Adverse Aftereffects Of Lsd Psychotherapy

LSD psychotherapy involves activation of deep unconscious material, its exteriorization, and conscious integration. Although the LSD sessions represent the most dramatic aspect of this treatment modality and ideally form a relatively completed psychological gestalt, psychedelic therapy is a continuous uncovering process which includes the dynamics of the free intervals between sessions. Within the framework of an LSD series, no clearcut boundaries can generally be drawn between the sessions and the events preceding and following them. The dynamic unfolding of various governing systems in the unconscious continues in a more or less subtle way for a long time after the actual pharmacological effect has subsided. A very convincing illustration of this process is found in dreams. The content of the dreams seems to form a continuum with the content of the psychedelic sessions. It is quite common that pre-session dreams anticipate the content of the LSD experience and post-session dreams are attempts to complete the gestalts that remained unfinished and to elaborate on the material involved.

Although internalization of the LSD sessions and active psychological work in the termination periods can considerably facilitate the integration of the material, there is never any guarantee that all the psychological gestalts will be completed by the time the pharmacological effect of LSD terminates. The risk that the integration of a session will be incomplete and will result in real clinical complications seems to be directly proportional to the degree of preexisting emotional problems in the subject and the negative circumstances in the session that , prevent consistent introspective work. The extreme examples of this are intensification of the original symptoms, emergence of new forms of psychopathology, ' prolonged reactions, psychotic breaks, and reoccurrence of LSD symptoms at a later date ("flashbacks"). All these should be seen as comprehensible phenomena which are part of the dynamic unfolding of the uncovering process and represent calculated risks of LSD psychotherapy.

Some of the papers discussing the probable mechanisms of these complications entertained the possibility of actual pharmacological presence of a certain amount of LSD in the brain for indefinite periods of time. This explanation is inconsistent with the basic principles of pharmacology and also with concrete laboratory findings on the metabolism and distribution of LSD in the body. According to these, the drug has left the brain by the time the psychedelic experience culminates. There seems to be sufficient clinical evidence that the adverse aftereffects of LSD sessions reflect deep, basic dynamics of the unconscious processes and should be understood and approached in this context.

The psychopathological symptoms that can manifest as a result of incompletely resolved LSD sessions cover a very wide range. Essentially, any aspect of an activated dynamic matrix or specific unconscious material that remains unresolved can persist after the session for an indefinite period of time, or recur at a later date. Most frequently, these are various emotional qualities, such as depression, a sense of inferiority, suicidal feelings, affective lability or incontinence, a sense of loneliness, anxiety, guilt, paranoid feelings, aggressive tension, or manic elation. Psychosomatic symptoms that can occur in this context involve nausea and vomiting, difficulties with breathing, psychogenic coughing and gagging, cardiovascular distress, constipation or diarrhea, headaches and pains in various parts of the body, chills and hot flashes, increased sweating, "hangover" feelings, flu-like symptoms, hypersalivation, skin rashes, and different psychomotor manifestations such as general inhibition or excitement, muscular tremors, twitches, and jerks. An activated and unresolved unconscious gestalt can also specifically in fluence the subject's thought-processes. Certain ways of thinking about various issues such as sex, men, women, marriage, and authority, or philosophical speculations about the meaning of existence, the role of religion in life, suffering, injustice, and many other problems can be direct reflections of the underlying unconscious material. Strong opinions, judgments, and systems of values in various areas can change drastically when a previously unfinished unconscious gestalt is completed.

The occurrence of various perceptual changes after unresolved sessions is relatively less frequent. Long after the pharmacological effect of the drug has subsided, the patient may still report anomalies in color-perception, blurred vision, after-images, spontaneous imagery, alterations in body image, intensification of hearing, ringing in the ears, or various strange physical feelings. Sometimes, various combinations of the above emotional, psychosomatic, ideational and perceptual changes constitute completely new clinical syndromes which the subject has never experienced before. The occurrence of new forms of psychopathol-ogy can be understood as a result of activation and exteriorization of the content of previously latent unconscious matrices. These symptoms usually disappear instantly when the underlying material is fully experienced and integrated.

