Professional Crisis Intervention And The Selfhelp Approaches
The present intervention offered by professionals in psychedelic crises is based on the medical model and usually creates more problems than it solves. The steps typically taken under these circumstances reflect a serious lack of understanding of the nature of the psychedelic experience, and are conducive to long-term complications. This is further complicated by the numerous demands on the time of a mental health practitioner and a lack of adequate facilities for handling casualties from the psychedelic scene. The tranquillizers that are routinely administered under these circumstances tend to prevent effective resolution of the underlying conflict and thus contribute to the incidence of chronic emotional and psychosomatic difficulties after the session. Instant transfer of the individual to a psychiatric facility in the middle of the LSD experience is not only unnecessary, but represents a dangerous and harmful practice. It disregards the fact that the LSD state is self-limiting; in most instances, a dramatic negative experience if properly handled will result in a beneficial resolution and the subject will not need any further treatment. The "emergency transfer" to a psychiatric facility, particularly if it involves an ambulance, creates an atmosphere of danger and urgency that contributes considerable additional trauma for a person who is already extremely sensitized by the psychedelic state and the painful emotional crisis. The same is true of the admission procedure in the psychiatric facility and the atmosphere of the locked ward which is the final destination of many psychedelic casualties.
Exposure to the routines of the psychiatric machinery while under the influence of LSD can cause a life-long trauma. The fact that psychiatric diagnosis and hospitalization may often represent a serious social stigma is another important factor to consider before proceeding with an unnecessary transfer and admission. Moreover, if the LSD process does not reach a satisfactory resolution, contemporary psychiatric care applies continued medication with tranquillizers instead of the uncovering therapy that is the preferred treatment under these circumstances.
The basic points of the above discussion can be illustrated with the following example:
When I was working in the Psychiatraic Research Institute in Prague,
Czechoslovakia, I was asked as consultant to see two employees of the pharmaceutical laboratories that were involved in the production of LSD. They had both suffered delayed adverse effects of an accidental intoxication with LSD, while synthesizing the drug. One of them, a man in his forties who was heading the department, showed symptoms of deep depression with occasional bouts of anxiety, a sense of meaninglessness of existence, and doubts about his sanity. He dated these symptoms to the time of his intoxication with LSD and subsequent brief hospitalization in a psychiatric facility. His assistant, a woman in her twenties who had experienced accidental intoxication with LSD several months after he did, complained about bizarre sensations in her scalp: she was convinced that she was rapidly losing her hair, although there were no objective signs to support this.
During the diagnostic interviews with them I tried to reconstruct the circumstances of their LSD experiences and the dynamics of the problems they presented. The story that I heard, although unbelievable of LSD therapists or people familiar with the nature of psychedelic states, is unfortunately a typical example of crisis intervention based on the conventional medical and psychiatric models. The pharmaceutical laboratories that were involved in the production of LSD were situated approximately two hundred miles from Prague, where most of the clinical and laboratory research with psychedelics was happening at that time. When the management received the order to start the synthesis of Czechoslovakian LSD, it was felt that, because of the nature of the substance, the staff should be informed about its effects and instructed about the necessary measures in case of accidental intoxication. The director invited from the nearby state mental hospital a psychiatrist who had no personal or professional experience of LSD and prepared himself by reading a few papers on the "model psychosis" approach to schizophrenia. During the seminar with the staff, this superficially informed psychiatrist managed to paint an apocalyptic picture of LSD. He told them that this colorless, odorless and tasteless substance could insidiously enter their system, as had happened to Dr. Albert Hofmann, and induce a state of schizophrenia. He suggested that they should keep a supply of Thorazine in their first-aid kit and in case of accidental intoxication bring the tranquillized victim without delay to the psychiatric hospital.
As a result of these instructions, both laboratory workers received Thorazine shortly after they had started to feel the effects of the drug, and were rushed in an ambulance to the locked ward of the state mental hospital. There they spent the rest of the intoxication period and a few following days in the company of psychotic patients. While under the influence of the LSD-Thorazine combination, the department chief witnessed several grand mal seizures and had a long discussion with a patient who was showing him his wounds after a suicide attempt. The fact that he was put by mental health experts in the company of severely disturbed patients contributed considerably to his fear that he might himself be developing a similar condition. Analysis of his LSD state, which was only incompletely truncated by the Thorazine medication, showed that he was experiencing elements of BPM II, and the confinement in the locked ward and his adventures there represented a powerful reinforcement of his desperate state.
The experience of his research assistant was more superficial; her reaction to the atmosphere of the locked ward was to pull herself together and maintain control at any cost. Retrospective analysis of her experience showed that she was approaching a traumatic childhood memory, but because of the external circumstances she suppressed it and prevented it from surfacing. Her feeling of losing her hair turned out to be a symptom related to this deep psychological regression; the infantile body image corresponding to the age when she experienced the traumatic event involved hairiessness as a natural condition.
During their visit to the Psychiatric Research Institute in Prague these two pharmaceutical workers were able not only to work on their symptoms, but also to change their image of LSD and the negative feelings associated with it. We explained to them the nature of the LSD state and discussed with them our therapeutic program and the principles of conducting sessions. Before they left they had ample opportunity to discuss the effects of LSD with patients undergoing psycholytic treatment who had experienced their sessions under substantially different circumstances. I assured them that there was no reason for alarm if someone was intoxicated by LSD; as a matter of fact, we were producing situations like that routinely in our program. They were advised to have a special, quiet room where the intoxicated individual could spend the rest of the day listening to music in the company of a good friend.
Several months later, I received a call from the department chief. He told me that they had had another "accident"; a nineteen-year-old laboratory assistant had experienced a professional intoxication. She spent the day in a comfortable room adjacent to her laboratory in the company of her friend and "had the time of her life." She found her experience very pleasant, interesting and beneficial.
The .avoidance techniques developed by the self-help movement, although less harmful than the approach based on the medical and psychiatric model, are also counterproductive. Attempts to engage the subject in superficial conversations ("talking them down"), to distract them by showing them flowers and beautiful pictures, or taking them for a walk does not solve the underlying problem. This can be seen at best as playing for time—keeping the individual occupied with distracting maneuvers until the crisis subsides or diminishes with the waning of the pharmacological effect of the drug. These approaches are based on the erroneous assumption that the drug has created the problem. Once we realize that we are dealing with the dynamics of the unconscious, not a pharmacological state, the short-sightedness of this approach becomes obvious. The danger in using techniques that encourage avoidance lies in the failure to confront and resolve the unconscious material that underlies the emotional and psychosomatic crisis. LSD sessions in which the emerging gestalt is not completed are conducive to prolonged reactions, negative emotional and physical aftereffects, and "flashbacks".
Continue reading here: Comprehensive Crisis Intervention In Psychedelic Emergencies
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