The Nature And Dynamics Of Psychedelic Crises

Understanding the dynamics of psychedelic experiences is absolutely necessary for effective crisis intervention. A difficult LSD experience, unless it results from a gross abuse of the individual, represents an exteriorization of a potentially pathogenic matrix in the subject's unconscious. If properly handled, a psychedelic crisis has great positive potential and can result in a profound personality transformation. Conversely, an insensitive and ignorant approach can cause psychological damage and lead to chronic psychotic states and years of psychiatric hospitalization.

Before discussing the difficult experiences that occur in psychedelic sessions, their causes, and the principles of crisis intervention, we will summarize our previous discussions about the nature and basic dynamics of the LSD process. LSD does not produce a drug-specific state with certain stereotypical characteristics; it can best be described as a catalyst or amplifier of mental processes that mediates access to hidden recesses of the human mind. As such, it activates deep repositories of unconscious material and brings their content to the surface, making it available for direct experience.

A person taking the drug will not experience an "LSD state" but a fantastic journey into his or her own mind. All the phenomena encountered during this journey—images, emotions, thoughts and psychosomatic processes—should thus be seen as manifestations of latent capacities in the experient's psyche rather than symptoms of "toxic psychosis." In the LSD state the sensitivity to external factors and circumstances is intensified to a great degree. These extraphar-macological influences involve all the factors usually referred to as "set and setting": the subject's understanding of the effects of the drug and purpose of ingestion, their general approach to the experience, and the physical and interpersonal elements of the situation. A difficult LSD experience thus reflects either a pathogenic constellation in the experient's unconscious, traumatic circumstances, or a combination of the two.

Ideal conditions for an LSD session involve a simple, safe and beautiful physical environment and an interpersonal situation that is supportive, reassuring and nourishing. Under these circumstances, when disturbing external stimuli are absent, negative LSD experiences can be seen as psychological work on the traumatic areas of one's unconscious. It is essential for the good outcome of an LSD session to keep it internalized and fully experience and express everything that is emerging. Psychedelic sessions in which the subject does not stay with the process tend to create a dysbalance in the basic dynamics of the unconscious. The defense system is weakened by the effect of the drug, but the unconscious material that has been released is not adequately worked through and integrated. Such sessions are conducive to prolonged reactions or to subsequent "flashbacks."

The only way to facilitate the completion and integration of an LSD session in which the experiential gestalt remains unfinished is to continue the uncovering work, with or without psychedelics. It is important to emphasize that the effect of LSD is essentially self-limited; the overwhelming majority of difficult psychedelic experiences reach a resolution quite spontaneously. Actually, those states that are , most dramatic and stormy tend to have the best outcome. The use of tranquillizers in the middle of a psychedelic session is a grave error and may be harmful. It tends to prevent the natural resolution of the difficult emotional or psychosomatic gestalt and to "freeze" the experience in a negative phase. The only constructive approach is to provide basic protection to the subject, and support and facilitate the process; the least one can do is to not interfere with it.

After this brief introduction, we can return to the problem of complications during unsupervised psychedelic experimentation. Although the basic principles discovered during clinical research with LSD are directly applicable to crisis intervention, it is important to emphasize the basic differences between the two situations. The LSD administered in clinical and laboratory research is pharmaceutical^ pure and its quality can be accurately gauged; most black market samples do not meet these criteria. Only a small fraction of a "street acid" specimen is relatively pure LSD; the black market preparations frequently contain various impurities or admixtures of other drugs. In some of the street samples that have been analyzed in laboratories, researchers have detected amphetamines, STP, PCP, strychnine, benactyzine, and even traces of urine. There have been instances where alleged LSD samples contained some combination of the above substances and no LSD whatsoever. The poor quality of many of the street specimens is certainly responsible for some of the adverse reactions that occur in the context of unsupervised self-experimentation. In addition, uncertainty about quality and dosage and the resulting fears can have a negative influence on the ability of the subject to tolerate unpleasant experiences, which are then readily interpreted as signs of toxicity or overdose rather than manifestations of the users' unconscious.

However, the quality of drug and the uncertainty about it seem to be responsible for a relatively small fraction of the adverse reactions to LSD. There is no doubt that extrapharmacological elements, such as the personality of the subject and the set and setting, are by far the most important factors.

In order to understand the frequency and seriousness of psychedelic crises that occur in the context of unsupervised self-experimentation, it is important to take into consideration the circumstances under which many people tend to take LSD. Some of them are given the drug without any prior information about it, without adequate preparation, and sometimes even without forewarning. The general understanding of the effects of LSD is poor, even among experienced users. Many of them take LSD for entertainment and have no provisions in their conceptual framework for painful, frightening and disorganizing experiences. Unsupervised experimentation frequently takes place in complex and confusing physical and interpersonal settings that can contribute many important traumatic elements. The hectic atmosphere of large cities, busy highways in the rush hour, crowded rock concerts or discos, and noisy social gatherings are certainly not settings conducive to productive self-exploration and safe confrontation with the difficult aspects of one's unconscious.

Personal support and a relationship of trust are absolutely crucial for a safe and successful LSD session, and these are seldom available under these circumstances. Not infrequently the person under the influence of LSD is surrounded by total strangers. In some other instances good friends may be present, but they are themselves under the influence of the drug or are unable to tolerate and handle intense and dramatic emotional experiences. When a group of people take LSD together, the painful experiences of one person can create a negative atmosphere which contaminates the sessions of others. There have even been episodes in which persons who took LSD or were given the drug were, for a variety of reasons, exposed to deliberate psychological abuse. It is easy to understand that such toxic circumstances are highly conducive to adverse reactions.

Continue reading here: Professional Crisis Intervention And The Selfhelp Approaches

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