during this
by journalists and newspaper headlines rather than scientific data generated by journey—images, emotions, thoughts and psychosomatic processes—should thus
research. Consequently, the casualties and complications of unsupervised experi- be seen as manifestations of latent capacities in the experient’s psyche rather
mentation with LSD, instead of being attributed to irresponsible and ignorant than symptoms of “toxic psychosis.” In the LSD state the sensitivity to external
use, have been interpreted as reflecting dangers inherent in the drug itself. factors and circumstances is intensified to a great degree. These extraphar-
Restrictive legislation has practically destroyed scientific research of psyche- macological influences involve all the factors usually referred to as “set and set-
delic substances, but has not been very effective in curbing unsupervised experi- ting”: the subject's understanding of the effects of the drug and purpose of inges-
mentation. While samples of psychedelic drugs of doubtful quality are readily tion, their general approach to the experience, and the physical and interpersonal
available in the streets and on college campuses, it is nearly impossible for a elements of the situation. A difficult LSD experience thus reflects either a
serious researcher to get a license for scientific investigation of their effects. As a pathogenic constellation in the experient’s unconscious, traumatic circumstances,
result of this, professionals are in a very paradoxical situation: they are expected to or a combination of the two.
give expert help in an area in which they are not allowed to conduct research and Ideal conditions for an LSD session involve a simple, safe and beautiful
generate new scientific information. The widespread use of psychedelics and rela- physical environment and an interpersonal situation that is supportive, reassuring
tively high incidence of drug-related problems are in sharp contrast to the lack of and nourishing. Under these circumstances, when disturbing external stimuli are
understanding of the phenomena involved; this is true for the general public as absent, negative LSD experiences can be seen as psychological work on the
well as the majority of mental health professionals. traumatic areas of one’s unconscious. It is essential for the good outcome of an
This situation has very serious practical consequences. Various emergencies LSD session to keep it internalized and fully experience and express everything
associated with psychedelic drug use are handled in a way that is at best ineffec- that is emerging. Psychedelic sessions in which the subject does not stay with the
tive, but more likely counter-productive and harmful. Crisis intervention in process tend to create a dysbalance in the basic dynamics of the unconscious. The
psychedelic sessions and treatment of the long-term adverse effects of unsupervised defense system is weakened by the effect of the drug, but the unconscious material
self-experimentation are issues of such medical and social relevance that they that has been released is not adequately worked through and integrated. Such ses-
deserve special attention. Much of the information that is essential for understand- sions are conducive to prolonged reactions or to subsequent “flashbacks.”
ing the problems involved and for an effective approach to this area has been The only way to facilitate the completion and integration of an LSD session
presented in various sections of this book. However, because of the importance of in which the experiential gestalt remains unfinished is to continue the uncovering
306
308 LSD PSYCHOTHERAPY: APPENDIX I Crisis Intervention 309

work, with or without psychedelics. It is important to emphasize that the effect of and successful LSD session, and these are seldom available under these circum-
LSD is essentially self-limited; the overwhelming majority of difficult psychedelic stances. Not infrequently the person under the influence of LSD is surrounded
experiences reach a resolution quite spontaneously. Actually, those states that are by total strangers. In some other instances good friends may be present, but they
most dramatic and stormy tend to have the best outcome. The use of tranquillizers are themselves under the influence of the drug or are unable to tolerate and
in the middle of a psychedelic session is a grave.error and may be harmful. It tends handle intense and dramatic emotional experiences. When a group of people take
to prevent the natural resolution of the difficult emotional or psychosomatic LSD together, the painful experiences of one person can create a negative at-
gestalt and to “freeze” the experience in a negative phase. The only constructive mosphere which contaminates the sessions of others. There have even been
approach is to provide basic protection to the subject, and support and facilitate episodes in which persons who took LSD or were given the drug were, for a varie-
the process; the least one can do is to not interfere with it. ty of reasons, exposed to deliberate psychological abuse. It is easy to understand
After this brief introduction, we can return to the problem of complications that such toxic circuinstances are highly conducive to adverse reactions.
during unsupervised psychedelic experimentation. Although the basic principles
discovered during clinical research with LSD are directly applicable to crisis in-
tervention, it is inyportant to emphasize the basic differences between the two PROFESSIONAL CRISIS INTERVENTION
situations. The LSD administered in clinical and laboratory research is phar- AND THE SELF-HELP APPROACHES
maceutically pure and its quality can be accurately gauged; most black market
samples do not meet these criteria. Only a small fraction of a “street acid” The present intervention offered by professionals in psychedelic crises is based on
specimen is relatively pure LSD; the black market preparations frequently contain the medical model and usually creates more problems than it solves. The steps
various impurities or admixtures of other drugs. In some of the street samples that typically taken under these circumstances reflect a serious lack of understanding of
have been analyzed in laboratories, researchers have detected amphetamines, the nature of the psychedelic experience, and are conducive to long-term com-
STP, PCP, strychnine, benactyzine, and even traces of urine. There have been in- plications. This is further complicated by the numerous demands on the time of a
stances where alleged LSD samples contained some combination of the above mental health practitioner and a lack of adequate facilities for handling casualties
substances and no LSD whatsoever. The poor quality of many of the street from the psychedelic scene. The tranquillizers that are routinely administered
specimens is certainly responsible for some of the adverse reactions that occur in under these circumstances tend to prevent effective resolution of the underlying
the context of unsupervised self-experimentation. In addition, uncertainty about conflict and thus contribute to the incidence of chronic emotional aud psych-
quality and dosage and the resulting fears can have a negative influence on the somatic difficulties after the session. Instant transfer of the individual to a psychi-
ability of the subject to tolerate unpleasant experiences, which are then readily in- atric facility in the middle of the LSD experience is not only unnecessary, but
terpreted as signs of toxicity or overdose rather than manifestations of the users’ represents a dangerous and harmful practice. It disregards the fact that the LSD
unconscious. state is self-limiting; in most instances, a dramatic negative experience if properly
However, the quality of drug and the uncertainty about it seem to be re- handled will result in a beneficial resolution and the subject will not need any fur-
sponsible for a relatively small fraction of the adverse reactions to LSD. There is ther treatment, The “emergency transfer” to a psychiatric facility, particularly if
no doubt that extrapharmacological elements, such as the personality of the sub- it involves an ambulance, creates an atmosphere of danger and urgency that con-
ject and the set and setting, are by far the most important factors. tributes considerable additional trauma for a person who is already extremely
In order to understand the frequency and seriousness of psychedelic crises sensitized by the psychedelic state and the painful emotional crisis. The same is
that occur in the context of unsupervised self-experimentation, it is important to true of the admission procedure in the psychiatric facility and the atmosphere of
take into consideration the circumstances under which many people tend to take the locked ward which is the final destination of many psychedelic casualties.
LSD. Some of them are given the drug without any prior information about it, Exposure to the routines of the psychiatric machinery while under the in-
without adequate preparation, and sometimes even without forewarning. The fluence of LSD can cause a life-long trauma. The fact that psychiatric diagnosis
general understanding of the effects of LSD is poor, even among experienced and hospitalization may often represent a serious social stigma is another impor-
users. Many of them take LSD for entertainment and have no provisions in their tant factor to consider before proceeding with an unnecessary transfer and admis-
conceptual framework for painful, frightening and disorganizing experiences. Un- sion. Moreover, if the LSD process does not reacl: a satisfactory resolution, con-
supervised experimentation frequently takes place in complex and confusing temporary psychiatric care applies continued medication with tranquillizers
physical and interpersonal settings that can contribute many important traumatic instead of the uncovering therapy that is the preferred treatment under these
elements. The hectic atmosphere of large cities, busy highways in the rush hour, circumstances.
crowded rock concerts or discos, and noisy social gatherings are certainly not set- The basic points of the above discussion can be illustrated with the following
tings conducive to productive self-exploration and safe confrontation with the example:
difficult aspects of one’s unconscious.
Personal support and a relationship of trust are absolutely crucial for a safe When I was working in the Psychiatraic Research Institute in Prague,
310 LSD PSYCHOTHERAPY: APPENDIX I Crisis Intervention 311

Czechoslovakia, I was asked as consultant to see two employees of the phar- elements of BPM II, and the confinement in the locked ward and his adven-
maceutical laboratories that were involved in the production of LSD. They ‘tures there represented a powerful reinforcement of his desperate state.
had both suffered delayed adverse effects of an accidental intoxication with The experience of his research assistant was more superficial; her reac-
LSD, while synthesizing the drug. One of them, a man in his forties who tion to the atmosphere of the locked ward was to pull herself together and
was heading the department, showed symptoms of deep depression with oc- maintain control at any cost. Retrospective analysis of her experience
casional bouts of anxiety, a sense of meaninglessness of existence, and doubts showed that she was approaching a traumatic childhood memory, but
about his sanity. He datcd these symptoms to the time of his intoxication because of the external circumstances she suppressed it and prevented it
with LSD and subsequent brief hospitalization in a psychiatric facility. His from surfacing. Her fecling of losing her hair turned out to be a symptom
assistant, a woman in her twenties wlio had experienced accidental intoxica- related to this deep psychological regression; the infantile body image cor-
tion with LSD several months after he did, complained about bizarre sensa- responding to the age when she experienced the traumatic event involved
tions in her scalp; she was convinced that she was rapidly losing her hair,
although there were no objective signs to support this. During their visit to the Psychiatric Research Institute in Prague these
During the diagnostic interviews with them I tried to reconstruct the two pharmaceutical workers were able not only to work on their symptoms,
circumstances of their LSD experiences and the dynamics of the problems but also to change their image of LSD and the negative feelings associated
they presented. The story that I heard, although unbelievable of LSD thera- with it. We explained to them the nature of the LSD state and discussed
pists or people familiar with the nature of psychedelic states, is unfortunate- with them our therapeutic program and the principles of conducting ses-
ly a typical example of crisis intervention based on the conventional medical sions. Before they left they had ample opportunity to discuss the effects of
and psychiatric models. The pharmaceutical laboratories that were involved LSD with patients undergoing psycholytic treatment who had experienced
in the production of LSD were situated approximately two hundred miles their sessions under substantially different circumstances. I assured them
from Prague, where most of the clinical and laboratory research with that there was no reason for alarm if someone was intoxicated by LSD; as a
psychedelics was happening at that time. When the managernent received matter of fact, we were producing situations like that routinely in our pro-
the order to start the synthesis of Czechoslovakian LSD, it was felt that, gram. They were advised to have a special, quiet room where the intox-
because of the nature of the substance, the staff should be informed about its icated individual could spend the rest of the day listening to music in the
effects and instructed about the necessary measures in case of accidental in- company of a good friend.
toxication. The director invited from the nearby state mental hospital a Several months later, I received a call froin the department chief. He
psychiatrist who had no personal or professional experience of LSD and pre- told me that they had had another “accident”; a nineteen-year-old labora-
pared himself by reading a few papers on the “model psychosis” approach to tory assistant had experienced a professional intoxication. She spent the day
schizophrenia. During the seminar with the staff, this superficially informed in a comfortable room adjacent to her laboratory in the company of her
psychiatrist managed to paint an apocalyptic picture of LSD. He told them friend and “had the time of her life.” She found her experience very
that this colorless, odorless and tasteless substance could insidiously enter pleasant, interesting and beneficial.
their system, as had happened to Dr. Albert Hofmann, and induce a state of
schizophrenia. He suggested that they should keep a supply of Thorazine in The avoidance techniques developed by the. self-help movement, although
their first-aid kit and in case of accidental intoxication bring the tranquil- less harmful than the approach based on the medical and psychiatric model, are
lized victim without delay to the psychiatric hospital. also counterproductive. Attempts to engage the subject in superficial conversations
As a result of these instructions, both laboratory workers received (“talking them down”), to distract them by showing them flowers and beautiful
Thorazine shortly after they had started to feel the effects of the drug, and pictures, or taking them for a walk does not solve the underlying problem. This
were rushed in an ambulance to the locked ward of the state mental can be seen at best as playing for time—keeping the individual occupied with
hospital. There they spent the rest of the intoxication period and a few distracting maneuvers until the crisis subsides or diminishes with the waning of
following days in the company of psychotic patients. While under the in- the pharmacological effect of the drug. These approaches are based on the erro-
fluence of the LSD-Thorazine combination, the department chief witnessed neous assumption that the drug has created the problem. Ounce we realize that we
several grand mal seizures and had a long discussion with a patient who was ‘are dealing with the dynainics of the unconscious, not a pharmacological state,
showing him his wounds after a suicide attempt. The fact that he was put the short-sightedness of this approach becomes obvious. The danger in using tech-
by mental health experts in the company of severely disturbed patients con- niques that encourage avoidance lies in the failure to confront and resolve the un-
tributed considerably to his fear that he might himself be developing a conscious material that underlies the emotional and psychosomatic crisis. LSD ses-
similar condition. Analysis of his LSD state, which was only incompletely sions in which the emerging gestalt is not completed are conducive to prolonged
truncated by the Thorazine medication, showed that he was experiencing reactions, negative emotional and physical aftereffects, and “flashbacks”.
312 LSD PSYCHOTHERAPY: APPENDIX 1 Crisis Intervention

