Borderline Psychotic States And Endogenous Psychoses

Psychiatric patients with borderline and manifest psychotic conditions need not necessarily be excluded from psychedelic therapy. Although clinical experiences of the treatment of schizophrenic and other psychotic states with LSD are rather limited, it is possible to make certain general conclusions. By and large, the prognosis in psychotic individuals seems to be much better than in certain severely defended neurotics, particularly obsessive-compulsive patients. However, this statement is conditional and needs clarification and specification. LSD work with severely disturbed individuals is a very demanding and intense process which requires special preparation and training. It should not be attempted by anyone who has not had sufficient experience of LSD sessions with "normal" and neurotic individuals. The intervals between the sessions may be characterized by dramatic exteriorization or intensification of various psychotic symptoms. In certain critical stages of the psychedelic process the inner experiences and behavior of the client can be almost entirely focused on the therapist, in the sense of a "transference psychosis." A special treatment unit with trained personnel and 24-hour-a-day supervision is an absolute necessity for this undertaking.

The deepest roots of schizophrenic symptomatology can always be found in the various perinatal matrices and in negative transpersonal experiences. A therapist sharing the complicated journey triggered in the psychotic patient by LSD has to remain grounded and centered during the entire process, which might turn out to be a wild emotional and conceptual roller-coaster. Because of its importance, not only to the LSD therapy for schizophrenia but also for the basic understanding of the dynamics of psychosis, I will illustrate this process with the story of Milada.

Milada was a 38-year-old psychologist who for many years before starting LSD treatment had suffered from a complicated neurotic disorder involving a variety of obsessive-compulsive, organ-neurotic, and hysterical conversion symptoms. She started systematic psychoanalytic treatment, but four months later had to be hospitalized because she developed acute psychotic symptoms. An important part of her clinical symptomatology was an erotomanic delusional system. Milada was convinced that her employer was deeply in love with her and she herself felt irresistible affection and sexual attraction toward him. She sensed a strange erotic and spiritual communion existing between them which they shared intrapsychically, beyond the facade of their rather formal social interaction. Several weeks later she started hallucinating the voice of her imaginary lover. In these hallucinations, she heard him describe in detail his passionate feelings for her, promise a beautiful shared life in the future, and give her advice or specific suggestions. During the evening and night hours Milada experienced powerful sexual sensations which she interpreted as intercourse at a distance, magically performed by her "lover." Although in actual sexual situations she had always been frigid, during these episodes she experienced orgastic feelings of cosmic proportions.

Milada's hospitalization became unavoidable when she started acting under the influence of her delusions and hallucinations. One day in the 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. She referred to his "voice," which allegedly had told her that divorces had been arranged for both of them and that they could now live together. After many months of unsuccessful treatment with a variety of tranquilizers and antidepressants, as well as individual and group psychotherapy, she was selected for psycholytie therapy with LSD.

After twelve LSD sessions, the psychotic symptoms completely disappeared and Milada developed full insight in regard to her irrational behavior 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 present problems to their emotional sources in her unhappy childhood. Much 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 emotional 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 realm and Milada experienced 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 1 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 free intervals. She experienced a mutual exchange of thoughts and even verbal communication. It was interesting that in some of these hallucinated interviews we "continued psychotherapy." Milada "discussed" various aspects of her life with me and carried out activities suggested by my illusory voice, such as several hours of bathing and physical training every day and exercises in feminine housework. In these hallucinated conversations 1 told her that 1 had decided to drop the therapeutic game and become her lover and husband; 1 also allowed her to use my last name instead of her husband's name. She was repeatedly assured of my 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 psychosomatic 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

The experience, during a trans-personal session, of elements of the collective unconscious. The patient became a member of an ancient culture that she could not identify by name, historical period or geographical location. However, she was able to draw and paint in its artistic style.

Archetypal demonic entities envisioned during transpersonal sessions.

Above. A stylized dragon of cosmic proportions representing the principle of metaphysical evil. Right. An image of a winged demonic creature that screens the source of divine light and prevents the subject from reaching and uniting with it.

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 weekly administrations of LSD despite her persisting psychotic symptoms. These sessions consisted almost entirely of negative experiences of a transpersonal nature. There was an important emphasis on reliving unpleasant intrauterine memories, which she related to the emo-Jional stresses and illnesses of her mother during pregnancy, various embryonal crises, and the mechanical discomfort of being twins in a uterus. She also had some negative karmic sequences and archety pal 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 attitude toward her children, and the ability to give up her previous unrealistic ambitions and fantasies. She was able to resume her job and perform it adequately, obtain a divorce from her husband, and live independently while taking care of her two children. To my knowledge, she lias not needed anv in- or out-patient psychiatric care during the more than twelve years since the termination of her LSD treatment.

In several other schizophrenic patients whom I treated with LSD therapy, the proccss was similar but less involved and dramatic than the one described above.3 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 I 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 consent, 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 < to a paranoid patient, he or she tends to experience the session in total ]• psychological isolation and blame all the emotional and psy chosomatic distress on 1 the therapist. The extraordinary nature and scope of the psychedelic experiences can, under these circumstances, not only powerfully reinforce and justify the conviction of the therapist's evil intentions, but magnify his or her image in the patient's eyes into a malefic figure of cosmic proportions.

Psychotic conditions of the manic-depressive type can also be treated by LSD psychotherapy, although special problems might be encountered in this category of patient. A single LSD session can frequently cause a complete remission of the depressive or manic episode. In a similar way, a single administration of the drug can change the phase of the disease, turning depression into mania or vice versa. In this sense, the effect of LSD is comparable to that of electroshock therapy. Within the conceptual framework presented in this book such changes can be understood as COEX or BPM transmodulations—chemically triggered shifts in the dynamic governing systems influencing the patient's ego. It seems that in manic-depressive disorders LSD can precipitate such changes much more easily and more frequently than in other diagnostic categories. This may be because lability and periodicity are typical and intrinsic characteristics of this disease.

The COEX or BPM transmodulations should not be mistaken for a cure of the disease. There is always a possibility that another depressive or manic phase will recur in the future when the dormant negative systems become activated by various physical triggers, specific psychological stresses, or physiological changes within the organism. However, in some cases it seems possible to influence the psychological roots and basic underlying mechanisms of this disorder by systematic intrapsychic work in serial LSD sessions. This procedure has its special risks, the main one being the possibility of triggering deep depressions with suicidal tendencies after some of the sessions. As with borderline psychotic conditions and schizophrenic psychoses, LSD psychotherapy of manic-depressive disorders should be carried out on an in-patient basis, or a suitable facility should at least be available at all times for temporary hospitalization if the condition of the client requires it.

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