Emotional And Psychosomatic Changes In The Postsession Intervals
The changes that occur in the content of LSD sessions during the course of psychedelic therapy have their counterparts in parallel changes in the subjects' clinical condition following the drug experiences. The specific dynamics of the post-session intervals and the therapeutic approach to complications have been discussed in an earlier section. Here we will describe certain general patterns of change associated 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 internalization of the sessions and active efforts at positive resolution and structuring of the termination period. The use of these two principles decreases the incidence of negative after-effects considerably, and thus reduces the oscillations of the clinical condition.
The discussion of the course of the LSD process under less-structured circumstances is important for two reasons: it provides a better understanding of the dynamics involved, and gives a rationale to future LSD therapists for active intervention in the reentry period. Although the LSD sessions were supervised, the lack of therapeutic intervention in the reentry period made the procedure more like non-medical self-experimentation. The observations made in this context are therefore also of great potential value for those professionals who practice crisis intervention and treat complications of unsupervised LSD self-experimentation.
Even when no active therapeutic help is offered during the termination period, negative aftereffects of LSD sessions are minimal in individuals who show reasonable emotional stability. As mentioned earlier, I have never seen in this category aftereffects that had the form and intensity of clinical psychopathology. Occasionally, we observed feelings of sadness, irritability, fatigue, existential questioning, headaches, or "hangover" on the day following the session; such manifestations, however, always remained within the normal range. Even at a time when these individuals were dealing with difficult perinatal material, the negative sequelae of their LSD sessions did not interfere with their everyday functioning. In fact, to focus one-sidedly on the negative consequences of LSD sessions in "normal" persons would be misleading. In most instances, one observed a distinct enhancement of vitality, an increase of zest, a sense of elation, unusual perceptual richness, and other distinctly positive changes for days or weeks following the psychedelic session.
The situation was quite different in psychiatric patients with severe neurotic and psychosomatic disorders. At the time when these patients were working in their LSD sessions on psychodynamic material, their clinical condition showed a considerable degree of variation and oscillation. After some LSD sessions, they would manifest signs of very dramatic improvement; because our knowledge of the nature and dimensions of the LSD procedure was rather limited at that time, this occasionally created a false impression that the therapy was approaching a successful termination. However, other LSD sessions were quite unexpectedly followed by a dramatic accentuation of pre-existing symptoms. In the remaining cases, the positive or negative changes were small and sometimes negligible. In addition to these oscillations in terms of alleviation or worsening of clinical symptoms, we occasionally observed dramatic transformations of the symptoms.
Within a few hours of the LSD session, old psychopathological manifestations, 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 never had before. For a detailed discussion of the dynamics underlying these changes, see p. 277 ff. of this book. In some instances, these changes were so fundamental that the patient moved into a completely different clinical category. This phenomenon is so striking and of such theoretical and practical significance that it deserves to be illustrated by a short clinical example:
Richard was a twenty-six-year-old student who had suffered for more than four years from severe unrelenting depression, and had made six serious suicidal attempts, one of them with rat poison. In addition, he had frequent attacks of free-floating anxiety, excruciating headaches, agonizing cardiac pains and palpitations, and severe insomnia. Richard himself related most of these emotional problems to disturbances in his sexual life. Although he had many friendly relationships with women, he was not able to approach them sexually and had never had sexual intercourse with a female. He tried to reduce his sexual tension by occasional masturbation; however, this resulted in self-hatred and tormenting guilt feelings. At irregular intervals, he got involved in homosexual activities, always in the role of the passive partner. Although he could reach momentary satisfaction in these situations, the feelings of guilt associated with them reached seJf-destructive proportions. In the state of despair that followed his homosexual affairs, he made several attempts at suicide and once tried to castrate himself by taking a large dose of estrogen hormones.
In his eighteenth LSD session, Richard completed the reliving and integration of a powerful negative COEX system that was functionally related to BPM II.5 This was followed by an ecstatic experience of several hours' duration. He felt self-assured, cured, whole and optimistic. However, during the reentry period he tuned experientially into a different memory constellation, one associated with the third perinatal matrix. It was an unpleasant surprise for him after what he believed to be the final resolution of his illness. Disappointed, and unwilling to face the new problems, he mobilized his defenses prematurely. He returned from his LSD session radiant, happy, and with a sense of physical well-being; however, to our surprise, the complex of his old symptoms was replaced by a classical hysterical paralysis of his right arm. It had all the typical features of a hysterical conversion reac-| tion, including the "belle indifférence"—a surprisingly indifferent emo-' tional attitude toward a seemingly serious and crippling symptom.