COMPREHENSIVE CRISIS INTERVENTION cumstances, it would be a mistake to attribute all “bad trips” to the drug itself.
IN PSYCHEDELIC EMERGENCIES The psychedelic state is determined by a variety of non-drug factors; the incidence
of serious complications depends critically on the personality of the subject, and
Having discussed the factors that contribute to the development of emergencies in the elements of set and setting. This can be illustrated by comparing the incidence
unsupervised LSD sessions and described the harmful practices that characterize of complications during the early supervised experimentation with LSD, and the
most professional and lay interventions, I would like to outline what I consider the psychedelic scene of the sixties. In 1960, Sidney Cohen published a paper entitled,
optimal approach to psychedelic crises, based on the understanding of their LSD: Side Effects and Complications. J. Nerv. Ment, Dis. 130:30, 1960. It was
dynamics. What constitutes an emergency in an LSD session is highly relative, based on reports from forty-four professionals who had administered LSD and
and depends on a variety of factors. It reflects an interplay between the subject’s mescaline to about five thousand persons over twenty-five thousand times; the
own feelings about the experience, the opinions and tolerance of the people pres- number of sessions per person ranging between one and eighty. In the group of
ent, and the judgment of the professional called upon to offer help. This last is a normal volunteers, the incidence of attempted suicides after the session was less
factor of critical importance; it depends upon the therapist’s degree of understand- than one in a thousand cases, and that of prolonged reactions lasting over forty-
ing of the processes involved, his or her clinical experience with unusual states of eight hours was 0.8 per thousand. The numbers were somewhat higher when psy-
consciousness, and his or her freedom from anxiety. In psychedelic crisis interven- chiatric patients were used as subjects; in every thousand patients there were 1.2
tion, as in psychiatric practice in general, drastic measures frequently reflect the suicide attempts, 0.4 completed suicides and 1.8 prolonged reactions lasting over
helpers’ own feelings of threat and insecurity, not only vis 4 vis possible external forty-eight hours. In comparison with other methods of psychiatric therapy,
danger, but also in relation to their own unconscious. The experience from LSD therefore, LSD appeared to be unusually safe, particularly when contrasted with
therapy and the new experiential psychotherapies clearly indicates that exposure other procedures used routinely in psychiatric treatment at that time, such as elec-
to another person’s deep emotional material tends to shatter psychological defenses troshocks, insuline comas, and psychosurgery. These statistics contrast sharply
and to activate corresponding areas in the unconscious of the persons assisting and with the incidence of adverse reactions and complications associated with un-
witnessing the process, unless they have confronted and worked through these supervised experimentation. During my visit to the Haight-Ashbury clinic in San
levels in themselves. Since traditional psychotherapies are limited to work on Francisco in the late sixties, I was told by its director David Sinith that tliey were
biographical material, even a professional with full training in analysis is inade- treating an average of fifteen “bad trips” a day, Although this does not necessarily
quately prepared to deal with powerful experiences of a perinatal and transper- mean that all these clieuts had long-lasting adverse effects from their psychedelic,
sonal nature. The prevailing tendency to put all such experiences into the category; experiences, it illustrates the issue in question.
of schizophrenia and suppress them in every way reflects not only a lack of under- The experience and sophistication of psychiatrists and psychologists in rela-
standing, but also a convenient self-defense against the helpers’ own unconscious tion to psychedelics was certainly not great during the early years and the settings
material. were far from ideal. However, the sessions reported in Dr. Cohen’s paper were
As the sophistication and clinical experience of LSD therapists has increased, conducted in protected environments, under reasonable supervision and by
it has become more and more evident that negative episodes in psychedelic sessions responsible individuals. In addition, those who had difficult experiences were in a
should not be seen as unpredictable accidents, but intrinsie and lawful aspects of place that was equipped to provide help in case of need and they did not have to
the therapeutic work with traumatic unconscious material. From this point of be subjected to the absurd ordeal of transfer to a psychiatric facility.
view the colloquial term “bummer” or “bad trip” does not make sense. To an The psychedelic crisis is caused by a complicated interplay of internal and
experienced LSD therapist an unsuccessful psychedelic session is not one in which external factors. The therapist has to distinguish which of the two sets of influ-
the subject experiences panic anxiety, self-destructive tendencies, abysmal guilt, ences is more important and proceed accordingly. The first and most important
loss of control, or difficult physical sensations. If properly handled, a painful and step in handling a psychedelic crisis is to create a simple, safe and supportive
difficult LSD session can bring about an important therapeutic breakthrough. It physical and interpersonal environment for the subject. In cases where external
can facilitate resolution of problems that have plagued the subject in subtle ways factors seem to have played a crucial role, it is important to remove the individual
for many years and contaminated his or her everyday life. An unsuccessful session, from the traumatic situation or change it by active intervention. If the crisis
however, is one in which difficult feelings begin to emerge, the subject does not occurred in a public locale, he or she should to be taken to a quiet, secluded place.
fully surrender to the process and the gestalt remains unresolved. From this point If the incident happens during a party in a private residence, it is important to
of view, all psychedelic experiences in which the process is thwarted by the simplify the situation by moving to a separate room or asking the guests to leave.
administration of tranquillizers and external distractions such as transfer to a A few close friends who appear sensitive and mature may be asked to assist in the
psychiatric hospital are not failures because of the nature of the psychological pro- process. They can provide group support or help the subject to actively work
cess involved, but because the crisis management has interfered with a positive through the underlying problem during the termination period of the session. The
resolution. techniques of group involvement in psychedelic sessions have been discussed
Although LSD can induce difficult experiences even under the best cir- earlier in this book {p. 157).
 314 LSD PSYCHOTHERAPY: APPENDIX 1 Crisis Intervention ©i B15
N.

After creating a safe environment the next important task is to establish playing for time might be the only solution. Under such circumstances, it is essen-
good contact with the subject. A relationship of trust is probably the most signifi- tial to use any possible means and existing resources to keep the LSD subject from
cant prerequisite for the positive outcome of a psychedelic session in general and hurting himself or others and causing serious material damage. While following
for successful handling of a crisis in particular. A person asked to intervene in a this basic rule, occasional attempts should be madc to establish rapport and gain
crisis triggered by LSD is at a great disadvantage as compared to an LSD therapist the individual’s cooperation.
facing a similar situation in the course of psychedelic treatment, because the ' If the gestalt of the experience remains unfinished when the effect of the
therapeutic session is preceded by a drug-free preparation period during which drug is subsiding, psychological and physical activity should be used to facilitate
there is enough time to establish good contact and a relationship of trust. If a dif- integration. Ideally, the subject should complete the session feeling comfortable
ficult situation arises in the course of an LSD series, the client can also draw on his and relaxed, without any residual emotional or psychosomatic symptoms. The
or her memories of previous sessions where painful experiences had been success- two techniques that have proven useful in this context—-the abreactive approach
fully worked through and integrated with the help of the therapist. and the cleansing hyperventilation—have been discussed earlier in this book (pp.
In contrast, the professional dealing with a crisis outside of the therapeutic 156-7, 159-60). After the subject reaches a psychologically and physically com-
context walks into the emergency situation as a stranger, usually without any fortable state, it is important to create a safe and nourishing atmosphere for the
previous contact with the subject and other persons involved. Trust and coopera- rest of the day and night. Ideally, a person who has been through a psychedelic
tion have to be established in a very short time and often under dramatic cir- crisis should not be left alone for at least twenty-four hours after the ingestion of
cumstances. Freedom from anxiety, an ability to remain centered, deep empathy, the drug. After this time the therapist should see the client again, reevaluate the
and intimate knowledge of the dynamics of psychedelic states are the only means situation and, depending on his or her condition, choose the future strategy. In
of generating trust under these circumstances. most instances no further provisions are necessary if the crisis was properly handled.
It is essential to convey a sense of safety and security by emphasizing the self- *
It is useful to discuss the LSD experience in detail and facilitate its integration into
limiting nature of the LSD experience. No matter how critical the condition ap- the client’s everyday life. If significant emotional and psycliosomatic complaints
pears to be, in most instances it will be resolved spontaneously five to eight hours have appeared as a result of the LSD experience, arrangements should be made
after the ingestion of the drug. This time limit should be clearly communicated to for follow-up uncovering therapy and body work. An individualized selection of
the subject and other people present; until that time there is absolutely no reason meditation techniques, Gestalt practice, neo-Reichian approaches, guided
to panic or worry, however dramatic the emotional and psychosomatic manifesta- imagery with music, controlled breathing, polarity massage or rolfing should be
tions might be. It is also of great advantage to keep the subject in a reclining posi- offered to the client.
tion, but this should be attained without using physical force and open restraint. Where the clinical condition remains precarious despite all the uncovering
With a little experience, one can develop a technique with which it is possible to work, this treatment may have to be continued on an in-patient basis. If all the
effectively restrain the individual using a context of support and cooperation above approaches prove ineffective, integration can be facilitated by chemical
rather than conflict. ‘means. Ideally, a supervised psychedelic session should be scheduled after ade-
When adequate contact has been established, a positive framework should quate preparation. This approach might seem paradoxical to the average mental
’ be offered for the difficult LSD experience. It is essential to present it as an oppor- heaith professional, since it involves administration of the same drug or category
tunity to face and work through certain traumatic aspects of one’s unconscious of drugs that apparently brought the client trouble in the first place. Yet judicious
rather than as an unfortunate and tragic accident. A person assisting in a use of psychedelics under these circumstances is the preferred treatment. Clinical
psychedelic crisis should make consistent attempts to internalize the experience of. __ experiences have shown that it is extremely difficult to restore defenses by the use of
the LSD subject and encourage him or her to face the critical issues involved. The
LSD subject should be encouraged to keep his or her eyes closed and confront the by a powerful psychedelic substance. It is ‘much easier to continue the uncovering
experience, whatever it is. The therapist should repeatedly communicate to the strategy and facilitate completion of the unfinished gestalt.
subject that the quickest way out of this difficult state is through surrendering to Psilocybin, methylene-dioxy-amphetamine (MDA), tetrahydrocannabinol
the emotional and physical pain, experiencing it fully and finding appropriate (THC), and dipropyltryptamine (DPT) are viable alternatives to LSD. They have
channels to express it. This process of surrendering can be greatly facilitated by the same general effects and are less contaminated by bad publicity. MDA and
music. If a good high-fidelity stereo set is available, and the subject is open to it, THC seem to be particularly useful in this context, because of their gentle effect
music should be introduced into the situation as soon as possible. and selective affinity to positive governing systems in the unconscious. Effective
When good rapport has been established, it is possible to offer active psychological work with these substances involves less emotional and
assistance using comforting physical contact, elements of playful struggle, and psychosomatic pain than when LSD is used.
pressure on or massage of the parts of the body where the energy appears to be__ Since the above psychedelics are not readily available, and obtaining per-,
blocked. This should not be done if the trust bond is precarious or absent; it is ab- mission to use them involves tedious administrative procedures, a session with
solutely contraindicated if the subject is paranoid and includes the people present Ritaline (100-200 milligrams) or Ketalar (100-150 milligrams) might be a more
among his or her persecutors. In some instances simply being with the client and feasible approach. Tranquillizers should not be used in any condition related to
316 LSD PSYCHOTHERAPY: APPENDIX I Crisis Intervention 317

the use of psychedelic drugs until all the above uncovering approaches have been ing them retrospectively useful. His condition oscillated for about an hour
tried and have failed. oe between mistrust with anxiety-laden aggressive impulses, and episodes of
Powerful non-drug approaches could also be used in lieu of tranquillizers in relief when it was possible to connect with him.
all those cases where a poorly resolved LSD experience results in a long-term. % As time went by and the LSD state became less intense, Peter slowly
psychotic condition and psychiatric hospitalization lasting months or years. If _ : | developed trust. He was more and inore willing to keep his eyes closed and
these do not bring about sufficient clinical improvement, psychedelic therapy, us-' face the experience, and we were even able to start working carefully on the
ing the substances mentioned above, is the next logical choice. Ketalar, a drug _blocked parts of his body, encouraging full emotional expression. By seven

oe
that is legally available and has been used in a medical context for general o'clock all negative elements completely disappeared from Peter's LSD expe-
anesthesia could prove promising in these otherwise desperate cases. rience. He felt cleansed and reborn, and was thoroughly enjoying the new
I would like to conclude this discussion of psychedelic crisis intervention day. His previous hostility turned into deep gratitude and he kept repeating
with a description of the most dramatic situation of this kind I have encountered how much he appreciated our intervention.
in my professional career. At about half-past-seven Laura appeared at the camper and joined us;
she was herself in very good condition, but was naturally concerned about
In my third year in Big Sur, California, I was awakened at 4:30 one Peter. Rick and I helped dispel the negative aftermath of the dramatic
morning by a telephone call. It was the night guard from the nearby Esalen events of the night and facilitated their reunion. We advised them strongly
Institute asking for help. A young couple called Peter and Laura, who were against driving that day. They spent a leisurely day by the Pacific Ocean
traveling down the coast, had parked their VW camper on coastal route | in and the next day continued their journey south. They were both in good
the vicinity of the Esalen Institute and had decided to take LSD together. spirits, although somewhat worried about the bill for the repair of their
They rolled out the bed in their car and shortly after midnight both of them damaged camper.
ingested the drug. Laura’s experience was relatively smooth, but Peter pro- 4
gressively developed an acute psychotic state. He became paranoid and
violent, and after a period of verbal aggression he started throwing things
around and demolishing the car. At this point Laura panicked, locked him
in the car and sought help at Esalen. She appeared at the guard shack com-
pletely naked, holding the car keys in her hand. The night guard knew
about my previous work with psychedelics and decided to give me a call; he
also woke up Rick Tarnas, a resident psychologist who had done his disser-
tation on psychedelic drugs.
While the guard was taking care of Laura, who calmed down and had
a pleasant, uncomplicated LSD experience, Rick and I walked to the
camper. As we approached the car we heard loud noises and shouting;
when we came closer we noticed that several of the windows were broken.
We unlocked the car, opened the door and started talking to Peter. We in-
troduced ourselves and told him that we had had considerable experience
with psychedelic states and had come to help him. I tentatively stuck my
head inside the door and looked into the camper; a half-gallon bottle missed f
me by about four inches and landed on the dashboard. I repeated this
several times, and two more objects came flying in my direction. When we
felt that Peter had nothing more to throw, we quickly moved into the
camper and lay down on the roll-out bed on either side of him.
We continued talking to Peter, reassuring him that everything would be
all right in an hour or two; knowing that he and his girlfriend had taken
LSD after midnight, we could give him this definite time limit. It became
obvious that he was in a paranoid state and saw us as hostile FBI agents
who had come to fetch him. We held his arms in a comforting and reassur-
ing way, changing this into a firm grip whenever he made an attempt to
escape, but avoiding real physical antagonism and struggle. All the while,
we kept talking about having had difficult experiences ourselves, and find-
 APPENDIX:
The Effects of LSD on
Chromosomes, Genetic
Mutation, Fetal Development
and Malignancy

