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 clinical 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 treatment 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.

The evaluation of the therapeutic potential of LSD psychotherapy presents many serious problems. Some of them are not specific to LSD-assisted therapy, but relate to any kind of psychotherapy or to psychiatric therapy in general. These include not only the difficulties with the accuracy and reliability of the measuring instruments, but a lack of agreement as to what the basic indicators of therapeutic change should be. Those authors who limit their efforts to symptomatic approaches tend to emphasize the reduction of emotional and psychosomatic distress as the major criterion of therapeutic progress. Those who are more dynamically oriented prefer to focus on the patient's ability to solve conflicts or problems of living and on the quality of interpersonal relationships. Some authors value more objective but less specific indices, such as changes in certain psychophysiological or biochemical parameters. This is further complicated by various criteria which reflect contemporary societal values, such as income, professional achievement, or residential adjustment. The difficulties in assessing psychotherapeutic results can be best illustrated by the fact that researchers of the stature of Eysenck seriously argue that there exists absolutely no scientific evidence for the therapeutic efficacy of any psychoanalytically oriented psychotherapy. (25)

The evaluation of LSD psychotherapy presents several additional problems of a more specific nature. This treatment modality involves much more than just administration of a powerful psychoactive substance; it is a complex process which is critically dependent on many non-drug variables. The personality and approach of the therapist and a variety of factors related to set and setting have to be considered integral parts of the treatment process. In the past, many authors approached LSD therapy simply as a chemotherapy, expecting therapeutic results from the administration of the drug alone without regard to all the extrapharma-cological factors involved. Others had various degrees of understanding of the complexity of the process and appreciation for the importance of the psychotherapy that precedes, accompanies, and follows the drug sessions. Unfortunately, most clinical reports about LSD therapy do not give sufficient information about the degree and quality of psychotherapeutic care involved. In discussing the therapeutic results achieved with the use of LSD it is essential to realize that all the drug can do is to bring previously unconscious material into consciousness; the outcome of this process depends critically on the way this material is dealt with and integrated. There is nothing inherently beneficial or detrimental about the effect of the drug per sc.

The state of mind and level of consciousness of the therapist is also an important variable in the treatment process. His or her ability to remain calm and supportive in the face of various extraordinary experiences and unusually intense emotions, and the degree of open-mindedness, tolerance, and permissiveness maintained towards the entire spectrum of psychedelic phenomena are factors critical to therapeutic success. The role of the therapist in the process is so vital that it is impossible for him or her to make an objective evaluation of the efficacy of LSD psychotherapy without critically assessing his or her role in it. For this reason, specialized training of the therapist, which includes first-hand experiences of psychedelic states of consciousness, is an important element in LSD psychotherapy. It is easier for LSD therapists to tolerate, encourage, and appreciate certain unusual experiences of a perinatal or transpersonal nature that have tliera-

peutic value if they have successfully confronted them in their own psychedelic sessions.

Evaluation of the therapeutic results of psychedelic therapy is further complicated by the fact that the clinical improvement is frequently associated with profound changes in life strategy, philosophical and scientific world-view, and the basic hierarchy of values. Alleviation of severe psychopathological symptoms can be accompanied by a distinct loss of interest in the pursuit of power, status, and position. An orientation toward competition and achievement can be replaced by one toward maximum well-being at minimum expenditure of energy and effort. Previously pragmatic and materialistic individuals can develop deep interest in and genuine appreciation of the spiritual aspect of existence. A tendency to control and dominate other people and nature might be replaced by synergistic and ecological concerns. A psychiatrist who sees the present Occidental value system, based on ambition and competition, as natural, healthy, and ultimately mandatory, may consider the above changes in a psychopathological framework and describe them as showing lack of initiative, loss of interest in socially desirable goals, or even development of psychotic delusional systems. This can be illustrated by an episode which occurred during my lecture at the Harvard University School of Medicine in 1968, after I described dramatic clinical improvements that I had observed in several of my patients during LSD psychotherapy. These changes followed death-rebirth experiences, feelings of unity with the whole universe, and various transpersonal phenomena. In the discussion, one of the participants offered the interpretation that the previously neurotic condition of these patients had actually changed into psychosis, because they had now become interested in spiritual pursuits, were seriously considering the possibility of reincarnation, and had become deeply interested in yoga and meditation.

