Physical And Emotional Contraindications
All clinical and laboratory evidence accumulated during the last three decades indicates that from the biological point of view pharmaceutically pure LSD is a surprisingly safe substance. This statement should not be automatically applied to so-called "street acid." The quality of samples sold in the black market varies considerably 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 extreme degrees of emotional and physical stress, the dimensions of which are beyond anything encountered in everyday life. It is therefore essential to screen out in advance individuals for whom intense emotions can be dangerous or even fatal. It was mentioned earlier that this involves in the first place persons with serious cardiovascular problems, such as a high degree of arteriosclerosis, thrombosis with a danger of embolism, malignant hypertension, vascular aneurysms, a history of myocardial infarction, myocarditis, decompensated cardiac failure, and bruin hemorrhage. Where there is the slightest doubt, the candidate for un LSD session should have a physical examination, including an electrocardiogram. In case of mild cardiovascular problems, one should be conservative with the dosage and proceed with caution. We have to bear in mind that we are not talking about direct noxious effects of LSD on the heart or vessels, but the risks associated with intense emotions. Although higher dosages usually evoke more powerful affective responses, this relationship is not linear. In individuals who are very emotional or who have enormous amounts of unconscious material close to the surface, a relatively small dose of LSD can trigger a very strong reaction.
Pregnancy should be an absolute contraindication.Although the existence of a direct teratogenic effect of the usual doses of LSD is questionable, there is a danger of disturbing the biochemical balance between the fetus and the maternal organism. An even greater risk is the intense uterine contractions that are part of many high-dose sessions, especially those involving perinatal material. As a result of a powerful LSD session female subjects may often start menstruating in the middle of their cycle. The issue of chromosomal damage and adverse effects on heredity has caused much controversy in the past; at present very few scientists believe that such dangers really exist. Because of their practical significance these problems are discussed in a special appendix to this book, (pp 318-47)
All other biological dangers are relative. Many clinical observations suggest that special caution is indicated in persons who have an epileptic disposition, especially those with a history of grand mal seizures. In these individuals LSD can occasionally trigger not only individual attacks but entire chains of seizures following each other in a rapid sequence. This so-called status epileplicus can be very difficult to control. However, certain forms of epilepsy and other types of seizure-like motor activity have responded favorably to LSD treatment in the past, and so this issue has to be considered individually for each case. This observation seems to be particularly true for temporal lobe epilepsy, though there is as yet no clear organic finding.
Sometimes the excessive muscular activity that frequently occurs in high-dose LSD sessions can be a specific danger for some of the patients. Extreme tension, tremors, cramps, jerks and complex twisting movements might lead to complications in individuals with pathological fragility of the bones, insufficiently healed fractures, or a disposition to recurrent dislocation of the joints.
There are some indications that individuals with severe liver damage have a tendency to prolonged LSD reactions, because the liver plays an important role in detoxifying LSD and excreting it from the body. Some researchers therefore tended in the past to screen out persons with insufficient liver function associated with cirrhosis, a history of hepatitis, or other pathological conditions. Our experience with chronic alcoholics and cancer patients, many of whom had considerable liver damage, indicated that this factor is negligible unless the dysfunction is of a critical degree.
If we follow the rules outlined above, LSD appears to be a drug with a wide range of biological safety. Dosages between 25 and 2000 micrograms have been used in clinical settings without any detectable adverse physiological effects. In our own research, we have administered LSD to persons up to the age of eighty-three and to a number of cancer patients in the terminal stages of their illness, without a single casualty. Our experience shows that the laboratory examinations routinely used in medical practice to detect diseases and dysfunctions, such as electroencephalography, electrocardiography, blood count, sedimentation, urine analysis and liver tests do not show any pathological changes even after a series of eighty to one hundred LSD sessions.
The situation is much more complicated in regard to emotional risks. Here the degree of safety is critically dependent on the pre-session emotional balance of the subject, and on the external circumstances. I have never seen adverse aftereffects of an LSD session in an individual who did not have considerable emotional problems prior to the session. In a person who is reasonably balanced and adjusted, the negative sequelae the day after a supervised psychedelic session seldom go beyond such complaints as feelings of fatigue, headache, or hangover. These negative consequences can be much more serious after experiences in complex and erratic social situations, in those instances where the drug was given to an unprepared or even unsuspecting individual, or where traumatic circumstances and pathological interaction complicated the course of the psychedelic reaction.
The risk of adverse aftereffects increases considerably when the drug is administered to persons who have serious emotional problems, show severe interpersonal maladjustment, or had psychiatric hospitalization in the past. Work with l! psychiatric patients, even when conducted by an experienced LSD therapist under the best circumstances, involves certain risks. Careful preparation of the patients, internalization of the experience, and active psychotherapeutic work reduces the hazards, but does not eliminate them completely. There will always be a risk that in spite of all the precautions and palliative measures some important unconscious material may remain unresolved. This can mean an intensification of pre-existing complaints, the occurrence of a new set of symptoms, incidence of prolonged reactions, or later recurrence of unusual states of consciousness (flashbacks). When we work with persons who have borderline schizophrenic symptoms or have had psychotic episodes in the past, triggering serious emotional reactions of a tem-, porary nature represents a calculated risk.
Unlike the case of somatic contraindications, where certain caveats are absolute, screening of LSD candidates on the basis of their emotional condition depends on many external factors. Under optimal circumstances, which involve a specially structured treatment facility and an experienced therapeutic team, LSD psychotherapy can be experimentally conducted with any psychiatric patient whose condition is clearly not of an organic nature. However, this requires an open-ended situation where no limits are placed 011 the number of sessions. In treating emotionally severely disturbed individuals, we have to be prepared to deal occasionally with transient psychotic states, aggressive behavior, or suicidal tendencies inside and outside of the sessions themselves. Experienced therapists, trained nurses, and the supportive atmosphere of a therapeutic community are necessary prerequisites for such an endeavor. Under circumstances where these criteria are not met, we have to carefully screen out individuals with borderline psychotic problems and a psychotic disposition. An example of this was the situation at the Maryland Psychiatric Research Center. There the number of LSD sessions for all categories of subjects except cancer patients was limited by the research design to three. The center had laboratories and treatment suites, but no bed facilities. In the case of a prolonged reaction or other complications, LSD patients had to be hospitalized at the Spring Grove State Hospital and, according to the routine local policies, this meant a stay in a locked ward and administration of phcnothiazincs. Despite these unfavorable conditions we worked with very severely disturbed patient populations, such as chronic alcoholics and heroin addicts who were prison inmates, and we were not overly anxious during the screening process. We had only two instances of prolonged reactions in our LSD subjects, both occurring in patients who had psychotic episodes in the past. They lasted only a few days, and could be bandied easily by conventional means.
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