In the last decade, a serious new dimension has been added to the LSD contro-
versy. A number of scientific papers have been published indicating that LSD
might cause structural changes in the chromosomes, genetic mutations, distur-
bances of embryonic development, and malignant degeneration of cells. However,
a comparable number of publications question the accuracy of these allega-
tions. Some are independent experimental studies which have yielded negative
results, others criticize the original papers for serious conceptual and methodolog-
ical inadequacies. Despite all the experimental work done in this area, and the
vast expenditure of time and energy, the results are ainbiguous and contradictory.
It seems appropriate to include in this book a critical review of all the relevant
research because the issue is extraordinarily important to the future of LSD
psychotherapy.
The following discussion is based almost exclusively on careful study of the ,

existing literature. I have limited firsthand research experience in this area, and
genetics is not my primary field of interest and expertise. In the LSD study con-
ducted in the Psychiatric Research Institute in Prague we did not examine the
effect of LSD on the chromosomes or its implications for heredity; there were at
that time no experimental or clinical observations that would suggest the need for
such studies. The first paper that attracted the attention of scientists to this area
did not appear until the late 1960"s. (22)* After my arrival in the United States, I
participated in a major study concentrating on structural changes of the
chromosomes in the white blood cells following LSD administration. This was one
of the few genetic studies using pure pharmaceutical LSD, a double-blind ap-
proach, and comparison of the samples before and after the administration of the
drug. (106)
The material discussed in this review will be divided into several thematic
| groups. The first group includes papers describing structural changes of the
chromosomes produced by LSD in vitro{; in these experiments various concentra- Motifs related to the North Amer-
tions of LSD are added to cultures of cells from human, animal, or plaut tissues in : ican Indian tradition; from trans-
a test-tube. The second group involves in vivoT studies of LSD; in this type of personal sessions.

“Numbers apply to references that appear after this Appendix.

{In vitro literally means in glass, and refers to experiments conducted in test-tubes; in vivo
is
a medical term for experiments in living organisms.

318 GE. 319

 The Effects of LSD on Chromosomes _ gz

research the effect of LSD is studied after the substance has been ingested by or in-
jected into animals or humans. The papers in the third group describe the results
of experiments studying the influence of LSD on the genes, and its mutagenic
effects. It includes a small number of papers dealing with the detailed mechanism
of the action of LSD on the deoxyribonucleic acid (DNA), the most important con-
stituent of the chromosomes. The fourth group consists of publications describing
the consequenecs of LSID administration on the growth, development and dif-
ferentiation of human and animal embryos. Finally, the fifth group comprises
papers focusing on the possible link between LSD and the development of malig-
nant changes in cells, especially in the case of leukemia.
In the following sections, the most relevant findings in these five thematic
categories will be briefly reviewed and critically evaluated.

THE EFFECT OF LSD ON

CHROMOSOMAL STRUCTURE
The possibility of inducing structural changes in the chromosomes by exogenous
agents such as radiation, viruses, and a variety of chemicals, has been a subject of
great scientific interest for a long time. The genetic controversy about LSD started
in 1967 when Cohen, Marinello and Back (22) published a paper suggesting that
LSD should be added to the list of substances capable of causing abnormalities in
the chromosomes. Because of the widespread use of LSD, this information created
vivid interest in scientific circles, and a number of investigators focused their at-
tention on this area. Two major approaches were used in these studies; in some the
effect of LSD on the chromosomes was studied in the test tube (in vitro), in others
in the living organism (in vivo). The cells studied were in most cases human white
blood cells (lymphocytes).
In the in vitro studies, the blood samples were drawn from normal, healthy
Egyptian motifs from = an_ ad- persons with no history of prior drug injection, radiation exposure, or recent viral
vanced LSD session of a subject infection. After incubation at 37° centigrade in appropriate media, colcemide
who had spontancous Kundalini was added to stop the cell division at the stage of metaphase. The cells were then
experiences in her everyday life. harvested, made into specifically stained cytological preparations and examined
Upper right. An insight into the with phase contrast microscopy. During the period of incubation, LSD dissolved
similarities between the Indian in sterile distilled water was added to the experimental cultures in various
concept of the Serpent Power and concentrations.
Egyptian symbolism involving
In the in vivo studies, the blood samples were drawn from subjects who had
snakes. Special emphasis was
placed on the parallels between been exposed to either “street acid” (illicit material allegedly containing LSD) or
the chakra system and the djed pharmaceutically pure LSD. In most of these studies, the chromosomes were
or spinal column of Osiris and the examined after the exposure to LSD (retrospective approach); in a minority of
relationship between the opening these studies, the checkups were done both before and after the administration of
of the third eye and the symbol the drug (prospective approach). The technical procedure employed in the in vivo
of the uraeus, Above right. The subject's eye, studies did not differ significantly from that described for the in vitro approach. A
Upper left. The blocking of the while watching the sunset, is
special and rather important subgroup of the in vivo studies are reports
Kundalini energy in the left eve transformed into a combination about the influence of LSD on the chromosomes of the germinal cells (meiotic
is connected to the symbolism of of the udjat eve and the winged
chromosomes).
the Eve of Horus (udjat eve). solar disk of Egyptian mythology.

320
 APPENDIX If The Effects of LSD on Chromosomes Sov
322
he LSD PSYCHOTHERAPY:

IN VITRO STUDIES Marinello and Back (22) was widely publicized by the mass media. As a result, the
significance of their findings was considerably over-emphasized, and many pre-
Cohen, Marinello and Back (22) added LSD to cultured human leucocytes obtain- mature conclusions were drawn for which there was not sufficient scientific
justification.
ed from two healthy individuals. They used five concentrations ranging from
Several important facts have to be taken into consideration before we can
0.001 to 10.0 micrograms of LSD per cubic centimeter (cc), and the time of ex-
posure was 4, 24, and 48 hours. The incidence of chromosome breaks for treated draw any substantial conclusions from the findings of increased chromosome
breakage associated with LSD in the in vitro experiments. It must be emphasized
cells was at least twice that of control cells for all treatments, except at the lowest
that the findings themselves were not completely consistent. In several studies
concentration and time (0.001 micrograms of LSD per cc for four hours) where no
there were no indications of increased chromosome breakage following the expo-
difference existed between treated and control cells. There was no simple linear
sure to LSD. (27, 73, 105). In addition, the concentrations of LSD and durations
relationship between the frequency of these aberrations and the LSD dosage or
of exposure used in these studies were usually much greater than those occurring
duration of exposure. In a later study, Cohen, Hirschhorn and Frosch (20) de-
scribed the results of a larger study in which they used peripheral leucocyte cul- in the human organism after the ingestion of LSD in the commonly used dosages.
Cohen, Marinello and Back (22) themselves did not find increased breakage of
tures from six normal, healthy persons; the concentrations of LSD and the times of
chromosomes at the lowest concentration and time (0.001 micrograms of LSD per
exposure were the same as in the original study. They found a significant inhibi-
ce for four hours). Loughman et al. (70) emphasized that it is precisely the lowest
tion of cellular division (mitosis) on addition of the drug in any concentration. The
suppression of mitosis was directly proportional to the duration of exposure. The concentration and duration of exposure used in this study that most closely ap-
lowest frequency of chromosomal breakage among the controls was 3.9 percent of proximates the expected concentration in blood, liver and other organs after a
cells; among the treated cultures, the lowest frequency was almost twice the con- dose of 100 micrograms of LSD ingested by a man weighing 70 kg. If the meta-
trol (7.7 percent) and ranged to over four times the control value (17.5 percent). bolic degradation of LSD is considered, then the effective concentration in vivo of
In 1968, Jarvik et al. (63) tried to replicate some of the in vitro experiments unchanged LSD would be considerably less than this, approximating 0.0001
micrograms per cc—a concentration used only by Kato and Jarvik, (65) who
of Cohen’s group. In addition to LSD, they used as testing substances ergonovine
(a drug commonly used in obstetric practice), aspirin, and streptonigrine. They found no increase in breakage at this dosage.
In general, special caution is required in extrapolating the in vitro findings
found a higher incidence of chromosome breaks in the LSD samples (10.2 percent
to the situation in the living organism. The intact human organism differs from
with the range 0.0-15.0) as compared to the control samples (5.2 percent with the
isolated cells in the test tube in its enormous complexity and in its ability to detox-
range from 0.0-9.0). They found, however, approximately the same breakage rate
with aspirin (10.0 percent) and ergonovine (9.6 percent). The concentration of ify and excrete noxious compounds. Substances that are toxic in vitro do not neces-
sarily have the same effect in vivo. In addition, some of the techniques used in the
LSD in blood used in this study approximates the level reached one to four hours
in vitro studies can create an artificial situation and introduce factors that do not
after injection of 1,000 micrograms of LSD. On the other hand, the level of
exist in the living organism. This issue has been discussed in detail in an excellent
aspirin used was considerably below the common therapeutic level. Strep-
review on LSD and genetic damage by Dishotsky et al. (28) These authors point to
tonigrine, a substance with a well-known dramatic effect on the chromosomes, in-
the fact that all the studies on cultured lymphocytes have used modifications of a
duced chromosome breakage in 35 percent of the examined cells. It is interesting
technique in which the lymphocytes are stimulated by phytohemagglutinin to
to note that two of the eight cases described in this paper did not respond to LSD
enter the reproductive cell cycle. In the normal state in vivo, small lymphocytes
with an inerease in chromosome breaks.
Corey et al. (24) performed an in vitro study in ten individuals; 1 micro- are in a phase of growth which precedes DNA synthesis; they do not grow, divide
gram per cc of LSD was added to the culture during the last twenty-four hours of or enter the cell cycle. Thus, in the studies in vitro, lymphocytes are exposed to
incubation. The authors found an increase in chromosome breaks in all ten sub- chemical agents during developmental stages of the cell cycle, including the syn-
jects. Although the in vitro concentration of LSD was much greater than any thesis of DNA, which do not normally occur in these cells in the body. Damage to
known comparable ingested dosage, the mean increase of 4.65 breaks per 100 cells a lymphocyte in this phase generally will not manifest itself as chromatid-type
change in a subsequent division. Most, if not all chromatid-type changes are in-
was small compared to the range of frequencies (0.0-15.2) observed in the un-
treated cultures. itiated by technical procedures, and the great majority of lesions reported in the in
vitro and in vivo studies were of the chromatid type. The findings of an increased
In this connection it is interesting to mention that Singh, Kalia and Jain (92)
rate of chromosomal breakage in lymphocytes exposed to LSD in vitro must
found an increased incidence of chromosome breakage in the cells of barley root as
therefore be interpreted with great caution.
a result of exposure to LSD in the concentration 25 micrograms per cc. On the
Many recent studies concerning the structural changes caused in chromo-
other hand, MacKenzie and Stone (73) reported negative results of experiments on
somes by LSD gave the impression that this effect was something specific and
lymphocytes, hamster fibroblasts and on the plant Vicia faba.
The above-mentioned findings of structural changes in chromosomes follow- unique. Most of these reports have silently bypassed a fact that would have made
the issue much less interesting and sensational. The changes in chromosomal struc-
ing LSD administration became the basis of speculations concerning the possible
ture described are not exclusively caused by LSD; they can be induced by a variety
influence of this drug on genetic mutations, fetal development and malignancy. In
of other conditions and substances. Factors that have been known to cause
the atmosphere of national hysteria then existing, the original report of Cohen,
324 LSD PSYCHOTHERAPY: APPENDIX HI The Effects of LSD on Chromosomes BB