At present, the situation in the world is quite different from what it was ten years ago. The limitations and dangers of the Occidental value system are more than obvious. Criticisms of the one-sided orientation toward unlimited industrial growth come from many different directions, the failures of competitive politics and technocracy are beginning to overshadow the successes, and ecological consciousness is gaining ground in view of the impending environmental disaster. The criteria of sanity are changing rapidly; according to Abraham Maslow and other humanistic and transpersonal psychologists, feelings of oneness with the universe or other mystical experiences need not be considered psychopathological phenomena. They can occur in healthy individuals and are conducive to self-actualization and self-realization. Oriental systems of thought and spiritual practices are attracting increasing numbers of mature and well-educated individuals who cannot be easily dismissed as ambulatory schizophrenics. Transpersonal psychology and psychiatry, a recently developed discipline that represents an attempt to integrate spirituality and mysticism into modern psychology and psychiatry, is gaining wider and wider acceptance among professionals.

Many theoretical physicists are coming to the conclusion that the mystical world-view is perfectly compatible with the philosophical implications of modern science, particularly relativity theory and quantum physics.1 It is quite possible, if the present trend continues, that individuals resisting mysticism will in the near future be considered evolutionary throwbacks. At present, however, the theory and practice of mainstream psychology and psychiatry is based on the Newtonian mechanistic model of the universe and on the Cartesian dichotomy between mind and matter. Perceptual and cognitive congruence with the Newtonian-Cartesian world-view and agreement with the present Occidental value system are used as important criteria of sanity. This fact cannot be ignored in evaluating the results of psychedelic therapy.

Because of the above factors, I will present my personal view of the potential of LSD psychotherapy, rather than a balanced synopsis of the clinical literature on the subject. Although I will occasionally refer to the work of others, the statements in the following sections should be seen in the context of the therapeutic philosophy and practice described in this volume.

In general, LSD psychotherapy is indicated in those conditions that have a psychological rather than organic basis, and are a result of learning in its most general sense. That does not necessarily exclude disorders with clear physical manifestations, as long as psychogenic factors have played an important role in their development. This definition of the indications for psychedelic therapy is rather loose and leaves much space for individual therapeutic experimentation. Whether a certain disorder is considered psychogenic or somatogenic depends on the level of development of medical science in general and on the degree of understanding of a specific disease in particular. Since medical opinion concerning 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 philosophy of the clinician.

There are conditions for which the degree of agreement among different researchers will be very high. Psychological factors are clearly of great importance in the genesis of various psychoneuroses, such as anxiety or conversion hysteria and obsessive-compulsive neurosis. Similarly, in character disorders, alcoholism, drug addiction, and various sexual dysfunctions and deviations, the psychogenic component seems to be unquestionable. Bronchial asthma, peptic ulcers, psoriasis, and ulcerous colitis are traditionally considered to be of psychosomatic origin. The opinions of clinicians about the ratio of psychogenic and somatogenic factors in various depressions, borderline psychotic states and so-called endogenous psychoses such as schizophrenia and manic-depressive disease, vary considerably. In some other conditions only a minority of researchers consider psychological factors to be of any relevance; cancer and collagenous diseases are important illustrations of these.

Fortunately, the nature of the LSD reaction seems to offer help in those cases where the therapist experiences uncertainty. One or two exploratory psychedelic sessions will usually make it clear for the client and the therapist whether the disorder has an important psychological component or not. Emotional and physical 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 psychodynamic, perinatal, and transpersonal roots of the problem. During the initial experiences, the patient also usually gets a clear feeling about the possibility of influencing the disorder by psychotherapeutic work in the LSD sessions. As I mentioned earlier, one of the most remarkable aspects of the effect of LSD is its ability to detect dynamic structures with intense emotional charge and bring their content to consciousness, making it available for introspective analysis and working through.