The general nature and specific characteristics of the adverse aftereffects of LSD sessions depend on the level of the unconscious that was activated and the specific content of the matrix involved. An active and unresolved matrix, whether of a psychodynamic, perinatal, or transpersonal nature, will influence the subject's perception of himself or herself and of the world, emotional reactions, thought-processes, and behavior patterns in a specific way. The clinical symptorris that are psychogenetically connected with the activated functional system may persist for days or weeks and even for unlimited periods of time. Sometimes the adverse aftereffects of the session are limited to accentuation and intensification of the original emotional, psychosomatic or interpersonal problems of the patient. At other times the post-session difficulties represent a recurrence of symptoms which he or she suffered from in childhood, adolescence, or some later period of life. In still other instances, the adverse aftereffects constitute a repetition of the situation that typified the onset of the subject's manifest neurotic or psychotic symptoms; this is true not only in terms of clinical symptoms, but also for specific interpersonal patterns.

One mechanism of crucial relevance has to be mentioned at least briefly in this context. We described earlier how an activated dynamic matrix determines the nature of the patient's experience and the specific ways in which he or she perceives the environment. This is quite regularly associated with a strong tendency to exteriorize the content of the unconscious constellation and enact its replica in the treatment situation, as well as in everyday life. If we carefully analyze the psychodynamics of this phenomenon, we find a very interesting underlying mechanism that can be described as intolerance of emotional-cognitive dissonance. Apparently, it is very difficult and disturbing to experience a deep incongruence between one's inner feelings and/or sensations and the nature of events in the external world, as cognitively interpreted. It seems to be much more acceptable to experience various unpleasant emotions as being reactions appropriate to or at least congruent with actual circumstances existing in objective reality, than to perceive them as incomprehensible and absurd elements coming from within.

Thus irrational feelings of anxiety and a sense of threat originating in the unconscious can result in maneuvers aimed at provoking hostility in the therapist, spouse, or employer. When these maneuvers succeed, previously incomprehensible 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 position or job. In more intense forms of such fear that border on vital threat, the patient might actually seek out dangerous situations in activities such as hazardous car driving, parachuting, walks in bad neighborhoods, or visits to bars and night clubs of questionable reputation. Similarly, an LSD patient tuned into deep irrational guilt feelings may behave in an utterly inappropriate way, break the basic rules of therapy, and try to offend, irritate, or verbally attack the therapist. Me or she can also do things in everyday life that are highly objectionable and guilt-provoking. As a result of this, the pre-existing guilt feelings can be rationalized, since they become attached to actual external events and appear to be congruent with the objective situation. The above are just a few concrete examples of very common mechanisms that can present considerable difficulties in the therapeutic situation, as well as in the patient's everyday life. It is absolutely essential for a successful course of psychedelic therapy that the therapist is familiar with this phenomenon and capable of handling it appropriately.

The changes caused by activation of different levels of COEX systems are usually not very dramatic and stay within the range of various neurotic and psychosomatic manifestations, unless the activated layer is from very early childhood and/or its emotional charge is excessive. When an important COEX system is activated and remains unresolved, the subject experiences in the post-session period an intensification of the clinical symptoms related to this system and perceives the environment with specific distortions reflecting its content. In addition, he or she may manifest a tendency to exteriorize the general theme of the system, or certain specific characteristics of one of its layers, in the treatment situation and in various aspects of everyday life. He or she may show peculiar idiosyncrasies and overreact to certain circumstances. The behavior of subjects under these conditions can involve complicated psychological maneuvers that tend to provoke specific reciprocal attitudes in the partners of their various interpersonal relationships. The external situations that result from such interaction represent approximate replicas of the original traumatic events that remained unresolved in previous sessions. Since this section focuses on complications of LSD therapy, we are naturally discussing activation of negative COEX systems. However, it is important to emphasize in this context that activation of a positive COEX system can have powerful positive consequences of a very similar kind.

When the adverse aftereffects of an LSD session result from an incomplete resolution of a COEX system, their general nature and specific content can be understood once the unconscious material becomes fully availiable. The basic characteristics of the emotional and interpersonal problems involved will reflect the general theme of the system; specific details will then make sense in terms of the individual layer of the COEX constellation that was activated. The therapist will frequently not be able to understand the dynamics of the problem when it occurs and he or she might have to wait until the time when the underlying unconscious material surfaces and the gestalt is completed. However, an experienced LSD therapist is not always dependent on retrospective understanding. In many instances the nature of the material to be experienced can be anticipated, at least in a general form, from the specific characteristics of the adverse reaction. Many of the elements discussed above are illustrated by the following clinical example:

Tom, a 26-year-old dropped-out student, was accepted into the program of LSD therapy for a severe impulsive neurosis with periodic running away from home, vagabondism, and excessive abuse of alcohol and various drugs (poriomania, dipsomania and toxicomania). His behavior during these episodes involved many distinctly antisocial elements. He usually did not pay in restaurants and inns: he either escaped without settling the bill or left some personal belongings as guarantee for later payment. Occasionally, he stole money or various objects from relatives, friends or strangers to cover his expenses. He slept in forests, public parks, and railway stations, and grossly neglected his personal hygiene. Tom was referred to the LSD program after two years of unsuccessful therapy by various conventional methods. Some of his previous psychiatrists had diagnosed his case as schizophrenia, and the history of his treatment included a series of insuline comas.