chromosomal breakage in vitro include radiation, changes in temperature, varia- than double the 11.0 percent rate in the controls. Only two of the eight users did
tions in oxygen pressure, impurities in tap water unless it is distilled twice, and a not have increased breakage rates. In a later and more extensive study carried out
variety of common viruses. The long list of chemical substances that increase the by Egozcue, Irwin and Maruffo, (33) the mean breakage rate in forty-six illicit
chromosomal breakage rates contains many commonly used drugs, including LSD users was 18.76 percent (with a range between 8 and 45 percent); this was
aspirin and other salicylates, artificial sweeteners, the insecticide DDT, morphine, more than double the rate of 9.03 percent found in control cells. Only three of the
caffeine, theobroinine, theophylline, tranquillizers of the phenothiazine type, forty-six users did not have a breakage rate higher than the inean control rate. In
some vitamins and hormones, and inany antibiotics such as aurcomycin, chloro- addition, the authors studied the chromosomes of four infants exposed to LSD in
mycetin, terramycin, streptomycin and penicillin. utero. All four showed breakage rates above the incan control value. There was no
In this connection it is interesting to quote Sharma and Sharma, (91) who evidence of disease or physical malformation in any of these children.
have written an extensive summary of the literature on chemically induced These findings were supported by Cohen, Hirschhorn and Frosch, (20) who
chromosome breaks: “Since the first induction of chromosomal mutations by studied eighteen subjects exposed to illicit LSD. They described an increased
chemicals and the demonstration of definite chromosome breakage by Oehlkers, chromosomal breakage in this group (mean 13.2 percent) which was more than
such a vast multitude of chemicals have been shown to possess chromosome break- triple that of the control group (3.8 percent). The authors also examined the
ing properties that the problem has become increasingly complex.” Jarvik, (61) chromosomes of four children born to three mothers who took LSD during preg-
discussing the paper by Judd, Brandkamp and McGlothlin, (64) was even more nancy. The frequency of chromosome breaks was elevated in all four, and was
explicit: “...and it is likely that any compound added at the appropriate time, in greater in the two children who were exposed to LSD during the third and fourth
the appropriate amount, to the appropriate cell type, will cause chromosome months of pregnancy than in the two infants exposed to low doses of LSD late in
breaks.” pregnancy.
In a later paper, Cohen et al. (21) reported that thirteen adults exposed to
illicit LSD showed chromosome breakage rates that were above the control mean.
IN VIVO STUDIES
In nine children exposed to illicit LSD in utero, they found a mean breakage of
Because of the limitations of the in vitro approach, in vivo studies are preferred 9.2 percent, as compared with 4.0 percent in four children whose mothers had
for assessing the possible genetic dangers associated with administration of LSD. used illicit LSD before but not during pregnancy. The breakage rate in the control
Unfortunately, of the twenty-one reports that have been published by seventeen group was 1.0 percent. All but two children had been exposed to other drugs dur-
laboratories many have serious methodological shortcomings and are more or less ing pregnancy; all were in good health and showed no birth defects.
inadequate, while individual reports contradict each other and their overall Nielsen, Friedrich and Tsuboi (82) found that their ten subjects exposed to
results are inconclusive. Two major approaches have been used in the in vivo illicit LSD had a mean breakage rate of 2.5 percent; this was significantly higher
studies. In fourteen of these projects, subjects were exposed to illicit substances of than that of the control group (0.2 percent). However, the allegedly pathological
unknown composition and potency, some of which were alleged to be LSD. In 2.5 percent rate is lower than that of the controls in other positive studies.
eleven studies, individuals were exposed to known quantities of pharmaceutically A number of investigators have not been able to demonstrate increased
pure LSD in experimental or therapeutic settings. chromosome breakage in LSD users. The synoptic paper by Dishotsky et al. (28),
Dishotsky et al (28) published a review in which they presented a synopsis of quotes nine groups of researchers who reported negative results of similar studies.
the studies of this kind conducted prior to 1971. According to this review, of a At the present time, therefore, the results of the in vivo studies are considered
total of 310 subjects studied, only 126 were treated with pure LSD; the other 184 rather controversial and at best inconclusive.
subjects were exposed to illicit or “alleged” LSD. Eighteen of the 126 subjects Many investigators have attempted to offer explanations for the existing dis-
(14.29 percent) in the group given pure LSD showed a higher frequency of crepancies between positive and negative reports. Some have criticized the
chromosome aberration than the controls. In contrast, 89 of the 184 subjects (48.9 breakage rate for controls in the studies by Cohen et al. (21) (3.8 percent) and
percent) in the group taking illicit LSD showed an increased incidence of aberra- Irwin and Egozcue (57) (11.9 percent and 9.03 percent) as being unusually high.
tions—more than three times the frequence reported for subjects given pharma- Others have suggested that the high control values could have resulted from viral
cologically pure LSD. Only 16.67 percent (18 of 108) of all the subjects reported contamination of the cultures, insufficiently fortified media interfering with
to have chromosome damage, were given pure LSD. There is, therefore, good chromosome repair, technical variation in cell culturing, and the approach to
reason to discuss the two categories of in vivo studies, those with pure and those chromosome evaluation. It was also pointed out that in these studies,
with “alleged” LSD, separately. chromosome-type and chromatid-type changes were not reported separately but
were combined and then converted to “equivalent numbers of breaks.” Combin-
Illicit LSD and Chromosomal Damage ing the two types of aberrations in a single index obscures the distinction between
The initial findings of chromosomal damage in illicit LSD users were reported by real chromosome damage occurring in vivo and damage arising in the course of
Irwin and Egozcue. (57) They compared a group of eight illicit LSD users with a cell culture.
group of nine controls. The users had a mean breakage rate of 23.4 percent, more However, these factors cannot account for the discrepancies between the
326 LSD PSYCHOTHERAPY: APPENDIX I The Effects of LSD on Chromosomes 397

findings of various teams of investigators. If they did, the aberrations resulting Retrospective Studies of Chromosomal Changes in Pure LSD Users. A
from these effects would be randomly distributed between groups exposed to illicit review of the studies in this category reveals that only two groups of investigators
LSD and control groups. Since the distribution is uneven, these factors do not ex- have reported an increased rate of chromosome breakage in their subjects. Five
plain the significantly elevated breakage rates in eighty of the eighty-six subjects other teams failed to confirm these positive findings.
exposed to illicit LSD studied by Cohen et al. and by Irwin and Egozcue. Cohen, Marinello and Back (22) reported in their initial study that they
A much more important clue to the understanding of this controversy seems found cliromosomal damage in the white blood cells of one paranoid
to be related to certain characteristics of the group of the “LSD users.” In this type schizophrenic patient who had been treated fifteen times in the past with LSD in
of research, the investigators depend on the recall and reliability of the subjects in dosages between 80 and 200 micrograms. Nielsen, Friedrich and Tsuboi (80) ex-
determining the type of drugs they have used in the past, the number and fre- amined the chromosomes of five persons treated with LSD and found “no correla-
quency of exposures, the alleged dosages, and interval since last exposure. Even in tion between any specific drug and the frequency of gaps, breaks, and hyper-
cases where the reports are accurate, tlie subjects usually do not know the content diploid cells.” The authors later regrouped their data, forming smaller groups on
and the quality of the samples they are using. The content of pure LSD in the the basis of age and sex. (81) After this revision of the original material, they con-
illicit LSD samples is almost always questionable, and various impurities and ad- cluded that LSD induced chromosomal damage. Tjio, Pahnke and Kurland (106)
mixtures rather frequent. The samples analyzed in the past have been demon- criticized this study on the basis of the insufficient number of cells analyzed for a
strated to contain amphetamines, mescaline, DOM (4-methyl-2, 5-dimethoxyam- reliable determination of breakage rates. Three of the five LSD subjects studied
phetamine, also called STP), phencyclidine (phenylcyclohexylpiperidine, PCP or had no chromosomal aberrations, and the two remaining subjects accounted for
“angel dust”), benactyzine and even strychnine. In addition, all the subjects tested all six breaks found. In addition, the 1.7 percent breakage rate is still within the
used or abused drugs other than street LSD. These drugs included, among others, values reported for the general population. Another study by Nielsen, Friedrich
Ritaline, phenothiazines, alcohol, amphetamines, cocaine, barbiturates, heroin and Tsuboi (82) which reported an increased breakage rate of 4.3 percent in a
and other opiates, and various psychedelic substances such as marihuana, hashish, group of nine former LSD users has been criticized by Dishotsky et al. (28) on the
psilocybin, mescaline, STP, methylenedioxyamphetamine (MDA), and dimethyl- basis of its unusual approach to data analysis.
tryptamine (DMT). Under the circumstances, one questions the logic of referring Sparkes, Melnyk and Bozzetti (99) did not find an increase in chroimosoinal
to this group in scientific papers as “LSD users.” Most of these subjects were ac- breakage in four patients treated with LSD in the past for medical reasons..
tually multiple-drug users or abusers exposed to a variety of chemicals of unknown Negative results were also reported by Bender and Siva Sankar, (11) who exam-
composition, quality and potency. ined the chromosomes of seven schizophrenic children who had been treated in the
In addition, it has been repeatedly reported that this population suffered past by prolonged administration of LSD. These children received LSD daily in
from malnutrition and had very high rates of venereal disease, hepatitis and two divided dosages of 100 to 150 micrograms for a period of weeks or months.
various other viral infections. It was mentioned above that viruses are one of the The frequency of chromosome breakage in this group was less than 2 percent and
most common factors causing chromosoinal damage; the possible role of malnutri- did not differ from that of the control group.
tion reniains to be evaluated. Dishotsky et al. (28) conclude their review of the in Siva Sankar, Rozsa and Geisler (93) studied the chromosome patterns in
vivo studies involving illicit LSD by relating the findings of increased chromosome fifteen children with psychiatric problems who had been given LSD, UML or a
breakage to a combination of factors such as long-term excessive exposure to illicit coinbination of both. LSD was administered daily; the average dose for the whole
chemical agents, the presence of toxic contaminants, the intravenous route of ad- group was 142.4 micrograms per day per patient, and the duration of therapy
ministration, and the physical debility of many drug abusers. According to them, varied from 2 to 1,366 days. The breakage rate for the group treated with LSD
positive results, when found, are related to the more general effects of drug abuse was 0.8 percent, for the group treated with both LSD and UML 1.00 percent.
and not, as initially reported, specifically to the use of LSD. This was not significantly higher than the rate of breakage in the controls. The pa-
tients in this study received LSD two to four years prior to the chromosome
Pure LSD and Chromosomal Damage studies. The authors admitted that the effects of LSD on the leucocyte chromo-
Chromosomal studies of persons who received pharmaceutically pure LSD in an somes might have been rectified over such a long period of time. In any case,
experimental or therapeutic framework are much more relevant and reliable as a this would indicate that LSD therapy has no long-lasting effects on the
source of information than the studies of illicit drug users. In these studies, there is chromosomes.
no uncertainty concerning purity, dosage, frequency of exposure and the interval Tjio, Pahnke and Kurland (106) published the results of chromosome analy-
between the latest exposure and blood sampling. Two different approaches can be sis of a group of eight “normal” subjects who had received pure LSD in research
distinguished in the chromosome studies using pure LSD. The studies of the first experiments one to twenty-six times, two to fifteen months prior to giving the
type are retrospective and use a “post hoc” design; they examine the chromosomal blood sample. The mean total chromosomal aberration rate for this group was 2.8
changes in subjects who were exposed to pure LSD in the past. The studies of the percent, and the individual rate in none of them exceeded the pre-LSD mean of
second type are prospective; the chromosomal patterns are examined both before 4.3 percent found in the patient sample.
and after the exposure to LSD, and each subject serves as his own control. Corey et al. (24) reported the result of a retrospective chromosomal study of
 The Lffects of LSD on Chromosomes _ / . JuY
328 LSD PSYCHOTHERAPY: APPENDIX IL

users. The amount of breakage was not directly proportional to the dosage;
sixteen patients, five of whom had been treated with LSD only, five with mesca- actually those in the low-dose range showed greater increases than those on high
line only, and six with LSD plus mescaline. In the eleven individuals who were dosage. The authors also examined a group of five persons who had taken illicit
clinically treated with LSD dosages ranging from 200 micrograms to 4,350 micro- LSD from four to thirty-six times before the study. In these subjects, blood
grams, frequency of chromosome breaks did not differ from that found in the thir- samples were drawn for seven to ten consecutive days before, during and after
teen controls. The respective frequencies were 7.8 percent for LSD, 5.6 percent for treatment with pure LSD either two or three times. Statistical analysis revealed no
mescaline, 6.4 percent for LSD plus mescaline, and 7.0 percent for the control: significant difference in the chromosomal aberration before and after LSD. In
group. another prospective study, Corey et al. (24) examined the chromosomes of ten per-
In an unpublished study, Dishotsky et al. examined the chromosomes of five sons before and after the administration of 200-600 micrograms of pure LSD. The
subjects exposed in the past to pure LSD. The mean breakage rate in this group authors found no significant difference in the rate of chromosome breakage be-
(0.40 percent) was not significantly different from that of the eight control persons tween the pre- and post-samples and confirmed the negative findings of the
(0.63 percent). In their review paper, Dishotsky et al. (28) indicate that fifty-eight previous study.
of seventy (82.9 percent) of the subjects studied after treatment with pure LSD did It is interesting to mention in this connection two prospective studies of
not have chromosome damage. Because of incomplete data on nine of the remain- LSD-related chromosomal damage which were conducted in Rhesus monkeys
ing twelve subjects, they were not able to compute the precise percentage of sub- (Macaca mulatta); the results of both studies were rather inconclusive. Egozcue
jects with elevated breakage rates. However, they estimated that this figure would and Irwin (32) administered high dosages of LSD (40 micrograms per kg.) four
range between 17.1 percent and 4.9 percent. All but one of the twelve subjects times at ten day intervals. Two of their animals showed increased chromosomal
were reported by a single team of investigators. The authors concluded that in breaks, whereas the other two stayed within normal values. Kato et al. (66)
view of the procedures, incomplete data, questionable re-analysis of the data, and described transitory changes in chromosomes after multiple, subcutaneous injec-
low breakage rates reported, there is no definite evidence from this type of experi- tions of LSD in high doses (125-1000 micrograms per kg. per injection) in Rhesus
ment that pure LSD causes chromosome damage. monkeys. The authors have not provided a statistical evaluation of the results;
Dishotsky et al., (28) who later analyzed their data, found them statistically non-
Prospective Studies of Chromosomal Changes in Pure LSD Users. The significant.
studies comparing the chromosomal changes before and after exposure to pure Dishotsky et al. (28) also offered a synoptic evaluation of the prospective
LSD represent the most adequate scientific approach to the problem from the LSD studies. According to them, only six of the fifty-six patients (10.7 percent)
methodological point of view, and are the most reliable source of scientific infor- studied before and after treatment with pure LSD had elevated breakage rates; of
mation. The first report in this category was published in 1968 by Hungerford et these, three received LSD intravenously and one had a viral infection. Of these six
al. (55) who examined the chromosomes of three psychiatric patients before and subjects, one individual was not available for follow-up determinations; in the re-
after repeated therapeutic administrations of LSD. Blood samples were taken maining five, breakage returned to that observed before treatment. From the total
from all patients before any LSD therapy, one hour before and one and fourteen number of subjects studied before and after treatment, 89.3 percent did not have
hours after each dose: follow-up samples were taken at intervals of one to six chromosome damage. The results of the prospective LSD studies are thus in agree-
months. An increase in chromosome aberrations was observed after each of three ment with the negative conclusion of five of the seven teams that studied subjects
intravenous injections of LSD. The increase was small in two of the three subjects; only after LSD treatment.
however, dicentric and multiradial figures appeared only after treatment, and
acentric fragments appeared more frequently after treatinent. In the follow-up Chromosomal Changes in Germinal Cells
study, a return to earlier levels was observed in all three patients. The data from In the past, the positive findings of some chromosomal studies have been used as a
this study indicated that pure LSD may produce transitory increases of chromo- basis for far-reaching speculations concerning the hereditary dangers associated
some abnormalities, but that these are no longer evident one month after ad- with LSD. Journalists, and also several scientific workers, described their rather
ministration of the final dose. The results were slightly complicated by the admin- apocalyptic visions of the offspring of LSD users. Such speculations were rather
istration of chlorpromazine (Thorazine), which in itself can produce chromosoinal premature, and insufficiently substantiated by experimental data. The reasoning
aberrations. It is interesting to note that Hungerford’s study is the only one in that refers to structural abnormalities of the chromosomes as “damage” and relates
which LSD was administered intravenously. them automatically to genetic hazards has serious gaps in its logic. In reality, it is
Tjio, Pahnke and Kurland (106) reported the results of a study of thirty-two not quite clear whether or not the structural changes in the chromosomes of the
hospitalized alcoholic or neurotic patients treated with LSD in the framework of a white blood cells have any functional significance, and whcther they are asso-
double-blind controlled study at the Maryland Psychiatric Research Center. The ciated with genetic abnormalities. There exist many chemical substances that
dosage of LSD was 50 micrograms in eleven patients and 250-450 micrograms in cause chromosomal breaks but have no adverse effects on genetic mutation or
twenty-one patients. The number of cells observed in this study (22,500) was more fetal development. The complexity of this problem cau be illustrated by the case
than twice the total number of cells observed in all other studies of pure LSD
330 LSD PSYCHOTHERAPY: APPENDIX li The Effects of LSD on Chromosomes 331