Despite the fact that LSD psychotherapy can be beneficial over a very broad spectrum of emotional and psychosomatic disorders, it should not be considered an easily available psychiatric panacea. It is a highly demanding and specialized procedure, and requires a rigorous training of the therapist. The course of LSD treatment is not always equally smooth and safe, nor is its outcome always predictable and successful. There are certain patients who require a large number of LSD sessions, and for whom the therapeutic progress is slow and painful. For reasons that are still insufficiently understood, there appears to be a small percentage of severely disturbed individuals who show very limited therapeutic gain despite large numbers of psychedelic sessions and a great investment of time and energy. In some others, the process is not limited to the time of the pharmacological action of the drug and the intervals between the sessions are difficult or even potentially dangerous.

Clinical conditions in which LSD psychotherapy has been successful fall into four major categories: I) depressions, neuroses, and psychosomatic symptoms; 2) alcoholism, drug addiction, character disorders, and sexual deviations; 3) borderline states and endogenous psychoses; 4) emotional distress and physical pain of the dying, particularly cancer patients.

DEPRESSIONS, NEUROSES, AND PSYCHOSOMATIC SYMPTOMS

In general, the less serious the clinical problem, the quicker and more dramatic are the results and the safer the treatment procedure. The best candidates for LSD psychotherapy seem to be subjects who have a good intellect and adequate interpersonal and professional adjustment, but-lack zest for life and a sense of meaning. Although they might appear to be highly successful by the standards of the society that surrounds them, they cannot connect emotionally with their achievements and enjoy them. These symptoms would fall into the category of what Victor Frankl calls noogenic depression. A single high-dose psychedelic session with LSD is frequently enough to change this situation dramatically. The selective accentuation of negative aspects of the world and the basically pessimistic philosophy of existence associated with this condition can be dissipated within a few hours. These previously almost-depressed individuals typically emerge from a successfully integrated LSD session with elevated mood, joyful appreciation of existence, enhanced self-esteem and self-acceptance, and greater capacity for meaningful 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, many of them are able to apply various insights from their psychedelic sessions in a creative way in their professional lives.

Various forms of depression seem to respond unusually well to LSD psychotherapy. In general, depression is the most changeable psychiatric symptom, one which shows great fluctuations even without any specific treatment. Two different kinds of changes of depression can occur as a result of psychedelic sessions, and it is important to distinguish between them. A single LSD session, well resolved and integrated, can totally dispel clinical depression, occasionally even a deep one that has lasted for months. However, that does not mean that the depression has been permanently cured and cannot recur; the patient may have a relapse as a result of various psychological or physiological factors.

This can best be illustrated by the influence of LSD on so-called periodic depressions. A patient suffering from this disorder has regular attacks of depression following a rather rigid pattern, in terms of occurrence of symptoms at certain times of the year and the specific duration of the episodes. A single LSD administration can frequently terminate a deep periodic depression that according to the usual recurrent pattern would have lasted several more weeks or months. However, this does not necessarily change the general course of the disorder, and the next episode of depression might appear on the usual date and last the expected period of time. Systematic work in sequential LSD sessions is necessary to change the complex underlying dynamic structure and influence the overall pattern of the disease.

Most neurotic disorders tend to respond well to LSD psychotherapy; however, even with the powerful catalyzing effect of the drug one should not expect therapeutic magic and overnight cures. Various psychoneuroses require long-term psychedelic sessions. In general, most authors seem to agree that the prognosis is best in those cases where anxiety and depression are important components. Psychiatric patients who suffer from free-floating anxiety or anxiety neuroses, as well as those whose anxiety is bound in the form of various phobias, respond well to psychedelic treatment. Conversion hysteria usually presents greater difficulties, but LSD therapy is frequently successful with this disorder. As in conventional psychoanalysis, anxiety and conversion hysteria might present special problems in terms of transference and countertransference. Monosymptomatic neuroses are not necessarily easier to treat than those that have rich, ramified, and complicated clinical pictures. Frequently, a single torpid symptom condenses problems from many different areas and levels in the patient, and a great number of LSD sessions might be necessary to resolve this.

Although success in treating obsessive-compulsive neurotics has occasionally been reported,2 in my experience they seem to have the dimmest prognosis of all the patient categories. Less debilitating obsessive-compulsive states have been successfully influenced by long:term systematic LSD therapy, but severe cases of this category belonged to our most painful failures. Usually much higher dosages have to be used to overcome the excessive resistances of these patients and a large number of sessions is necessary for any therapeutic progress. However, it is conceivable that these therapeutic failures reflect our limited understanding and inadequate technique, rather than an intrinsic aspect of this emotional disorder. The fact that the psychological resistances of these patients are intimately linked to the problem of control of the anal sphincter might be one of the important variables.