The continuation of psychedelic treatment brought about interesting results. In several subsequent sessions, Richard's paralysis was lifted every time the LSD started taking effect. Two important areas of problems underlying his hysterical paralysis kept emerging and had to be worked through. The first was Richard's relationship with his father, fraught with aggression and conflicts about patricide. His father was a brutal and despotic alcoholic who physically abused both Richard and his mother. On several occasions, his father had hurt him so seriously that Richard had to be taken to a hospital. In puberty, Richard used to have violent fantasies and dreams about killing his father.
In the LSD sessions of this period, Richard repeatedly saw me as transformed into his father. As soon as his arm and hand could move under the influence of the drug, he would inevitably aim his fist toward my face. However, lie never completed the movement; his hand would stop several inches from my nose, withdraw, and strike again with new force. At times, his fist would oscillate in this way for several hours in front of my face, as if tossed around by contrary impulses of the Freudian id and superego. As this was happening Richard kept reliving various traumatic memories involving his father, and had a number of symbolic visions related to patricide.
The second theme underlying Richard's paralysis involved problems around masturbation. As he experienced strong conflict between his overwhelming desire to masturbate and his guilt and fears associated with it, his hand kept reaching toward the genital area and then pulling back into a position near his hip joint. While his hand was involuntarily oscillating back and forth, Richard had numerous experiences involving sex and punishment. Finally, he relived with intense emotions a traumatic memory of being caught and severely punished by his father for masturbating.
Both areas of conflict described above had their deeper roots in the perinatal area and thus also reflected Richard's relationship with his mother. In these sessions, sequences of the death-rebirth struggle were closely interwoven with biographical material related to his relationship with his father. It took seven sessions to work through these two areas of conflict. When this was completed, Richard regained full control of his hand and arm; this time no new symptoms emerged and his old complaints did not return. Several weeks later, he had the first heterosexual intercourse of his life.
In spite of the oscillations in their clinical condition, a general trend toward improvement was observed in most neurotic patients in our study. After a certain number of sessions, which varied greatly from person to person, many of them temporarily reached a point where their symptoms were considerably alleviated or even non-existent and there was a good level of overall adjustment. With a few exceptions, they could be discharged and continue LSD therapy on an out-patient basis.
This degree of improvement was probably comparable to the result of very successful psychoanalysis or some other type of systematic long-term psychotherapy. In retrospect, from a conventional point of view this would have been a good time to terminate therapy. However, with most of our patients this did not happen. For several reasons, it seemed appropriate at the time to continue LSD psychotherapy beyond this point. My orthodox psychoanalytic training and background were very important factors in the decision to continue, which eventually opened up for me an entirely new avenue of research into the human mind.
Although at this stage these patients showed a satisfactory level of symptomatic improvement in the periods between LSD sessions, their psychedelic experiences still involved episodes of aggression, anxiety, guilt, and various psychosomatic symptoms. In a way these were actually becoming triore primitive and elemental. Much of the material that these patients were dealing with had a definite oral emphasis. This was for me an indication that their therapy was coming to an end, and I continued the LSD sessions in the belief that we just had to work through a few "residual problems," to prevent a relapse. According to psychoanalysis, we are born a "tabula rasa" — a blank tablet — and the psychological problems of our development start in the oral period; there is nothing from before birth and thus there was not much further to go. My expectation at that time was that the amount of biographical material would be limited and that we would eventually reach a point where no new areas of problems would be detected and activated by LSD. Since the reliving of traumatic memories was frequently followed by ecstatic and contentless episodes, I expected serial administration of LSD to ultimately result in undifferentiated and unitive experiences with a great potential for healing and integration. This basic premise proved to be correct, but the way to such experiences was much longer and more complicated than I had expected.
The continuation of therapy was thus a result of ignorance of the nature and basic laws~c>rthe LSD process; it also reflected the use of an inadecjuate and limited theoretical model which underestimated the dimensions of the human personality. The toll paid for this was much unexpected emotional and psychosomatic suffering on the part of my patients, and much conceptual confusion and a real testing of therapeutic optimism and endurance on my part. Despite all these difficulties, this period became the most fascinating intellectual and spiritual adventure of my life. It revealed for me new and uncharted areas of the human unconscious, led to countless unsuspected situations and events, and confronted" me with hundreds of incomprehensible and puzzling observations. The final outcome of this process was a radical break with the old conceptual frameworks, a much broader understanding of the human mind, and even a drastic change in my concepts concerning the nature of reality.