of viruses. A variety of virus diseases (such as herpes simplex and shingles, measles, tration in mice and Rhesus monkeys. The mice in this study received 5 micrograms
chicken pox, influenza, yellow fever, and possibly mumps) induce marked per kg of LSD daily in a number of injections increasing from one to ten. Four
chromosomal damage without causing fetal malformations. According to Nichols, adult male Rhesus macaques ingested doses of either 5, 10, 20 or 40 micrograms
(79) one of the exceptions is rubella (German measles), a disease that is notorious per kg of LSD. Six months after their single dose of LSD, three of the monkeys
for causing severe fetal malformations when acquired by the mother in the first received four doses each, at ten-day intervals, of 40 micrograms per kg of LSD per
trimester of pregnancy. dose. The authors reported essentially negative results in both the mice and the
In addition to the methodological problems involved and the inconsistency monkeys. In mice, occasional chromosomal breaks and fragments were observed
of the findings discussed above, one more important fact has to be taken into con- in similar proportions in the control and the experimental groups. In the Rhesus
sideration. In all the studies quoted, the effect of illicit or pure LSD, in vitro or in monkeys, no significant differences were found before or after acute or chronic
vivo, was assessed in the chromosomes of the white blood cells. No direct conclu- treatment.
sions about the hereditary dangers associated with the administration of LSD can Jagiello and Polani (60) published the results of a detailed and sophisticated
be drawn on the basis of these studies since the lymphocytes are not involved in study of the effect of LSD on mouse gerin cells. They performed acute and chronic
the reproductive processes. Speculations about such dangers could be made only experiments on both male and female mice. The dosage of LSD in the chronic ex-
on the basis of chromosomal findings in germ cells such as the spermatozoids and periments ranged between 0.5-5.0 micrograms; in the acute experiments a single
ova, or their precursor cells. Unfortunately, the few existing studies of the subcutaneous dose of 1,000 micrograms per kg of LSD was administered. The
chromosomes of germinal cells (the so-called meiotic chromosomes) yielded as in- results of this study were essentially negative. The authors attributed the
conclusive results as the studies of the chromosomes of somatic cells. discrepancies with other studies to mode of administration, dosage and the animal
Skakkebaek, Phillip and Rafaelsen (95) studied meiotic chromosomes from strain involved.
six healthy male mice injected with large dosages of LSD (1,000 micrograms per In two of the existing studies, the effects of LSD on the meiotic chromosomes
kg); the number of injections and intervals between exposures varied. Several were tested in the banana fly, Drosophila melanogaster, an organism that has
chromosomal breaks, gaps and unidentifiable fragments were found in the treated played an important role in the history of genetics. In one of these studies, Grace,
animals but, with a few exceptions, not in the control animals. The authors con- Carlson and Goodman (44) injected male flies in concentrations of 1, 100 and 500
sider their finding tentative evidence that high doses of LSD may influence micrograms per cc. The dosage used is equivalent to approximately one liter of the
meiotic chromosomes in mice. They admitted that the number of abnormalities same solution in humans (1,000, 100,000 and 500,000 micrograms respectively}.
was small and technical errors could not be excluded, but concluded that the No chromosomal breaks were observed in premeiotic, meiotic or postmeiotic
changes found could have influence on fertility, size of the litter, and the number sperm. The authors concluded that LSD is in a class quite distinct from that of
of congenital malformations. In a later study, Skakkebaek and Beatty (94) injected ionizing radiation and mustard gas. If it is a mutagenic or radiomimetic agent in
four mice subcutaneously with dosages of 1,000 micrograms per kg of LSD twice a human chromosomes, it is not a very powerful one. In another study, Markowitz,
week for five weeks. Analysis carried out on a blind basis showed a high frequency Brosseau and Markowitz (74) fed LSD to male fruit flies in a 1 percent sucrose
of abnormalities in two of the treated mice. In addition, the spermatozoa of LSD- solution for twenty-four hours; the concentrations used were 100, 5,000, and
treated inice also showed morphological differences, with a more rounded convex 10,000 micrograms per cc. In these experiments, LSD had no detectable effect on
side of the head and broader heads in general. The practical significance of these chromosome breakage. The authors concluded that LSD is a relatively ineffective
findings is considerably reduced by the fact that the dosages used far exceed chromosome breaking agent in Drosophila.
anything used in clinical practice. A comparable dose in humans would come to Considerable caution is required in extrapolating the data about the effect of
60,000- 100,000 micrograms per person, which is 100 to 1,000 times more than the LSD on meiotic chrornosomes obtained from animal experiments to humans,
dosages commonly used in experimental and clinical work with LSD. because of rather wide interspecies variability. The only report about the effect of
Another positive finding of meiotic chromosome damage induced by LSD LSD on human germ cells was published by Hultén et al. (54) These authors ex-
was reported by Cohen and Mukherjee. (23) These authors injected thirteen male amined the testicular biopsy in a patient who had used massive doses of illicit LSD
mice with a single dose of LSD at a concentration of 25 micrograms per kg. In this in the past, up to an alleged 1,000 micrograms. For a period of four weeks he
study the meiotic cells were apparently less vulnerable than somatic cells. How- practiced the administration of these dosages daily. There was no evidence of an
ever, there was an obvious tenfold increase in chromosome damage among the increased frequency of structural chromosome aberrations in the germinal tissue of
mice treated with LSD. This reached a maximum between two and seven days the testicles.
after injection, with a subsequent decrease and return to almost normal levels «Concluding this discussion of the effects of LSD on chromosomal structure,
after three weeks. On the basis of evidence from clinical human cytogenetic we can say that the results of the existing studies are inconclusive despite the
studies, the authors concluded that chromosome anomalies of this type may lead fact that the dosages used in many experiments far exceed the doses used in clinical
to reduced fertility, congenital abnormalities and fetal wastage. practice. Whether LSD causes structural changes in the chromosomes or not re-
The other existing studies of the effect of LSD on meiotic cells brought essen- mains an open question. If it does, the circumstances and dosage range in which
tially negative results. Egozcue and Irwin (32) studied the effects of LSD adminis- these occur have not been established, and the interpretation of these changes and
332 LSD PSYCHOTHERAPY: APPENDIX I The Effects of LSD on Chromosomes
333

their functional significance is even more problematic. This question could not be and its inactive brominated analogue by helical DNA of the calf thymus. Binding did
answered even on the basis of results of methodologically perfect chromosomal not take place with yeast RNA or nonhelical DNA, suggesting that this binding is
studies. In future research, much more emphasis should be put on the study of the specific for helical DNA.
effect of LSD on genetic mutation and embryonal development. Wagner (112) concluded on the basis of his experiments that LSD interacts
directly with purified calf thymus DNA, probably by intercalation, causing
con-
formational changes in the DNA. According to him, it is unlikely that this
could
MUTAGENIC EFFECTS OF LSD influence the internal stability of the DNA helix enough to cause chromosom
al
breakage. However, it may lead to the dissociation of histones, which could
In the past, the classic experimental animal for the study of genetic-mutations has render DNA susceptible to enzymatic attack. Smythies and Antun (98) performed
been the banana fly, Drosophila melanogaster. Several studies exist in which the similar experiments and arrived at the conclusion that LSD binds to nucleic
acids
effect of LSD on genetic mutation has been observed in this fly. Grace, Carlson by intercalation. According to Dishotsky et al,, (28) this evidence of LSD
inter-
and Goodman (44) studied the mutagenic effects of intra-abdominal injections of calation into the DNA helix provides a clue to the physical mechanism involved
in
LSD in concentrations ranging from I to 500 micrograms per cc. They have not the mutagenic effects of high doses of LSD in Drosophila and the fungus,
as
found an increase in induced mutations in the LSD-treated group. On the basis of reviewed above.
these negative findings, the authors consider it improbable that LSD induces Nosal (83) investigated the effects of LSD on the Purkinje cells of the cere-
mutation in humans. Markowitz, Brosseau and Markowitz (74) fed LSD to male bellum of growing rats. These studies were specifically focused on the action
of the
flies in concentrations of 100, 5,000 and 10,000 micrograms per cc. In this experi- ribonucleoproteins (RNP) of the differentiating nucleus-ribosome system.
Only
ment, LSD produced a significant increase in the frequency of sex-linked recessive large doses of LSD (100-500 micrograms per kg) seemed to induce changes in
the
lethal mutations. The authors concluded that LSD at high concentrations is a structure and staining properties of this cellular system.
weak mutagen in Drosophila. Obviously, much inore research is needed for the final clarification of the in-
In several studies performed in Drosophila flies, lower concentrations of teresting interaction between LSD and various chemical substances involved
in
LSD had no mutagenic effects, but an increased frequency of induced mutations the genetic mechanisms.
was observed after excessive dosages. Vann (111) reported that dosages of 24,000
micrograms per kg produced no significant increase in the frequency of recessive
lethals, whereas a dosage of 470,000 micrograms per kg did. Browning (15) ad- TERATOGENIC EFFECTS OF LSD
ministered intraperitoneal injections of 0.3 microliters of a solution containing
10,000 micrograms per cc of LSD; this dosage corresponds to about 4,000,000 It has been frequently hypothesized in the past that LSD may be a potential cause
micrograms per kg of body weight. Out of seventy-five flies, only fifteen survived of abortions, fetal wastage and congenital malformations. The actual experi-
this procedure, and ten were fertile. Under these circumstances, a significant in- mental studies of the effect of LSD on embryonic development have been made
crease in recessive lethal mutations in the X-chromosome of male flies was ob- primarily in rodents. Since free transplacental transfer of LSD has been demon-
served by the author. A 1:1 dilution of the original solution, when injected into strated in an autoradiographic study performed by Idanpddn-Heikkila and
one hundred males, resulted in thirty-five survivors of which thirty were fertile; Schoolar, (56) it is conceivable that it might influence the developing fetus. In
this
the frequency of mutations markedly dropped. Srdm (101) concluded on the basis study, the injected LSD rapidly passed the placental barrier into the fetus;
of his experiments with LSD in the Drosophila fly that LSD is a weak mutagen however, according to the authors, the relatively high affinity of LSD for the
producing gene and chromosome mutations only when used in very high concen- maternal organs seemed to diininish the ainount of the drug available for transfer
trations; this finding is in basic agreement with the existing literature on the into the fetus itself.
mutagenic effects of LSD. The experimental data from mice, rats and hamsters have been rather con-
The effects of LSD were also tested on another standard genetic system, troversial. Auerbach and Rugowski (10) reported a high rate of embryonal mal-
namely the fungus Ophistoma multiannulatum. Zetterberg (118) exposed the cells formations in mice following relatively low doses of LSD administered early in
of this fungus to 20-50 micrograms per cc of LSD; he did not find any difference pregnancy. In all cases the induced malformations involved characteristic brain
between treated and control cells. The data on Drosophila flies and fungi suggest defects. Abnormalities of the lower jaw, shifts in the position of the eyes, and
that LSD is a weak mutagenic agent that is effective only in doses far exceeding modifications of the facial contour were frequently associated with these defects.
those commonly used by human subjects. There was no observable effect on the embryonic development if the LSD expo-
There are several interesting studies focusing on the interaction of LSD with sure occurred later than the seventli day of gestation. These findings were partial-
deoxyribonucleic acid (DNA) and ribonucleic acid (RNA); these studies could con- ly supported by Hanaway (47) who experimented with LSD in mice of a different
tribute to our understanding of the mechanism of interaction between LSD and strain. Using comparable dosages, he described a high incidence of lens abnor-
the chromosomes or genes. Yielding and Sterglanz (115), using spectrophotometric malities; however, he was unable to discover any malformation of the central ner-
methods, were able to demonstrate binding of LSD, its inactive optical isomer, vous system, even on histological examination. DiPaolo, Givelber and Erwin (27)
 Lhe Effects of Low on Chromosomes _ Jou
LSD PSYCHOTHERAPY: APPENDIX I
334