Traumatic emotional neuroses resulting from singular major traumas, such as war situations, natural catastrophes, or mass accidents, have in the past been the best indications for drug-assisted qbreaetive therapy (narcoanalysis) or hypnotic interventions (hypnoanalysis). LSD can be used with great success for these disorders because of its unique properties as an abreactive agent. A single high-dose LSD session can frequently alleviate or remove very debilitating symptoms in these cases. On occasion, it is possible to use the same approach in cases where the traumatization was prolonged and chronic. We should mention in this context a unique LSD program for victims of the Nazi regime conducted by A. Bastians and his team at the University of Leiden in Holland. These researchers have reported success in working through delayed traumatic consequences of incarceration in former inmates of a concentration camp (the so-called "concentration camp syndrome"). (7)

Sexual experiences and behavior can be deeply influenced by the LSD pro-cess. The intensity, depth and completeness of the sexual orgasm and the ease with which it occurs seems to be closely related to the process of letting go of psycho-1 logical defenses. Many problems in this area can be traced back to unconscious confusion between the pattern of genital orgasm and that of the total physical release that characterizes the orgasm of birth. As LSD subjects learn to let go in the death-rebirth process, their orgasmic ability increases considerably; this improvement of sexual experiences can be observed in both males and females. In those individuals who did not have any major psychopathological symptoms prior to the LSD session, the same effect can usually be observed after one or several high-dose psychedelic experiences. Sexual neuroses, such as frigidity, vaginal spasms (vaginism), genital pain during intercourse, impotence and premature ejaculation frequently respond well to LSD psychotherapy; however, effective treatment of these disorders usually requires serial administrations of the drug and experiential confrontation of the roots of these disorders on the perinatal level.

A wide variety of psychogenic physical problems have in the past been favorably influenced by LSD psychotherapy; this applies equally to organ-neurotic manifestations, symptoms that have the dynamic structure of hysterical or pregenital conversions, and psychosomatic diseases. Painful conditions of various kinds, such as ordinary or migraine headaches, severe menstrual cramps, gastric or intestinal spasms, pains in the neck muscles or in the lumbar area, and even arthritic pains without a detectable organic basis can be traced back to their origins and worked through in the course of LSD therapy. Neurotic disorders of various organs, such as cardiac dysfunction, gastric distress, breathing difficulties, excessive sweating, muscular tremors, constipation or diarrhea, and menstrual irregularities often disappear in the course of LSD treatment. Far-reaching improvements of myopia, which occurred as an unexpected side-effect during LSD psychotherapy with two neurotic patients in Prague, suggest that in some cases of this disorder there is a substantial component of psychogenic muscular tension that can be resolved by psychedelic treatment. Pregenital conversions, such as psychogenic asthma, various muscular tics, and stammering are usually relatively resistant to LSD therapy, which may be related to an underlying obsessive-compulsive personality structure. However, the situation is far from hopeless, and patients with these disorders have on occasion been successfully treated with serial LSD sessions. An especially interesting indication for LSD psychotherapy seems to be psoriasis; dramatic improvements even in severe cases have been independently reported by several therapeutic teams. Clearing of various skin disorders, particularly various eczemas, are rather common observations in psychedelic treatment.

In some patients, LSD psychotherapy can lead to dramatic improvement of certain recalcitrant physical problems that are traditionally considered organic in origin; certain chronic infections such as cystitis, bronchitis, and sinusitis are examples of this. A possible therapeutic mechanism is suggested by the fact that such physical changes immediately follow the resolution and integration of a psychological gestalt in which the corresponding area is meaningfully involved. The experience of Tanya described in a later section can be mentioned here as an illustration of this. (p. 288) This suggests that the infectious agent is just one element in the development and perpetuation of the condition, and possibly even a secondary one. A much more important factor seems to be decreased vitality of the organ or tissue, which accounts for the ineffective defense against the bacterial invasion. It is not difficult to see how psychological factors could play an important role in this situation. One of the possible mechanisms could be, for example, psychogenic constriction of the afferent vessels resulting in limited blood supply to and reduced immunobiological resources in the afflicted area. It is interesting that during the session immediately preceding the clinical improvement of a physical problem of this kind, LSD subjects usually report that a block has been removed and free flow of blood and energy established in the afflicted area. This is typically associated with an invigorating feeling of pleasant warmth, and tingling sensations.