His first twenty-six LSD sessions followed an unusually monotonous course. He experienced anxiety, occasionally mounting to panic, and showed great agitation associated with massive muscular jerks and tremors. This was accompanied by recurrent visions of a pale, grimacing female face. In later sessions, another element was added to the content of his experiences. Every time he heard the sound of water running in a nearby bathroom, he was overcome by anger and had great difficulty in controlling his aggression. He also could not tolerate the presence of a female therapist or nurse, even briefly, and responded to them with irritation and rude verbal attacks. The visions of the pale female face were now supplemented by images related to water. In this context, various dangerous situations associated with seas, lakes and rivers alternated with courageous sailors and aquatic animals of prowess, symbolizing mastery over the water element.

At this time, Tom's problems in the free intervals between LSD sessions bordered on psychosis. He experienced bouts of unmotivated panic anxiety and felt intense hatred towards women. His idiosyncrasy in regard to running water continued and he almost physically attacked everyone who turned on the water tap. Tom's behavior resulted in numerous conflicts with the co-patients and nurses since he tended to provoke hostility by his intolerance, recklessness, and aggression. He appeared agitated and manifested a variety of involuntary motor phenomena, particularly massive jerks.

Several sessions later, new elements appeared in the visions accompanying Tom's LSD experiences. At first, their content was quite puzzling and incomprehensible. He saw rapid sequences of various trivial objects related to bathing, such as shower nozzles, water taps, soap bars, tile patterns, sponges, bath brushes, and bath toys. The innocent nature of these visions seemed quite incongruent with the intensity of anxiety and the powerful motor discharges that accompanied them. Tom was very dissatisfied with these sessions and found them confusing; he referred to his experiences as "a crazy pell-mell," "mish-inash," or "chaos." All these disconnected experiences suddenly made sense when Tom relived in a complex way certain traumatic memories from his early childhood. When he was two and three years old, he had an emotionally disturbed nurse who finally turned out to be psychotic. She used to maltreat him and frighten him in a very sadistic way, particularly during bathing. The authenticity of Tom's recollections was later verified by his step-mother; she fired the nanny after having discovered how much she had abused the child. After full and complex reliving of these traumatic memories, most of the elements described above disappeared from Tom's sessions. However, the anxiety and muscular jerks persisted, despite the fact that they originally seemed to belong to the traumatic memory involving the nanny. At this point, the anxiety in Tom's LSD sessions became much more primitive and elemental; the twitches now appeared to be associated with very unpleasant tastes and oral sensations. This gradually developed into reliving of early childhood experiences that involved the application of various disinfectant solutions to the mucous membranes of his mouth when he suffered from a fungus disease. The musuclar jerks were particularly emphasized around Tom's head and neck and he identified them as escape reactions associated with these medical interventions. In the intervals between these sessions, Tom showed a strong negative attitude toward hospitals and medicine; he criticized and ridiculed the medical aspects of our treatment procedures and revolted against them.

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 the first seven months of his life. At this time, he craved the presence of and physical contact with women, and asked for the female therapist and nurses —persons whom he previously could not stand—to be present. In this context they seemed to compensate for the frustration and emotional deprivation which he had experienced in the nursery, where the superficial professional attitudes of the personnel had failed to satisfy his infantile needs. In the free intervals between these sessions, Tom was haunted by the desire to find the ideal woman; his depression was accentuated and he felt an irresistible urge to consume great quantities of alcohol and various drugs.

When Tom started to relive his difficult birth, during which his mother had died and he himself had barely survived, he recognized that many of his symptoms were actually rooted on the perinatal level. His panic anxiety, aggression, guilt, and driving tension suddenly made sense as derivatives of the birth trauma. He now saw his massive muscular jerks and twitches as belated discharges of pent-up energies related to the "hydraulic" aspects of the delivery. Tom's behavior around the birth sessions was impulsive, ruthless and erratic; it was characterized by acting out of strange ambivalent tendencies and conflicts between dependence and independence. Much of this was expressed in the context of the transference relationship; by conventional standards Tom's behavior during this period would be labelled psychotic.