development of white rabbits. Thalidomide had a marked embryotoxic effect and

administered LSD to pregnant mice and hamsters. The total amount of LSD in- produced an increased incidence of resorptions, decreased the mean fetal weight,
jected in mice ranged from 0.5 micrograms to 30 micrograms per pregnant and induced malformations of fetuses. Pregnant rabbits given LSD in a dosage of
animal; Syrian hamsters were injected with a single dose ranging between 10 and 20 or 100 micrograms per kg of body weight produced litters which were not
300 micrograms. The authors concluded that their investigation failed to significantly different from the controls. Decrease of the mean fetal weight at
demonstrate that LSD is teratogenic for mice and Syrian hamsters. They inter- twenty-eight days was the only effect which could be detected in the litters of does
preted the increased frequency of malformed embryos in some of the experiments — treated with daily doses as high as 100 micrograms per kg.
as an indication of a potentiating effect of LSD on individual threshold dif- As emphasized by Dishotsky et al., (28) an overall view of the rodent studies
ferences. It is necessary to emphasize that the doses used in this study were 25 to indicates a wide range of individual, strain, and specics susceptibility to the effects
1,000 times the human dosage. Alexander et al. (4) administered 5 mierograms of LSD. The effect, when found, occurs at a highly specific time early in gesta-
per kg of LSD to pregnant rats. They described a significantly increased frequency tion; no effect was reported with exposures occurring late in pregnancy. Extreme
of stillbirth and stunting in two of their experiments where LSD was administered caution is required in extrapolating results from the rodent studies to the human
early in pregnancy. In the third experiment, where the animals received similar situation, since fetal development and growth in these species is markedly dif-
single injections of LSD late in pregnancy, there was no obvious effect on the off- ferent. Rodents lack the chorionic villi in the placenta, so that the fetal blood is
spring. Geber (42) reported a study in pregnant hamsters in which he ad- separated from the maternal sinuses only by endothelial walls. This makes the
ministered LSD, mescaline and a brominated derivative of LSD. He described a
rodents much more sensitive than humans to the teratogenic potential of any given
markedly increased frequency of runts, dead fetuses and reabsorbed fetuses in the substance.
experimental groups. In addition, he observed a variety of malformations of the In the only existing experimental study in primates, Kato et al. (66) admin-
central nervous system such as exencephaly, spina bifida, interparietal men- istered multipte subcutaneous injections of LSD to pregnant Rhesus monkeys. Of
ingocele, omphalocele, hydrocephalus, myelocele and hemorrhages of local brain four animals treated, one delivered a normal itfant, two were stillborn with facial
areas, as well as edema along the spinal axis and in various other body regions. deformities and one died at one month. The two control animals delivered normal
The dosages of LSD used in this experiment ranged between 0.8 micrograms per offspring. The dosage used in this study was more than 100 times the usual experi-
kg and 240 micrograms per kg. However, there was no correlation between the mental dose for humans. The authors themselves concluded that the small size of
dose and the percentage of congenital malformation. LSD and mescaline pro- their sample made it impossible to draw any definite conclusion. .
duced similar malformations; mescaline appeared to be a less potent teratogen, as The information about the influence of LSD on the development of human
judged by the dose. embryos is scanty and exists only in the form of clinical observations. For obvious
There exist a number of studies in which negative results were reported in reasons, this problem cannot be approached in an experimental manner in
all the species mentioned. Roux, Dupuis and Aubry (88) administered LSD in humans. There are six reported cases of malformed infants born to women who
dosages from 5-500 micrograms per kg per day to mice, rats and hamsters. There ingested illicit LSD prior to or during pregnancy. Abbo, Norris and Zellweger (2)
was no inerease in fetal mortality or decrease in the mean weight of the fetuses for described a child born with a congenital limb anomaly. Both parents of the child
any group of experimental animals. There was no significant increase in the inci- had taken alleged LSD of unknown purity and amount from an unidentified
dence of external malformations, and sections performed in approxiinately 40 per- source on an indefinite number of occasions. The mother took LSD four times

gee MONS a whale dele ce ag

cent of the experimental animals showed no visceral malformations. The authors during pregnancy, twice during the first three inonths, which is the time at which
concluded, on the basis of the results, that in the three species studied, no abortifi- the limbs are differentiated. Zellweger, McDonald and Abbo (117) reported the
cient, teratogenic or embryonic growth-depressing factors were observed, even case of a child born with a complex unilateral deformity of the leg. This anomaly,
after enormous doses. the so-called fibular aplastic syndrome, includes absence of fibula, anterior bow-
At least four studies of the teratogenic effect of LSD carried out on rats ing of the shortened tibia, absence of lateral rays of the foot, shortening of the
brought negative results. Warkany and Takacz (113) found no abnormalities in femur, and dislocation of the hip. The parents of this child took illicit LSD, the
their experimental Wistar rats, despite the fact that they used large doses of LSD mother on the 25th day and three times between the 45th and 98th day after her
a
(up to eighty times those given by Alexander et al.). (4) The only finding was last menstrual period. The authors emphasized the fact that the seventh week of
reduction in size in one of the young. Nosal (83) administered LSD to pregnant
gestation is the period of most active differentiation of the lower limbs; this was
rats in dosages of 5, 25, and 50 micrograms per kg on the fourth and seventh days also established for the thalidomide embryopathy. Hecht et al. (49) observed mal-
of gestation. He did not observe any external malformations of the head, vertebral formation of the arm in the case of achild whose parents had taken LSD and smoked
column and extremities, or macroscopic lesions of the central nervous system and marijuana. The mother took unknown amounts of LSD before and during early
viscera. There were no differences from the controls as to mortality and fetal pregnancy. The authors concluded that the relation of the deformity to LSD in
resorption or reduced number and size of the offspring, even with higher dosages. this case is unclear. Carakushansky, Neu and Gardner (16) reported a similar
Negative results were also obtained in two studies performed and published by case. It involved an infant with a terminal transverse deficit of portions of fingers
Uyeno. (109, 110) on the left hand and syndactyly of the right hand with shortened fingers. This
Fabro and Sieber (35) studied the effect of LSD and thalidomide on the fetal
336 LSD PSYCHOTHERAPY: APPENDIX Il The Effects of LSD on Chromo
somes
337
malformation is characterized by a failure of the fingers to separate and function rng
in to note i nisi context
that the hypothesis of the poss
independently. The mother was believed to have been exposed to LSD and can- breakeee Tn ne nally ‘ eriv ible teratogenic action of
ed from observations of
nabis during pregnancy. Eller and Morton (34) gave a report of a severely de- ateibe ae increased chromosomal
jority of the reported cases of
formed baby with an anomaly involving defective development of the thoracic actual congenital malformation
o LSD, the chromosomal findings
part of the skeleton (spondylothoracic dysplasia). This rare condition had were normal, Conversely, the
chil.
previously been described only in infants of Puerto Rican parents. The mother in,
this case happened to take LSD once around the time of conception. The authors to publ
! ish ccase
ase histories with negagatiti ve results, Sato and Pergamen
question the causal relationship between LSD and the deformity. Finally, Hsu, one in their discussion of the t
case of Zellweger et al.. (117)
Strauss and Hirschhorn (53) published the report of a female infant born with new om whose mother had ‘They 4 scribed 4
taken LSD before and during
multiple malformations, to parents who were both LSD users prior to conception. me e pregnancy was uneventful, earl ore nancy x
During pregnancy the mother also took marijuana, barbiturates and methedrine. and she gave birth to a full-ter
oychedahe oe aceed renner by the mother were m, hecl hy
The malformations in this case were associated with chromosomal aberrations ‘ . sufficient to produce a
She took L uring the critical stage for
indicating the so-called trisomy 13 syndrome. deformities, as in Zellweger's product; i
case, but no fetal deformities
Berlin and Jacobson (12) studied 127 pregnancies in 112 women where one Aase, Laestadius and Smith developed. ortimb
(1) observed a group of ten
or both of the parents admitted taking LSD before or after the infant’s conception. pregnant women
According to the authors, sixty-two pregnancies resulted in live birth, six of these
infants had congenital abnormalities, with one neonatal death. One of the fifty-six
normal newborns died from an intrapulmonary hemorrhage. Sixty-five pregnan-
cies were terminated by abortion; seven abortions were spontaneous and four of
these fetuses were abnormal. Out of fourteen therapeutic abortions, there were
four abnormal fetuses. The rate of defects of the central nervous system was about
sixteen times that in the normal population. One of the findings in all the abortion
specimens was failure of fusion of the cortex. Three of the six abnormal children
born alive had myelomeningocele and hydrocephalus; one had hydrocephalus
only. The authors themselves emphasized that the mothers in this study were a
very high risk obstetric population for many reasons. In addition to ingestion of observation that women who b ecame schii zoph
alleged LSD, there was multiple drug use (15 percent used narcotics), infectious renic with}
tion gave birth to female offs
pring only prrenie waitin one month of “ne
diseases and malnutrition. Most of the therapeutic abortions were done for psychiatric fol McGlothlin, , Sparkes and e
' A rnold (76) studied
jed 148 human
reasons. Thirty-six percent of the women had undergone extensive radiological in- IC dean ingestion of LSD; this pre i
was part of a larger study of 300
vestigations for abdominal complaints. ora rom a population of persons random.
750 who received LSD orall
Berlin and Jacobson’s study, as well as all the previously mentioned case iments o mye hotherapeuti y in either an ex i.
c setting, The number of
reports of fetal abnormalities, involve infants born to parents who ingested illicit n cig y- ves and the usual sessions ranged between one
dosages were 25-400 microgra
substances of unknown dosage and origin that were considered to be LSD; to date Pregs an ins. For twent “seven
ere was additional use of
LSD under non-medical cond
there is no report of congenital malformations in human offspring exposed to pure c al p ntage marihuana (8 percent) itions Ina
and ‘stron g psychedelics such
LSD. In addition, as Blaine (13) pointed out in his rather bitter and emphatic rent asin psilocybin were also used. i e
The authors found no evid
criticism of the paper by Eller and Morton, (34) there is no scientific evidence in c in reasonable doses ence ther the
by men before intercourse lead
these individual case histories of a causal relation between the ingestion of illicit ing to conception is
substances and the subsequent development of the embryonal malformation. The
findings could represent pure coincidences and be related to any number of situa-
tions that contribute to congenital abnormalities, such as maternal nutrition,
physiological, psychological and pathological states, socio-economic circum-
stances, or various cultural practices. Differences in type and severity of mal- denitad ane Ceseribed in this study increased
the risk of having a child with a con
formations may be due to genetic factors, both embryonic and parental. possible higher ne only increased risk
There exists a considerable amount of clinical evidence contradicting or observed in this study, therefore, was
LSD. Spontareon idence a
limiting the above findings. Three studies focusing primarily on the frequency of
oO Spontaneous abortions among women
exposed to
had taken LSD thes or ions occurred signif
chromosome breaks in children exposed to illicit LSD in utero reported elevated icantly more often when the niother
breakage rates of the chromosomes. (27, 33, 54) However, all fourteen infants explanations for this fi di, 4 father only had taken it. The authors offered two
the ova
studied were in good health and had no indications of birth defects. It is interest- 'Sis very
. . n ing: (1) The
long; it takes several period required for the maturation process of
years, as compared to a few weeks
for the
 LSD PSYCHOTHERAPY: APPENDIX I The Effects of LSD on Chromosomes
338 339