ALCOHOLISM, DRUG ADDICTION, CHARACTER DISORDERS, AND SEXUAL DEVIATIONS

Many of the emotional and psychosomatic disorders described above are, by and large, within the range of indications for traditional analytically oriented psychotherapy. The use of LSD as an adjunct in these cases will intensify, deepen, and accelerate the therapeutic process. However, LSD psychotherapy can be successfully applied in some diagnostic categories which are outside the realm of the traditional indications for dynamic psychotherapy. Many clinical studies of psychedelic therapy have reported dramatic results in chronic alcoholics. Unfortunately, in a great majority of them the evaluation was based on clinical impressions. Like most results reported in psychoanalytic literature, these are open to questioning and criticism from the point of view of rigorous research methodology.

In a large, controlled study conducted by our team at the Maryland Psychiatric Research Center, 135 hospitalized alcoholics were randomly assigned to either high-dose (450 micrograms) or low-dose (50 micrograms) LSD treatment. After six months, an independent evaluation team rated fifty-three percent of the high-dose group as "essentially rehabilitated," as compared to thirty-three percent of the low-dose group. In statistical terms this difference had only five chances out of one hundred of being coincidental. Differences between high- and low-dose groups were no longer as great after eighteen months, with 54 percent of the high-dose patients considered greatly improved versus 47 percent of the low-dose patients.

The overall results of this study were quite impressive, considering that the patients were volunteers selected from the population of the Alcoholic Rehabilitation Unit of a state mental hospital, and that most of them had only one high-dose LSD session and several hours of drug-free psychotherapy preceding and following it. An interesting and unexpected research finding was the dramatic improvement in some patients in the control group who received only 50 micrograms of LSD on a double-bind basis, as compared to 450 micrograms for the experimental group. In our original thinking the dosage of 50 micrograms was considered to be an active placebo, the therapeutic effect of which should be negligible. In reality, several patients in the low-dose group had quite significant experiences, while a few of the individuals in the high-dose category had uneventful psychedelic sessions. The interested reader will find a more detailed description of this study in a paper by the Spring Grove team entitled The Experimental Use of Psychedelic (LSD) Psychotherapy. (77)

The above results of the Spring Grove team are in sharp contrast with the outcome of an extensive controlled study conducted by Ludwig, Levine and Stark (59) at the Mendola State Hospital in Madison, Wisconsin. The authors randomly assigned the 176 alcoholic patients who had volunteered for this project to one of the following four groups: I. "psychedelic therapy" with LSD, 2. hypnodelic treatment with LSD, 3. administration of LSD alone, and 4. no specific therapy at all (milieu therapy). In addition, half of each group was offered Antabuse 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 months between 70 and 80 percent of the patients in all the categories were drinking, and after a year this number ranged between 80 and 90 percent. Even the introduction of Antabuse did not make any difference in this context.

