The Need For A Comprehensive Theory Of Lsd Therapy

Therapeutic experimentation with LSD, and psychedelic research in general, has been very negatively influenced by the existence of the black market, unsupervised self-experimentation, sensational journalism, and irrational legislative measures. Despite the fact that LSD now has been known for almost three decades, the literature describing its effects and therapeutic potential is controversial and inconclusive. Further developments in this field would require that independent teams in different countries interact and cooperate in collecting experimental data and exchanging information. However, the number of places studying LSD has been cut down considerably and continues to decrease. Although the present prospects for extensive psychedelic research are rather grim, there are indications that systematic exploration will be resumed after the general confusion has been clarified and rationality reintroduced into the study of the problems involved.

Whatever becomes of LSD research in the future, there are good reasons to analyze the observations and results of past psychedelic experimentation and pre sent the most important insights and findings in a simple and comprehensive form. Such an effort seems justified whether this study becomes an epitaph to the LSD era or a manifesto for future psychedelic researchers. If we are witnessing the "swan song" of psychedelic research, it would be interesting in retrospect to be able to throw more light on the controversies and lack of theoretical understanding concerning the nature of the LSD effect. If LSD research continues into the future, clarification of the present confusion and disagreements would be of great practical importance. Additional controlled studies on a large scale are needed to assess the efficacy of LSD as an adjunct to psychotherapy with a satisfactory degree of scientific accuracy. However, unless the critical reasons for past controversies can be clearly identified and taken into consideration in future research, the new studies will probably perpetuate old errors and yield correspondingly inconclusive results.

As indicated above, individual authors and research teams used LSD starting from very different premises. They followed different therapeutic objectives, adhered to different theoretical systems, employed differing technical approaches, and administered the drug in the most disparate frameworks and settings. It is my belief that the main reason for the controversies about LSD therapy is a lack of understanding regarding the nature of the LSD effect, and the absence of a plausible and generally acceptable conceptual framework that would reduce the vast amounts of observed data to certain common denominators. Such a theoretical system would have to provide understanding of the content and course of separate sessions as well as of repeated exposures to LSD in a therapeutic series. And it should be able to explain the paramount importance of extrapharmacological factors—the personalities of the subject and the guide, their mutual relationship, and the elements of the set and setting—in the development of LSD sessions.

Other important problems that should be accounted for within a comprehensive theoretical framework are the occasional prolonged reactions and even psychotic breakdowns that occur after some of the sessions, or the later recurrences of the LSD-like states ("flashbacks"). The general understanding of these phenomena is at present very incomplete and unsatisfactory, a situation that has serious practical consequences. One result of it is that the approach of mental health professionals to complications of the non-medical use of psychedelics is generally ineffective and often harmful.

A comprehensive theory of LSD psychotherapy should also be able to bridge the gap at present existing between psycholytic and psychedelic therapy, the two most relevant and vital approaches to LSD treatment, and some other therapeutic modifications such as anaclitic and hypnodelic therapy. It should be possible to find important common denominators and explanatory principles for these various approaches and understand their indications and contraindications, as well as successes and failures. A conceptual framework correctly reflecting the most important aspects of the LSD effect should be able to provide practical directives concerning the optimal conditions for the use of this substance in psychotherapy. This would involve general treatment strategy, as well as details concerning dosages, effective approaches to various special situations, use of auxiliary techniques, and the specific elements of set and setting. Finally, a useful, comprehensive theory should provide a number of partial working hypotheses of a practical and theoretical nature that could be tested with the use of scientific methodology.

In view of the complex and multileveled nature of the problems involved, it is extremely difficult to formulate at present a conceptual framework that would fully satisfy all the above criteria. For the time being, even a tentative and approximate theoretical structure, organizing most of the important data and 1 providing guidelines for therapeutic practice, would represent distinct progress. In the following chapters an attempt will be made to present a tentative framework for the theory and practice of LSD psychotherapy. It is lny belief that a conceptual system that could account for at least the major observations of LSD therapy requires not just a new understanding of the effects of LSD, but a new and expanded model of the human mind and the nature of human beings. The researches on which my speculations are based were a series of exploratory clinical studies, each of which represented an exciting venture into new territories of the mind as yet uncharted by Western science. It would be unrealistic to expect that they would be more than first sketchy maps for future explorers. I am well aware of the fact that, following the example of old geographers, many areas of my cartography would deserve to be designated by the famous inscription: Hie sunt leones.5

The proposed theoretical and practical framework should be considered as an attempt to organize and categorize innumerable new and puzzling observations from several thousand LSD sessions and present them in a logical and comprehensive way. Even in its present rough form, this conceptual framework has proved useful in understanding the events in psychedelic sessions run in a clinical setting, as well as LSD states experienced in the context of non-medical experimentation; following its basic principles has made it possible to conduct LSD therapy with maximum benefit and minimum risk. I believe that it also offers important guidelines for more effective crisis intervention related to psychedelic drug use and more successful treatment of various complications following unsupervised self-experimentation.

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