As the LSD sessions proceeded into the perinatal realms, the emotional qualities and psychosomatic sensations that had to be confronted, broadened and deepened beyond all imaginable limits. Sooner or later, every single patient started to experience agonies and ecstasies of cosmic proportions. As the patients dealt with various aspects of the death-rebirth process, a similar dichotomy also occurred in the intervals following psychedelic experiences. After some LSD sessions, the clinical condition of the patients would deteriorate drastically. On occasion, persons who came into treatment with severe neurotic symptoms and then at a certain point appeared almost cured, suddenly showed transitory psychotic symptoms. Not infrequently, temporary rehospitalization was necessary in patients who had already returned to their ordinary life situation and were continuing therapy on an out-patient basis. Less frequently, the LSD sessions of this stage terminated in deep ecstatic states and were followed by clinical improvement of an order qualitatively different from anything observed earlier on the psychodynamic level. These changes were characterized by not only a considerable reduction of symptoms, but also an actively joyful approach to existence with a distinctly spiritual undertone ("psychedelic afterglow").
As LSD patients come closer to the moment of the final ego death, some of the free intervals become rather precarious. Deep depressions, aggressive tension, self-destructive tendencies, and manic states are not uncommon at this stage. Although complications of this kind can be considerably decreased by active work in the reentry period, a special treatment facility with trained personnel should be available when individuals with severe emotional problems reach this critical phase of LSD psychotherapy.
At this time, some of the original clinical symptoms that had been alleviated or even eliminated by previous therapy might temporarily be accentuated or reappear. As the patient moves during the psychedelic process from the psycho-dynamic realm into the perinatal area, various psychopathological syndromes may gradually lose their specific characteristics and be reduced to their perinatal roots. Psychiatric patients who started LSD therapy with the most variegated clinical problems typically show a striking convergence., and ultimately manifest in the LSD sessions and in their free intervals a quite similar symptomatology. In this stage, there may be little difference between patients who started with symptoms of claustrophobia, alcoholism, or inhibited depression; they all manifest symptoms characteristic of an activated second perinatal matrix. Similarly, sadomasochism, asthma, hysterical seizures, and agitated depression can be stripped of their biographically determined specific differences and reduced to typical BPM III phenomenology. Observations of this kind throw an entirely new light on the dynamic structure of various psychopathological syndromes and make it possible to construct a revolutionary model of mental illness and of psychotherapy. Theoretical implications of this kind will be discussed in the next volume.
After many sequences of agony, death, and rebirth, LSD patients in the psycholytic study in Prague typically reached the final experience of ego death. This is an important turning point in LSD psychotherapy; beyond this point, elements characteristic of BPM II, III, and IV no longer appear in the sessions or as determinants of the free intervals. The first perinatal matrix and various combinations of transpersonal matrices take over and govern the psychedelic experiences from then on. From the clinical point of view, this is usually associated with dramatic improvements over a broad spectrum of neurotic and psychosomatic disorders. However, full experiential shift from the perinatal into the trans-personal area does not mean that all negative experiences are permanently eliminated from the content of LSD sessions or from the post-session intervals. The content of purely transpersonal sessions shows the same dichotomy as that of biographical and perinatal experiences. The same is true for the dynamics of the post-session periods; here too, the emotional and psychosomatic condition of the individual can be strongly influenced by positive or negative transpersonal matrices. Thus the everyday feelings, thoughts, behavior, entire world-view and life style can reflect elements of the oceanic bliss of the intrauterine state or the all-encompassing horror of fetal crises; positive karmic patterns or past-incarnation tragedies; and the energy of nourishing or destructive archetypal constellations.
The fact that the subject has transcended the biographical and perinatal levels docs not mean that from then on the content of his or her LSD sessions has no personal significance or relevance. The biographical history is now freely available on the adult level without repression and emotional distortion. There is no more painful reliving of individual traumatic events nor narrow emphasis on deciphering the dramas in the nuclear family and their impact on one's life. Similarly, the life-and-death struggles, the claustrophobic nightmares, scatological scenes, and sadomasochistic orgies of birth do not reappear in the sessions. However, no matter how grandiose and cosmic the scale of transpersonal experiences, they are always intimately connected with the everyday life of the individual. Working through negative transpersonal matrices and connecting with positive ones has a therapeutic influence on the subject's emotional, psychosomatic and interpersonal processes. It also provides new levels of understanding of one's own identity, the dimensions of being, human life, and existence in general. Although there is no more specific "archaeological" work to be done on one's present life history, the interpretation of its meaning changes constantly as the conceptual frameworks are expanded to accomodate new experiential data.