This study met the formal criteria of contemporary medical research so well that it received the Hoffheimer Award from the American Psychiatric Association. For this reason the negative results of this project deserve special attention; they can be used to demonstrate some of the basic principles emphasized in this book. In the following text I will refer to an incisive critique that Charles Savage presented in March 1971 at a staff-meeting of the Maryland Psychiatric Research Center, of which he was Associate Director. He pointed out that very serious deficiencies could be detected in this study, which on the surface appeared to be methodologically sound and meticulously designed. In the past, substantial claims for fast and dramatic therapeutic success in alcoholism have only been made for the psychedelic model; no LSD therapist has ever indicated that one psycholytic session with LSD can have a profound effect on alcoholic patients. Ludwig and his associates were familiar with the essential characteristics of psychedelic therapy, as evident from the accurate definition given in their book. However, in the actual study they rejected the psychedelic model, while pretending to test it, and neglected many of the elements that psychedelic therapists consider mandatory for therapeutic success. The therapists engaged in this project were thirteen residents and state hospital psychiatrists who were not committed to the work and performed it as a peripheral activity. None of them had personally explored the psychedelic or hypnotic state; they were not experienced in either LSD therapy or hypnotherapy and had only a superficial "crash-course" in both. The preparation for the LSD session was limited to one two-hour session, half of which was spent on measurements of suggestibility. The ex-post justification that the authors gave for this drastic condensation of the preparatory work was that none of the patients became psychotic. This fact might be used as an illustration of the safety of LSD, but certainly does not prove that the procedure was adequate for therapeutic purposes. Although the dosages they used were in the lower range of those used in psychedelic therapy, (3 micrograms per kg.) the approach was essentially psycho-lytic. There was continuous verbal exchange, which is known to increase the patient's resistance and interferes with deep regression. The therapists attended the patients for only three hours of the session and left them alone for the remaining hours of the drug action. The mystical experiences that are considered of utmost importance in the psychedelic model were reported by only 8.4 percent of the patients, as compared to the 78 percent of the Spring Grove study. Charles Savage concluded that the project reflected a strong bias in the authors. At a time when LSD was popular, Levine and Ludwig (58) had reported positive results using the hvpnodelic technique with addicts, a group generally much more difficult to treat than alcoholics. When LSD fell out of favor and the positive results became politically unwise, they obtained negative results. Unconsciously or consciously they built into their study a number of antitherapeutic elements that guaranteed a therapeutic failure. The use of inexperienced and unmotivated therapists, defective preparation, antimystical orientation, violation of the basic rules of psychedelic therapy, and a critical lack of human support and care can be mentioned here as important elements. LSD can best be described as a facilitator, and in the above study it seems to have facilitated mediocrity, however brilliantly reported and adumbrated with elegant statistical techniques.

On the basis of encouraging results with alcoholics, the team at the Maryland Psychiatric Research Center carried out a study of LSD psychotherapy with heroin addicts. All volunteers for this program were male addicts serving a sentence in Maryland correctional institutions, mostly for theft, robbery, and involvement in illegal drug traffic. Those who were interested in participating in the study were recommended by the research staff for an early parole hearing by the Board of Parole and Probation. Only individuals who had been granted parole were accepted into the research program. One half of the volunteers had one high-dose psychedelic session after an average of twenty-three hours of intensive psychological preparation, while the other half participated in a regular program of non-drug therapy at the out-patient clinic, which lasted a comparable amount of time. The assignment of patients to the experimental and control group was done on a random basis. Both groups were required to remain in regular contact with the outpatient clinic after treatment and give samples of urine for chemical analysis. The results of this experimental treatment program were reported by two members of the Spring Grove team, Charles Savage and Lee McCabe (93). Eleven of the thirty-four patients in the LSD group did not return to narcotics during the six-month follow-up period, while only one control subject showed a comparable improvement. At the one-year follow-up, eight LSD patients were still abstaining as compared to none in the control group. Although not dramatic in absolute terms, this has to be considered a very promising result for this extremely difficult category of patients. Short-term follow-up studies of narcotic addicts indicated that typically 94-97 percent of the patients return to drug use within a few weeks following conventional treatments.

One aspect of psychedelic therapy with alcoholics and heroin addicts deserves special notice. While successful treatment of psychoneuroses and psychosomatic disorders usually requires a whole series of therapeutic psychedelic ses sions, in these two categories quite striking improvements may frequently be observed after a single LSD experience. It was mentioned earlier that this might be related to the ease with which many alcoholics and drug addicts achieve transcendental states of mind. In the Spring Grove program, the number of sessions per patient was limited by the research design. All heroin addicts and most alcoholics received only one LSD session; some alcoholic patients had two or, quite exceptionally, three sessions. There is good reason to believe that much better clinical results could have been achieved if the research design had been less rigid. In a more open-ended situation in Prague, where it was possible to administer serial LSD sessions without any limitations, we observed in several instances not only lasting abstinence but deep positive restructuring of the alcoholic's or addict's personality.