In his sixty-fifth psyeholytic session, Tom seemed to have completed the birth process and had his first deep trancendental experience, followed by a dramatic but not lasting improvement. It took six more sessions and several months of unstable clinical condition before he reached a new equilibrium.

In the years following his LSD therapy Tom has not needed hospitalization and did not have to rely on psychiatric help. He married and was able to maintain a job arid take care of his two children.

Sometimes seemingly bizarre sensations, emotions, and thoughts occurring in the context of an adverse LSD reaction can be explained naturally and logically when one uncovers and identifies the underlying unconscious material. The fear of a male patient that his penis is shrinking can thus be traced to an emotional fixation on a body image corresponding to the age of an unfinished childhood memory. In a similar way, a female patient who is psychologically tuned into an activated memory from the preadolescent period can lose the awareness of her breasts from the body image, or can develop a conviction that she is losing her hair when she connects emotionally to -early infantile memories. Naive and childlike perception of the environment, inappropriate fears, increased dependency needs, or doubts about bladder or bowel control are some other examples in this category. Of particular interest for psychosomatic arid internal medicine are j those instances in which, following an LSD session, an apparently somatic problem turns out to be an integral part of a traumatic memory from childhood. Because of the special clinical importance of this phenomenon, I will illustrate it with several examples.

Renata, a patient suffering from severe canceropliobia, relived in one of her sessions a sexual episode that supposedly happened when she was four years old. In this scene, her stepfather was lying in bed and she crawled under the blanket with him expecting to be fondled and caressed. During their play, however, he gradually directed her to his genital area and abused the situation for his sexual gratification. The discovery of his erect penis was a particularly exciting and frightening aspect of this situation. While reliving a part of this episode, in which her forearm was the most important area of contact with her step-father's body, she suddenly developed a massive circumscribed infiltration and reddening of the skin. In front of my eyes and within a matter of minutes this area reached the consistency of shoe-leather; it became thick, hard and covered with protruding skin eruptions. This condition, which was diagnosed as eczema by a consul-tant dermatologist, persisted for ten days until the next LSD session. After !' the traumatic memory had been fully relived and integrated, it disappeared over several hours.

In another of her sessions, Renata relived a childhood scene in which she had fallen on ice while figure-skating and badly hurt her head and knee. During the following week she experienced intense pain in the "injured" parts of her body. She could not turn her head, was limping considerably, and maintained a typical protective posture of her right leg. All these phenomena disappeared after the incident was fully relived.

Another interesting example of a similar kind was observed during the LSD therapy of Dana, a patient with complicated neurotic problems. In one of her sessions, she started reliving a traumatic episode which had occurred at a time when she suffered from severe bronchitis. In this context, she suddenly began manifesting all the typical symptoms of a bronchial infection. These symptoms persisted even after the actual pharmacological effects of LSD had worn off; during the following week, she continued to cough excessively and complained about severe chest pain. The internist who saw her as a consultant diagnosed bronchitis on the basis of elevated temperature, characteristic rales during stethoscopic examination, coughing, and production of thick phlegm. The only signs that distinguished this condition from genuine bronchitis were its sudden onset at the time when the traumatic memory started to emerge and its equally abrupt termination when the psychological gestalt was completed.

The governing influence of activated basic perinatal matrices on the post-session intervals is usually much more dramatic, and is of great practical and theoretical importance. If the subject is under a strong influence from one of these matrices at the time that the pharmacological action of the drug is wearing off, he or she can experience its influence in a mitigated form for days, weeks or even months. If a deep level of a negative matrix is activated, the individual difficulties following the session can reach psychotic proportions. The consequences are quite distinct and characteristic for each of the perinatal matrices.

When the termination period of an LSD session is governed by BPM II and the subject stabilizes under its influence, the post-session interval is characterized by deep depression. Under these circumstances, individuals are vexed by various highly unpleasant feelings, thoughts, and physical sensations. They have access only to unpleasant memories and cannot see any positive elements in their entire life history. Guilt, inferiority, and shame seem to dominate their thinking about the past. Their present life appears to be unbearable and fraught with problems that have no solution; they do not have any perspective on anything, and the future looks equally hopeless. Life is devoid of any meaning, and there is an absolute inability to enjoy anything. The world is perceived as threatening, ominous, oppressive and without colors. Suicidal ideation is not uncommon in this situation; it typically has the form of a wish to fall asleep or be unconscious, forget everything, and never wake up again. Persons in this state of mind have fantasies about taking an overdose of sleeping pills or narcotics, drinking themselves to death, inhaling domestic gas, drowning in deep water, or walking into snow and freezing, (suicide I) Typical physical symptoms accompanying this condition are headaches, oppression of the chest, breathing difficulties, various cardiac complaints, ringing in the ears, severe constipation, loss of appetite, and a total lack of interest in sex. Feelings of exhaustion and fatigue, drowsiness and somnolence, and a tendency to spend the entire day in bed or in a darkened room are also common.