spermatozoa. (2) In one-half of the cases the mothers were given medical PsP for leukemia and other neoplastic diseases. The authors also pointed out that cells of
therapeutic purposes. It is a well-known fact that greater emotiona stress in neoplastic origin show a variety of chromosomal aberrations, many of which are
neurotic patients increases the incidence of abortions, and this suggests tha the not unlike those they had found in subjects after ingestion of LSD. In addition,
connection found in this survey between LSD and abortion might not be causal a some of the agents known to produce similar chromosome aberrations, such as
coincidental. radiation and various viruses, are known carcinogens.
a Me oe cn Hetn (7) presented at the Congress of the European Medical The carcinogenic hypothesis was supported by the finding of Irwin and
Association for Psycholytic Therapy at Wiirzburg in 1969 data about the offspring Egozcue (57) that nine subjects who had taken illicit LSD had chromosomal
of 4,815 former LSD patients from several European countries, jnoanng fragments resembling the so-called Philadelphia (Phi) chromosome, often
England. Of 170 children born to these patients after they had comp ete St associated with chronic granulocytic leukemia. Grossbard et al. (46) found a Ph,-
therapy, frequently involvin g multiple exposures, only two shower congen like chromosome in all thirty-five peripheral leucocytes from an individual who
anomalies. One child had a dislocation of the left hip joint; another child, born to had used illicit LSD and other drugs and who later developed acute leukemia.
a couple where the father used LSD, had the little finger and ring Finger pn one Several serious objections can be raised against this hypothesis. First, the
hand grown together (syndactyly). Two women from this sample took st evidence that pure LSD causes chromosomal aberrations is rather problematic and
within fourteen days after conception (in one case 400 micrograms), an “ inconclusive. Second, the cause of the chromosomal lesions in the above men-
children were normal. Thus, out of 170 infants, only two showed pathology t < tioned inherited disorders is not known, nor has it been established whether these
author felt that even in these two cases the anomali es were of a common kind an lesions have any relation to subsequent neoplastic developments. There exist many
ttributed to LSD for any sound reason. chromosome breaking agents which are not associated with leukemia, and quadri-
cous The oe cotlmentel and clinical evidence for the teratogenic effects of LSD radial and other rearrangement figures have also been found in the white blood
can be. summarized “as follows. Increased incidence of congenital malformation cells of normal individuals. Third, Cohen’s comparison of the effects of LSD with
has been reported in mice, rats and hamsters; however, there exist a num fer oO those of radiation does not seem to be well substantiated by experimental and
papers contradicting these findings. The information from experiments 08 ower clinical findings. According to Dishotsky et al., (28) long-term chromosomal
primates, although preliminary, suggests a possible teratogenic effect an eserves damage following LSD injection has been reported in three retrospective studies.
further investigation. There exist several case reports of malfor med chi ren born In two reports of subjects studied before and after they took LSD (prospective ap-.
to users of illicit LSD, and one study suggesti ng a high incidenc e of birth defects proach), the occasional damage that was found was without exception transitory,
and abortions in this group. The causal relation of these malformations to the use suggesting a reversibility of effect unlike that associated with radiation. Fourth,
of LSD is not established. The unknown chemical composition of the samp! “oe the Ph,-like chromosome was reported in only two studies; in both of them it was
alleged LSD, as well as the existence of many other important varia ns found in peripheral leucocytes. In chronic granulocytic leukemia, the Ph,
characterizing the group of “LSD users” (such as infections, malnutrition, multi- chromosome is characteristic only of myeloid and erythroid cells, which normally
ple drug use, and emotional disorders) leave all the conclusions open to question. do not divide in peripheral blood. Dishotsky et al. (28) quote Nowell and Hunger-
There are indications of an increased risk of spontaneous abortions relate to the ford (84) who initially described this lesion: “A chromosome compatible with the
use of LSD. There is no evidence at present that pure LSD causes birth defects or Ph, would have to be observed in blood cells other than lymphocytes to be rele-
fetal wastage in humans. However, for practical clinical purposes pregnancy vant to the question of chronic granulocytic leukemia.”
tern

should be considered a contraindication for the administration of LSD. This isme Only two cases of leukemia have been reported in individuals who were
something unique and specific to LSD; similar caution is required in regas ne treated in the past with pure LSD. (41, 108) In both of thein it remains to be
many other substances. The balance between the maternal organism and ne established whether the association represents a causal relation or a coincidence.
develop ing fetus, especial ly in the first trimeste r of pregnancy, is very precario u In one of these cases, reported by Garson and Robson, (41) there was a
and can be disturbed by a wide variety of external influences. “remarkable incidence of childhood malignancies strongly suggestive of a familial
predisposition to malignant disease.” At the present time the carcinogenic
hypothesis seems to be rather poorly supported by experimental and clinical data
CARCINOGENIC EFFECTS OF LSD and remains in the realm of pure speculation. There appears to be no definite
evidence that LSD is a carcinogenic agent.
It has repeatedly been mentioned in the literature that LSD might have carcino-
genic potential. This speculation appeared for the first time in the paper y
Cohen, Marinello and Back. (22) The authors drew this conclusion from their SUMMARY AND CONCLUSION
findings of a markedly increased frequency of chromosomal breakage ane a
quadriradial chromosome exchange figure in a patient with paranoid schizo- Two-thirds of the existing in vitro studies have reported some degree of increased
phrenia who had undergone extensive LSD psychotherapy. This is a combination chromosomal breakage following exposure to illicit or pure LSD. With one excep-
occurring in three inherited disorders: Bloom's syndrome, Fanconi S anemia and tion, these changes were observed with concentrations of LSD and durations
of ex-
ataxia teleangiectatica. These disorders are connected with a high incidence o posure that far exceeded the dosages commonly used in huinans. In none of the
340 LSD PSYCHOTHERAPY: APPENDIX I References
~. 341
studies was there a clear dosage-response relationship. Since similar findings have may be coincidental. The increased occurrence
of malformations in the LSD us
been reported with many commonly used substances, including artificial reported in one of the studies may be explained
by many other variables charac.
sweeteners, aspirin, caffeine, phenothiazine tranquillizers and antibiotics, there is terizing this group, and there is no logical reason
to implicate LSD as the singl ve
no reason why LSD should be singled out and put in a special category. There is most important factor. At the present time
there is no clear evidence that pt re
no justification for referring to the structural changes of the chromosomes as LSD is teratogenic in humans, However, in view
“chromosomal dainage™; their functional relevance and relation to heredity re- of the high vulnerabilit of the
developing fetus to a great variety of substa
nces and conditions, the ad in t .
mains to be established. In addition, the fact that the in vitro experiments bypass tion of LSD is contraindicated for the gestation period
the excretory and detoxifying systems present in the integral organism casts doubt . mene 7

oe
There is no clinical or experimental data demon
on the overall relevance of the in vitro results. strating that LSD has c
cinogenic properties, as suggested by some of
In the in vivo chromosomal studies, the majority of positive findings was the early studies. No increase in the
incidence of tumors among LSD users has
reported in persons who had been exposed to illicit, “alleged” LSD. Dishotsky et ever been detected. Case reports f
leukemia and malignant tumors in the popula
al, (28) in their excellent synoptic review of the chromosomal studies made in the tion of LSD users have heen ex d
ingly rare. In the three existing case reports
of leukemia there has been no nro f
past, summarized the existing evidence in the in vivo papers as follows: “In or even indication of a causal relationship,
and the association of leukemi vith
twenty-one in vivo chromosomal studies, a total of 310 subjects were reported. Of LSD use may have been merely a coincidence.
these, 126 were treated with pure LSD; the other 184 were exposed to illicit, ; As this review shows, no convincing experimental omen
alleged LSD. Only 18 of 126 (14.3 percent) of the subjects in the pure LSD group or clinical evidence exists
© prove that the commonly used dosages of pure
were reported to have chromosomal aberration frequencies above mean control LSD produce genetic mutati
congenital malformations or malignant growth
s. As far as illicit LSD i con.
rates. In contrast, 89 of 184 (48.9 percent) of the subjects in the illicit LSD group cerned. the situation is much more complex,
and the results of the studies of illicit
had elevated aberration frequencies. Of all the subjects reported to have D users should not be considered relevant
to the question of the biological
chromosomal damage, only 18 of 108 (16.7 percent) were exposed to pure LSD. dangers of LSD. Uncertainties about the dosage, and the
The frequency of individuals with chromosomal damage reported among illicit contaminat
ion ofblack
market samples of psychedelic drugs by
various impurities and additives con-
drug users was nearly triple that associated with the use of pharmacologically tribute a very important dimension to the
already serious psychological | az is
pure LSD.” These findings indicate that chromosomal aberrations when found associated with unsupervised self-experimentati
on. - men er’
were related to the more general effects of drug abuse and not to LSD per se; it is There is absolutely no indication in the
moderate dosages produces research data currently available
highly improbable that pure LSD ingested in that responsible experimental and th erapeu
tici use of LSD by i
chromosomal aberrations in the white blood cells. sionals should be discontinued. . Py experienced profes:
The positive findings in some of the chromosomal studies using human leu-
cocytes were interpreted as indicating genetic damage and danger to future
generations. To be of direct genetic relevance, however, the chromosomal damage
would have to be demonstrated in the germinal cells, the sperms and ova, or their
precursor cells. Several existing studies of the effect of LSD on the meiotic
chromosomes have been inconclusive despite the use of excessive dosages. The
mutation studies in Drosophila melanogaster indicate no mutagenic effect from
0.28 to 500 micrograms of LSD per cc and a definite mutagenic effect from
2,000-10,000 micrograms of LSD per cc. The fact that truly astronomic dosages
have to be used to induce mutations in Drosophila shows LSD as a rather weak
mutagen that is unlikely to be mutagenic in any concentration used by human REFERENCES
subjects.
ando
In some of the early studies, LSD was implicated as a potential cause of con-
d the T rela ted d w oO I ks consulted by the

genital malformations, abortions and fetal wastage. The original reports of tera-
I Aase, > J. M., ; Laestadius, ,N.,
N.. Smith » D D. W.: Chili
togenic effects in hamsters, rats and mice have not been confirmed by later LSD in Pregnancy. Lancet I: 100, 1970.
studies. The experiments in rodents indicated a rather wide range of individual Naren of Mothers who Took
strain and species susceptibility to the effects of LSD. It is highly questionable 2 Abbo, ,G.,
G., Norris, ,A.,
A., Zellwe ger, H.: Lysergici Acidi Diethylamj
and Chromosome Breaks. Humangenetik -
whether and to what extent the results of such investigations can be extrapolated 6:253, 1968. amide (LSD-25)
to the situation in humans. There have been six individual cases reported of 3 Aghajanian, ,G.K. G. K.,, Bin g, O. H.: Persiistance of Lysergic
Acid Diethylami
malformed children born to parents who have used illicit LSD. Only one team of in the Plasma of Human Subjects. Clin. Pharm
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workers reported an increased frequency of congenital malformations in the off- 4 Alexander, G. J., Miles, B. E., Gold, G. M.,
spring of illicit LSD users. In regard to the high frequency of unexplained “spon- Alexander, R. B.: LSD:
qilect
Injectiaion 57Early
aeo. in Pyacenancy Produces Abnormalities
taneous” birth defects and the wide-spread abuse of LSD, the above observations ities ini Offspring
i of Rats.
 LSD PSYCHOTHERAPY: APPENDIX I References
342 343

der, G. J., Gold, G. M., Miles,

i B. E., Ennes, B. B., Alexander, R. B.: 25 Court Brown, W. M.: Is Lysergide a Teratogen?
Lancet 1:1154, 1967.
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Aptekar, R. G.: Possible Effects of LSD. New Eng. J. -_ ne 1970. 27 DiPaolo, J. A., Givelber, H. M., Erwin, H.: Evalua
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 Index
349