One aspect of everyday existence that shows particularly intimate connections with the psychedelic process is the individual's dream life. In a course of psychotherapy involving serial LSD sessions, there is a clear continuity between the nature and content of the drug-induced experiences and mental activity during sleep and the hypnagogic period. Dreams before the LSD session often anticipate the content of the psychedelic experience, and dreain life in the post-session periods typically elaborates on various themes from the preceding drug session. This is particularly striking when important gestalts remain unresolved in the preceding session and much unconscious material with strong emotional charge becomes experientially available.
When the emphasis in the psychedelic process is on biographical issues, the dreams have the typical dynamic structure known from Freudian psychoanalysis. Much of their content seems to make sense in terms of the individual's emotional history, and can be easily deciphered by an interpreter who is familiar with the basic principles of dream work. When LSD patients experientially enter the perinatal area, the quality of their dreams changes and the Freudian approach to interpretation is no longer adequate. Although formal analysis usually produces some material from the individual's history that appears to be relevant and thematically associated with the content of such dreams, any purely biographical interpretation remains superficial and unconvincing. The dreams of this phase are very primordial, elemental, and fraught with intense emotion. Their content is usually a more or less direct derivative of the typical themes associated with the individual perinatal matrices. Thus perinatal dreams related to BPM II involve passive experiences of tortures in prisons, concentration camps, and gas chambers; frightening claustrophobic experiences in caves, underwater passages, or progressively narrowing corridors, tunnels and pipelines; and a world of meaningless cardboard figures, circus sideshows, and automatons or robots. More mitigated forms of these dreams involve a variety of hopeless no-exit situations on different levels. Various aspects of BPM III generate dreams of titanic warfare or natural catastrophes of enormous proportions; murders, accidents, bloody massacres, rapes, and sadomasochistic orgies; pornographic scenes full of outrageous sexual deviations and perversions; and an atmosphere of decay and unimaginable dirt. Final phases of this matrix are associated with dreams of exciting adventures in military expeditions, hunts, amusement parks, and particularly in colorful carnivals. The transition from BPM III to BPM IV is reflected in dreams about individual and mass death, enormous fires, volcanic eruptions, atomic wars, and the destruction of the world. Dreams derived from BPM IV involve elements of divine revelations, triumphant victories, escape from dangerous situations, loving recoil-
ciliation or reunion, and joyful celebration. Heavenly realms, paradisiacal atmosphere, beautiful natural sccneries, and oceanic states in dreams reveal the involvement 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 I recognized the dream as bearing a deep resemblance to certain sensations I had had in recent LSD sessions. In these sessions I appeared to be reliving 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 how, in the birth of my son, the head seemed to rotate at the culmination of the birth process, and the entire picture seemed to fit together — this dream seemed to represent in a symbolic manner many of the essential aspects of the ego death.
Once the individual moves into the transpersonal stage of the LSD process, this has important consequences for the nature and content of his or her dreams. Many of the elements and sequences, or even the entire content of certain dreams can represent (ranspersonal phenomena in a more or less pure form. Such dreams cannot be adequately interpreted in Freudian terms and the results of such analysis are bound to be superficial and inaccurate. These dreams do not show the distortion and condensation characteristic of those that are biographically determined, and have the quality of past-incarnation memories, ancestral or phylo-genetic experiences, encounters with archetypal entities, various types of extrasensory perception, or out-of-body travels. Recognition and acknowledgement of the specific nature of such dreams is essential for their correct understanding and interpretation. Because of the deep organic link between the dream life and psychedelic experiences, the work with dreams should be an integral part of every comprehensive program of psychedelic therapy.
A synoptic representation of a dream which the author had during his analytical training. He was in a horrible dungeon, chained to a slab and exposed to various inhuman tortures. These were associated with the motif of the little cup that provides unlimited amounts of cream of wheat to anyone knowing the magic word—a theme from a popular Czech fairy tale.
In the dream this magic cup was outside the prison, pouring out enormous <jiiantities of nourishing liquid. It was clear that the torments would end at the moment the cream of wheat reached the window and started flowing in. Free associations arising from this dream included the Spanish Inquisition and the ingenious torture instruments used; the instinctual life of apes; many oral themes, including the buccal repositories of hamsters; and details concerning a Czech king who spent his entire life in prison. Various concrete childhood incidents, 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 consequently interpreted the dream as a composite formation condensing all the interferences with libidinal satisfaction which the analysand suffered in his early life.
This explanation appeared superficial and unsatisfactory. Later the elements of the dream reappeared in a high dose LSD session and made perfect sense in the context of the birth trauma. The dungeon is the delivering uterus and the tortures will end when the nursing stage is reached. Identification with the king illustrates the connection between birth and the child-king archetype ("crowning"). Identification with monkeys and their uninhibited biological indulgence points to the unleashing of a variety of instinctual impulses (polymorphous perversion) in the perinatal process.
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