Stabilization of an LSD session under the dominance of BPM III results in feelings of intense aggressive tension, frequently associated with strong but vague apprehension and anticipation of a catastrophe. Subjects in this state liken themselves to "time bombs" ready to explode at any minute. They oscillate between destructive and self-destructive impulses and are afraid of hurting other people or themselves. A high degree of irritability and a strong tendency to provoke violent conflicts is typical. The world is perceived as a dangerous and unpredictable place, where one has to be constantly on guard and prepared to fight and struggle for survival. Painful awareness of one's real or imagined handicaps and limitations is combined with exaggerated ambitions and efforts to prove oneself. In contrast to the inhibited and tearless depression related to BPM II, the clinical picture here can take the form/ of an agitated depression accompanied by emotional incontinence and psychomotor excitement. Suicidal thoughts, fantasies and tendencies are quite frequent, and follow a pattern distinctly different from that described for BPM II. Individuals in this state contemplate bloody and violent suicides, such as throwing themselves under trains, jumping from a window or cliff, hara-kiri, or shooting themselves, (suicide II) The only suicidal fantasies observed in this context that do not involve blood are related to strangulation and hanging. This seems to reflect the fact that high degrees of suffocation are frequently experienced in the final stages of birth. Typical physical symptoms associated with this syndrome involve intense muscular tension, frequently resulting in tremors, twitches, and jerks, pressure headaches, pains in various other parts of the body, nausea with occasional vomiting, intensification of intestinal activity and diarrhea, frequent urination or urethral spasms, and profuse sweating. A characteristic manifestation in the sexual area is excessive augmentation of the libidinal drive, for which even repeated orgasms do not bring satisfactory relief. In male subjects, this intensification of sexual tension is sometimes associated with impotence2 and premature ejaculation; in females, with an inability to achieve sexual orgasm, premenstrual emotional turbulence, dysmenorrhea, and painful genital cramps during intercourse (vaginism).

Subjects whose LSD session terminates under the influence of BPM IV present a very different picture. The most remarkable aspect of this state is a (dramatic alleviation or even disappearance of previous psychopathological symp-' toms, and a decrease of emotional problems of all kinds. Individuals feel that they have left the past behind and are now capable of starting an entirely new chapter in their lives. Exhilarating feelings of freedom from anxiety, depression and guilt are associated with deep physical relaxation and a sense of perfect functioning of all physiological processes. Life appears simple and exciting, and the individual has the feeling of unusual sensory richness and intense joy.

As far as BPM I is concerned, the individual can stabilize under the influence of its positive or negative aspects. In the former case, the postsession interval resembles the one described for BPM IV. However, all the feelings involved are much deeper and are experienced in a religious or mystical framework. Subjects see new dimensions in the world and in the universe, have strong feelings of being an integral part of creation, and tend to regard ordinary things and activities in everyday life—such as eating, walks in nature, playing with children, or sexual intercourse—as manifestations of the divine. The experience of cosmic unity has an unusual therapeutic potential and can have lasting beneficial consequences for the individual.

If the subject remains after an LSD session under the influence of the negative aspects of BPM I or negative transpersonal matrices, he or she experiences various forms and degrees of emotional and physical distress associated with conceptual confusion. These difficulties are typically interpreted in a metaphysical framework—in spiritual, occult, mystical, or religious terms. These unpleasant conditions are attributed to the adverse forces of destiny, "bad karma," malefic astrological or cosmobiological influences, or various evil spiritual entities. In extreme cases this condition can reach psychotic proportions. After the individual works through and integrates the experience, he or she assumes a more tentative and metaphorical approach to such extreme interpretations.