conception, experience of one's 87

INDEX
Fadiman, J. 37, 262
Condrau, G. 22, 24, 25
consciousness of animals 88, 290 Feld, M. 258
consciousness of plants, 88, 290
fetal memories 87, 114
consciousness of inorganic matter flashbacks 43, 51, 124, 137, 146, 165,
88 168,
consciousness of organs, tissues and 186, 194, 195, 196, 307
Abramson, II. A. 22, 28 birth traurna 71, 128 note, 183, 205, 279, cells 88 fly-agaric 269
conversions 25, 44 note
acetylcholine shock 25 280
Cordova Nios, M. 270 Klying Dutchman 81]
Adonis 86 Bizet, G. 154 Fogel, S. 40
cosinic engulfment 80, 86
aggregate LSD therapy 40 Blair, D. 32 Frankenstein 93
Cosmic Man archetype 102
Ahasverus 81 Blewett, D. 37, 270, 272 Frankl, V. 237
Cosmic Sun 86
alchemy 295 Boeri, G. 25 Frederking, W. 22
Creature from the Black Lagoon 93
Allen, M. H. 37 Bohm, D. 231 note Freud, S. 26, 56, 61, 62, 64, 80, 81, 84,
Cybele 86, 102
Alpert, R. 37 Bonny, H. 37, 161 note 86, 102, 109, 111, 120, 121, 132, 133,
Amahuaca Indians 30, 263 bootstrap philosophy of nature (G. Chew) 147, 215, 295
Dahlberg, C. 32
Amanita muscaria (fly agaric) 269 294 fusion technique (P, McCririck) 39, 12]
Dali, S. 260
anaclitic therapy 38, 109, 121 Bosch, H. 260
Datura ceratocaulum 42
Anadenanthera peregrina (cohoba) 270 Brahmanism 263
Datura Stramonium (thronapple or jimson Ganesha 102
ancestral memories 79, 87, 102, 290 Brahms, J. 155 Garden of Eden
weed) 263 79
Anderson, E. W. 25 brainwashing 22, 71, 110 Genghis Khan 93
Davidson, R. 270
anima 102 Brandrup, E. 254 note Gestalt practice 10, 30, 109, 157, 195-6,
deadly nightshade 263
animus 102 Breuer, J. 26 death-rebirth 72, 73, 81, 85, 144, 169, 197, 258, 298
Aphrodite 93 Buckman, J. 32 Giberti, F. 25, 28
222, 223, 253, 281, 282
Apollo 93, 102 Buddha 102 Delay, J. 28 Giger, H. R. 260
archetypal experiences 79, 88, 222, 291 Buddhism 199 note
Deren, M. 44 note Ginsberg, A. 261
Arendsen-Hein, G. W. 32, 56, 243 bufotenine (dimethylserotonin) 263 Descartes, R. 128 note, 230 Godfrey, K. 32, 951
Asperen de Boer, S. R. van 271 Busch, A. K. 22
Deuter, G. 155 Godzilla 93
:
Assagioli, R. 41 DiLeo, F. 37 Gogh, V. van 260
Association Albert Schweitzer (S. Roquet) Caesar Nero 93 dimethylserotonin 263 Good Friday experiment (W. Pahnke)
Caligari, Dr 93 950. 053
273
41 Dionysus 77, 86, 210 note
Astarté 82 ncer patients ; “good breast’ experience 38, 79, 148,
Ditman, K. 32, 37 289
astral projection 269 Cannabis indica and sativa (hemp) 263, 269 Doctor Faust 96 “good womb’ experience 38, 79, 148,
Capra, F. 128 note, 254 note 282
rology 231 note Don Juan 93 Goodman, J. R. 258
Auman’ Brahmen union 35, 79, 86 cardiazole shocks 25 DPT (dipropyltryptamine) 28, 253 Gounod, C. 155
Atropa Belladonna (deadly nightshade) 99, carpopedal spasms 160 Dracula 93 Grant, J. 289
263 Casanova, J. 93 dreams and LSD Great Hermaphrodite archetype 102
223, 224
Cavanna, R. 271 Dvofak, A. 155 Great Mother archetype 38, 73, 86, 102,
Bach, J. . 155 Cayce, E. 290 Dytrych, Z. 32 210
Banisteviopsis caapl iyaee) 263, 270 chakras 88, 160 Gregoretti, L. 25, 28
ma, P. .R. 27 Chandler, A. L. 32 Grieg, E. 155
Bake Pavinatal Matrices (BPM) 71, 100, Chew, G. 294 ; eboga 263, 270
Grof, S. 37, 45 note, 116-7 notes,
114, 277, 282 chlorpromazine (Thorazine) 27, 168 ego death 85, 101, 170, 229 231
notes, 254 notes, 273 note, 295 note
BPM I. 73, 193, 206, 223, 227, 229, Christ 81, 82, 86, 100, 102, 210, 282 Einstein, A. 135, 261
guided affective imagery (H. Leuner)
Christian mysticism 135 Eisner, B. 32 157,
note 197
Christianity 134, 135 electroshock 24, 25, 27, 252
BPM Il. 80, 192, 199 note, 206, 222, Guido, J. A. 258
223, 231 note, 281 Chwelos, N. 37 Elysian Fields 79, 86
BPM III. 81, 192, 199 note, 206, 222, Cimonetti, T. 37 embryonal memories 87, 287
Haeckel, E. 291, 295 note
231 note, 281 clairaudience 88 encounter 195, 196, 298
Handel, G. F, 155
BPR 1V. 85, 193, 206, 223, 229, 231 clairvoyance 88 epena 270
Ernst, M. 260
Halifax, J. 254 note
note Clark, W. H. 244, 264 Halpern,
erotogenic zones 73, 80, 81, 84, S. 155
Bastians, A. 238, 239 Clifton, L. 98 2 86 Harman,
Escher, M. 260 W. 37, 262
Becker, A. M. 25 Coatlicue 85, harmin (yageine, banisterine) 270
Beethoven, L. van 153, 155 COEX system 65, 66, 71, 73, 86, 98, 102, evolutionary experiences 79, 87, 102
Hartman, M. A, 32
Belsanti, R. 25 114, 115, 188, 205, 227, 277, 278 existential crisis 72
exorcism 29]
hashish (charas, bhang, kif) 263
Benedetti, G. 25 COEX transmodulation 252, 278
experience of cosmic unity 48,
Hassidism 135
Bentov, I. 254 note Cohen, S. 32 79, 289 Hausner, M. 32
Berlioz, H. 155 cohoba 270 experience of the Void 48, 88
Hayman, M. 37
bioenergetics 10, 20, 157, 258 complex (C. G. Jung) 116 note experimental psychoses 20, 21, 208
extrasensory perception heaven 79
biofeedback 10 concentration camp syndrome 239 (ESP) 88, 269-273 hebesynthesis (H. A. Abramson) 28
348
350 Index
351
Hefner, H. 93 Kast, E. 252
model psychosis 20, 21, 108, 137,
hell 81, 199 note Kekulé, F. A. von 261 257 Psilocybe mexicana (teonanacatl) 30, 243,
model schizophrenia 21, 47, 137,
hemp 263, 269 Kelsey, D. 289 259 263, 270
Mogar, R. 37, 259
henbane 263 Kennedy, J. F. 270 Mohammed psilocybin 28, 243-4, 273 notes
ketamine (Ketalar) 42, 198, 199 note 102 psilocybin mushrooms 42, 252
Herbert, N. 254 note moksha 35
Hercules 82 King Augeas 82 Moloch
‘psychedelic afterglow’ 221
82, 85, 210
Hindu philosophy 133 King Kong 93 Moniz,
Psychedelic Experience Questionnaire
E. 161 note
Hinduistn 199 note Koestler, A. 45 note, 273 note
Moreno, (PEQ) (W. Pabnke and W. Richards)
J. 109
hippie personality 138 Krippner, S. 270, 273 morning glory (ololiuqui) 42, 263, 270 45 note
Hitler, A. 93 Kundalini or Serpent power 88 Moses 102
psychedelic therapy (IH. Osmond) 28
Hoffer, A. 32, 37, 40, 270 Kundalini yoga 160 Mozart, W. A.
psychodrama (J. Moreno) 109, 197, 258
155 psychodramatic experiences 63-7]
Hofmann, A. 17-20 Kurland, A. A. 37
music 153-5
Holmes, Sherlock 96 mystical categories (W. Pahnke) 45 note, psycholysis (IR. Sandison) 28
holonomic theory (D. Bohm and K. Laing, R. D. 27 psycholytic therapy 31-2, 109, 12], 122,
79, 273
Pribram) 231 note Leary, T. 37, 243 148, 280
orn, P. 155 Leihy, R. 37
narcoanalysis 24, 238 psychosynthesis (R. Assagioli) 41, 258
Honcton, J. 10, 116, 270, 271-2, 273 note LeShan, L. 254 note
Native American
psychosynthesis (S. Roquet) 29
123 Church 30, 263
Hovhanness, A. 155 Leuner, H. 45 note, 116 note, purgatory 84, 199 note
neo-Reichian approaches 10, 30, 195-6
Hubbard, A. 35, 37 Levine, J. 28, 29, 40, 241-2 ’ pyrocatharsis 81, 210
197, 294, 298
Hugo, V. 44-5 note Ling, T. M. 32 neurological symptonis in LSD sessio
Huichol Indians 30, 263 Liszt, F. 154 ns 52 quantum-relativistic physics 11, 135,
Newton, I. 128 note, 230, 294
,
231
Huitzilopochtli 85 Lobell, J. 37 no exit experience 80-1, 144, 171,
note
Huxley, A. 20, 252, 261 Loewi, O. 261 195,
209, 280
Hyoscyamus niger (henbane) 263 lobotomy 161 note Rachmaninoff, §. 155
hyperventilation syndrome 161 note Lophophora williamsii (peyote) 30, 42, oceanic ecstasy 84, 222
racial and collective unconscious
79, 87,
hypnoanalysis 24, 238 ; 263, 270 oloiuqui 263, 270 102
:
hypnodelic treatment (J. Levine and A. LSD analysis (J. Martin and P. oneiroanalysis (J. Delay) 28
Rain Dass 51
Ludwig) 28-9, 40, 121, 241 McCririck) 28 Rank, O. 147, 215, 294, 295
Orr, L. 160
hypnosis 40 Ludwig, A. 28, 29, 40, 241-2 Osiris 86, 210 Rappaport, M, 27
lyserganalysis (F. Giberti and L. Osis, K. 271 Rasputin, G. 93
1 Ching 36 Gregoretti) 28 Osmond, H. 20, 28, 32, 37, 108, 270
Rastafarians 263
ibogain 28, 30 / Rawnsley, A. 25
out-of-the-body experience 88
instant mysticism 22, 263 MacLean, R. 28, 37 rebirthing 10, 160
insulin therapy 24, 25 Magritte, R. 260
Pahnke, W. 37, 45 note, 79, 161
Reich, W. 215, 294, 298
intrauterine experiences 79, 114 aier, G. J. 24 note, 253 ’ Rhijn, C. HW. van 28, 32, 116-7 note
271, 273 note
Ipomoea violacea (morning glory) 270 Mandvagon, officinarum (mandrake) 263 paradise 79 Richards, W. 37, 45 note, 253
Isis 86, 102 Martin, J. 28, 38, 39. 122 Paris, B. D, 244
Rinkel, M. 257
lxion 81 arxist philosophers
peacock symbotism 86
Ritaline 39, 198
Izumi, K. 261 Moa ea 35.79, 166 note, 133, 229, rites of passage 55, 88, 275
peak experience (A. Maslow) 79, 269,
9, 287 Pelletier, K. 254 note
287 Robinson, J. T. 26
Janiger, O, 273 note Masters, R. 10, 116 note, 270, 271-2, 273 rolfing 157
perinatal experiences 71-87, 221, 298
Janov, A. 128 note note Roquet, S. 29, 41, 109
Perls, F. 61, 109
jimson weed 263 Mazatec Indians 30, 263 Rothlin, E. 18
Perry, J. 27
Jivaro Indians 30, 263 McCabe, O. L. 37, 242 Roubiéek, G. 25, 257, 273 note
peyote 30, 42, 263, 264, 270
Johnsen, G. H. 32 McCririck, P. 28, 37, 39, 111, 122 phencyclidine (PCP, ‘angel dust’) 109, Rush, L. 37
Johnson, W. C. 22 McDonald, D. 37 163,
308
Jost, F. 26, 27, 28 McGovern, W. 270 samahdi 35
Phoenix 82
aism 135 MDA (methylene-dioxy-amphetamine) 28, Picasso, P. 260
Sandison, R. 22, 27, 28, 31, 32
joel C. G. 116 note, 272, 294, 295 198
planetary consciousness 88 Sandox 18, 20
Jungian psychology 30, 109, 147, 215, 272, Meduna mixture (carbon dioxide and Poirot, Hercule 96 Satan 102, 210
294 oxygen) 198 Poppea 93 satori 35
Meher Baba 264 Savage, C. 37, 241, 242, 299
Poulenc, F, 155
Kabbalah 135, 295 Mendelssohn, L. 154 pranayama 160 Savary, L. 161 note
Kali 82, 85, 102 mescaline 28, 252, 262 precognition 88, 269 scatalogical experiences 81, 223
Kappers, J. 271 metamotivations and metavalues (A.
Pribram, K. 231 note
Schiffman, M. 37
karmic experiences 79, 87, 102, 210, 222, Maslow) 36, 116 note, 133, 229 primal therapy 10, 128 note,
schizophrenia 20, 21, 26-8, 88, 108,
157, 245-
287 Metzner, R. 37 195-6, 51, 257, 258, 281, 287
298
Kashmir Shaivism 230 Miller, E. 290
Prometheus 81 Schultes, R. 263
Schumann, R. 155
 mien AeA :scarnaceinnaenascen tcl

352 Index

Scriabin, A. 155 Thorazine 27, 168

self-actualization and self-realization Thornapple 263 :
(A. Maslow) 36, 269 Tibetan Book of the Dead (Bardo Thédol) :
sensory isolation 10 37
sensory overload 10 Tibetan Buddhism 295
serotonin (5-hydroxytryptamine) 21 Tlacolteutl (Devourer of Filth) 82
Servadio, E. 271 Toad skin 263
set and setting 163, 307 Toben, B. 254 note
Shakti 93 transference phenomena 29, 37, 87-9, 276
shamanism 88, 262, 272 transference psychosis 226, 245
Shankar, R. 155 transintegrative therapy (R. MacLean) 28
Shaw, E. 21 transmodulation 278
Sherwood, F. 37 transpersonal experiences 79, 87-9, 210,
Shiva 93, 102, 210 222, 223
Shiva the Destroyer 85, 210 transpersonal psychology 120, 128 note
Silverman, J. 27 transphenomenal dynamic system
Sisyphus 81 (H, Leuner) 116 note
Smith, C. M. 37 Troxler, F. 17
Smith, Hl. 264
Sobotkiewiczova, J. 32 Unger, S. 37
soma 262, 264 universal symbols 37
Soskin, R. 37 Upanishads 127
spectrum psychology (K. Wilber) 231 note,
294 Vajrayana 110
Spencer, A. M. 22, 32 Valhalla 86
Sphinx 98-9 Valjean, J. (corrective experience) 44-5
spirit possession 291 note
Spring Grove 127, 166, 242, 243, 281, 291 Vangaard, T. 254 note
Sri Ramana Maharishi 102 Venus 102
Srnec, J. 25 Verdi, G. 155
Stalin, J. V. 93 Vicari, R. 27, 28
Stark, L. H. 241 Virgin Mary 86
status epilepticus 52, 137, 164 Virola theidora (epena) 270
Stolaroff, M. 37 Vivaldi, A. 155
Stoll, A.17, 19 — Voivod Draeula 93
Stoll, W. A. 20, 25, 257 volcanic ecstasy 84
STP 109, 138, 163, 308
Strauss, R. 155 Wagner, R. 154, 155
strychnine 109, 163, 308 Wasson, V. D. 252
Sufism 110, 135, 263 Watts, A. 264
suicide 192-3, 280 Wesley, J. 44 note
symbolysis (C. H. van Rhijn) 28 Whitelaw, J. D. A. 22, 27, 32
synchronicity (C. G. Jung) 272 Whittlesey, J. 32, 37, 271
Wilber, K. 231 note, 294
Tabernanthe iboga (eboga) 263, 270 Winter, P. 155
Tantalus 81 Wise Man archetype 102
Tantric Buddhism 230 Witches’ Sabbath 99, 263
Tao 79, 86 Wolf, S. 37
Taoism 110, 230 Woolley, D. W. 21
Tarnas, R. 231 note
Tart, C. 40 yagé (Banisterfopsis caapi) 30, 263, 270
Tat tvam asi 79 Yensen, R. 37
Tate, D. L. 244 yin-yang 231
Tautermann, J. 32 yoga 110, 229
telepathy 88 Young, A. 254 note
teonanacatl 263, 264, 270
Terrible Mother archetype 73, 210 Zaehner, R. C. 264
Tesla. N. 261 Oe Ton Ruddhien 110 19%