Another category of difficult patients with poor prognosis that can occasionally be reached by LSD-assisted psychotherapy should be mentioned in this context. There are indications that certain individuals with asocial, antisocial, and criminal tendencies can benefit from LSD treatment. Several aspects of the psychedelic process seem to make it possible to achieve positive results with these subjects. The most serious obstacle to effective psychotherapy of sociopathic individuals under normal circumstances is their inability to form, develop and maintain relationships. This interferes significantly with the treatment process, since a strong emotional connection with the therapist is considered an important element of therapeutic change. It is well-known that during psychoanalysis just the sharing of intimate personal material tends to result in development of a transference relationship in most subjects. This factor is much more powerful in psychedelic therapy; merely sitting in an understanding and supportive way in a person's LSD sessions will automatically result in formation of a strong emotional tie. This bond can be positive, negative, or distinctly ambivalent, but the patient cannot easily avoid some sort of response. Although this is just a prerequisite for effective therapy and not necessarily a therapeutic element per se, it is an essential condition for the successful treatment of individuals with sociopathic traits. In addition, the LSD experience provides effective channels for the discharge and integration of enormous amounts of aggression and destructive feelings underlying antisocial activities. Experiential access to the areas of transcendental feelings and connection with the system of metavalues seems to be even more important in this context. As a result, criminal behavior is often taken out of the narrow context of a revolt against human society and can suddenly be seen as violation of the cosmic order.

Several LSD therapists occasionally described good results in individual patients with antisocial tendencies in the context of larger clinical studies involving a broad range of diagnostic categories. In several instances, researchers conducted special studies focusing on antisocial and criminal populations. Arendsen-Hein (4) treated twenty-one severely-criminal psychopaths with regular LSD sessions using dosages of 50-450 micrograms. After a period of ten to twenty weeks of therapy, twelve were clinically improved and two greatly improved.

In the early sixties, a team of Harvard psychologists headed by Timothy Leary initiated a research program of psychedelic therapy with recidivists at the Concord State Prison in Massachusetts. (55) The drug used in this project was not LSD, but the closely related psilocybin, the active psychedelic principle from the

Mexican sacred mushrooms Psilocybe mexicana. The unique aspect of this research was that the psychologists ingested the drug along with the convicts, although a non-drugged "ground control" and supervising psychiatrist were always present. The result of this study, in which over two hundred psychedelic sessions were run with men incarcerated for their antisocial behavior, was a statistically significant reduction in new crimes committed by the group that hud had psilo-cybin experiences. Several years ago, Walter Huston Clark carried out an informal follow-up study, with quite impressive results. At least one interesting attempt has been made to integrate LSD therapy into a complex therapeutic regime under the conditions of maximum security. The results of this experiment conducted at the Maximum Security Division of the Mental Health Center at Penetanguishene, Ontario, have been reported by G.J. Maier, D.L. Tate, and B.D. Paris. (61)

Favorable clinical results have occasionally been described in patients with various sexual abnormalities that are usually very unresponsive to conventional psychotherapy or therapy in general. Among them, individuals showing sadistic and masochistic tendencies seem to have the most favorable prognosis. Once the psychedelic process reaches the perinatal level, powerful channels become available for discharge and integration of enormous amounts of aggressive and self-destructive impulses. Experiences of the death-rebirth sequences offer unique opportunities for the resolution of the intimate perinatal link between sexuality and aggression which underlies sadomasochism. Some other sexual deviations that can respond to psychedelic therapy include fetishism, exhibitionism, and coprophilia. Although favorable results have occasionally been reported for male and female homosexuality, it is difficult to make any generalized statements in this area because of the heterogeneity and complexity of the problems involved. The prognosis of patients in this category is critically dependent on the nature of their problem, their own attitude toward their sexual behavior, and the motivation for therapy. A positive outcome can be expected only when the individual considers the deviation to be a problem, has a strong intrapsychic conflict about it, and shows an active interest in treatment.

Character disorders of various kinds, sometimes even severe and complicated cases, can be considered for LSD therapy if a well-equipped facility with trained personnel is available. Usually, a few exploratory sessions will give the therapist a sufficient indication of the prognosis for a particular individual. In the course of the LSD therapy of character disorders that were originally symptom-free, one can frequently observe temporary manifestations of various neurotic and psychosomatic symptoms in the free intervals between the sessions.

Continue reading here: Borderline Psychotic States And Endogenous Psychoses

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