The four major complications of LSD sessions that are of great practical relevance and should be specifically discussed are activation of preexisting symptoms, prolonged réactions, psychotic decompensations, and "flashbacks. " They can all be reduced to a common denominator, namely, the weakening of the defense system and incomplete resolution of the unconscious material that was thus made experientially available. The weakening of resistance is most apparent in those situations where the symptoms that the subject originally had are activated and intensified after a particular LSD session. In this case, no major change has occurred; the underlying matrix remains the same but its dynamic influence is experienced more strongly than before. In the case of a prolonged reaction, the specific defense system collapses but the material behind it is not worked through. The experience then continues not because of the persisting pharmacological action of the LSD, but as a result of the emotional chargé of the unleashed unconscious material. The emerging unconscious theme is now too energetically charged and too close to consciousness to be repressed and covered up again, but a subject unfamiliar with the psychodynamics of this process usually tries to prevent it from emerging fully and completing itself.

A temporary psychotic decompensation after an LSD session can be seen as a special example of a prolonged reaction. It occurs when the unconscious material that became activated and remained unresolved is a theme of fundamental relevance and carries excessive emotional charge. It may occasionally be a major trauma from very early infancy; however, in most instances such an episode involves perinatal material or some powerful negative transpersonal matrix. I have never seen an incident of this kind after supervised LSD sessions with persons who showed a reasonable degree of emotional, interpersonal and social adjustment prior to the experience. In individuals who have serious psychiatric problems that border on psychosis, or have had schizophrenic episodes in the past, occurrence of transient adverse reactions of this depth is not uncommon.

The recurrences of LSD-like states days, weeks, or even months after the actual administration of the drug has stirred much publicity and deserves special attention in this context. Careful study of the psychodynamics of the LSD reaction over many years has convinced me that these episodes, popularly known as "flashbacks," have a very similar basis to the prolonged reactions and psychotic breaks immediately following the sessions. The difference is that in this case the defense mechanisms are strong enough to cover up the activated and unresolved material in the termination period. The experience appears to be completed, but this is true 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 individual starts consciously experiencing the. unfinished gestalt. Since it is a continuation of a process that started during the LSD experience, the uninformed 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 under circumstances which physiologically involve weakening of defenses, such as the periods between waking and sleep (the hypnagogic and hypnopompic state), physical fatigue, or sleep deprivation. More dramatic instances are usually associated with the use of drugs such as alcohol, marijuana, and psychostimulants, or virus diseases and other somatic processes. On occasion, later psychotherapeutic sessions, especially those that involve techniques using hyperventilation, can facilitate what the subject considers to be an LSD "flashback." Meditation and various other spiritual practices or the individual and group exercises used in growth centers can have similar effects.

In addition to the above factors which have a general catalyzing influence, the mechanism of "flashbacks" frequently involves an element of very specific psychological stress. This mechanism is of such importance that it deserves special emphasis. Powerful triggers for the recurrence of the LSD state are situations of everyday life that involve elements similar or identical to the unconscious matrix or theme that remained unresolved. An example of this would be a subject whose last LSD session, spent mainly under the influence of BPM II, did not end with a satisfactory resolution. Under these circumstances a crowded, overheated, poorly ventilated, and noisy subway can provide an experience which is extremely close to the basic characteristics of the "no exit" situation. Driving a car in the rush-hour on a busy highway or use of a crowded elevator can have a similar impact. All these situations can thus function as powerful facilitators of the content of the second perinatal matrix.

In a similar way, a subject psychologically tuned into BPM III could have a "flashback" as a result of watching a movie or TV-show involving rape, sadism and violence, or while driving a car and reaching a speed that appears dangerous. Sometimes the triggering stimuli come from the external world, more or less accidentally and without active participation of the subject. I11 some other instances, the subject is instrumental in creating a situation in everyday life that is an approximate replica of the unresolved traumatic gestalt. The mechanism underlying such situations was described earlier in detail. Since this process typically involves interpersonal partners and external circumstances it takes some time for it to reach critical dimensions. The period necessary for such development would then explain the frequently long period that elapses between the drug experience and the "recurrence." Examples of this mechanism would be: recreating for oneself a "no-exit" situation in everyday life, contaminating a sexual relationship by elements of the third perinatal matrix, reenacting an unresolved father problem in the daily interaction with one's employer.

Understanding that the adverse aftereffects of LSD sessions are comprehensible and lawful phenomena reflecting the basic psychodynamics of the unconscious, and not capricious spin-offs of the pharmacological effects of a bizarre and unpredictable substance, suggests a general strategy and certain specific techniques for their prevention and therapy.

Continue reading here: Prevention And Management Of Complications In Lsd Psychotherapy

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