Therapeutic Experimentation With
From the point of view of our discussion, the most important area of LSD research has been experimental therapy with this substance. Observations of the dramatic and profound effects of minute quantities of LSD on the mental processes of experimental subjects led quite naturally to the conclusion that it might be fruitful to explore the therapeutic potential of this unusual compound.
The possibility of therapeutic use of LSD was first suggested by Condrau (21) in 1949, only two years after Stoll had published the first scientific study of LSD in Switzerland. In the early fifties several researchers independently recommended LSD as an adjunct to psychotherapy, one which could deepen and intensify the therapeutic process. The pioneers of this approach were Busch and Johnson (17) and Abramson (1,2) in the United States; Sandison, Spencer and Whitelaw (91) in England; and Frederking (28) in West Germany.
These reports attracted considerable attention among psychiatrists, and stimulated clinicians in various countries of the world to start therapeutic experimentation with LSD in their own practice and research. Many of the reports published in the following fifteen years confirmed the initial claims that
LSD could expedite the psychotherapeutic process and shorten the time necessary for the treatment of various emotional disorders, which made it a potentially valuable tool in the psychiatric armamentarium. In addition, there appeared an increasing number of studies indicating that LSD-assisted psychotherapy could reach certain categories of psychiatric patients usually considered poor candidates for psychoanalysis or any other type of psychotherapy. Many individual researchers and therapeutic ¿earns reported various degrees of clinical success with alcoholics, narcotic-drug addicts, sociopaths, criminal psychopaths, and subjects with various character disorders and sexual deviations. In the early sixties a new and exciting area was discovered for LSD psychotherapy: the care of patients dying of cancer and other incurable diseases. Studies with dying individuals indicated that LSD psychotherapy could bring not only an alleviation of emotional suffering and relief of the physical pain associated with chronic diseases, it could also dramatically change the concept of death and attitude toward dying.
Since the appearance of the early clinical reports on LSD much time and energy has been invested in research of its therapeutic potential, and hundreds of papers have been published on various types of LSD therapy. Many psychophar-macological, psychiatric, and psychotherapeutic meetings had special sections on LSD treatment. In Europe, the initially isolated efforts of individual LSD researchers resulted in an effort to create a homogeneous organizational structure. LSD therapists from a number of European countries formed the European Medical Society for Psycholytic Therapy, and members held regular meetings dealing with the use of psychedelic drugs in psychotherapy. This organization also formulated the specifications and criteria for selection and training of future LSD therapists. The counterpart of this organization in the United States and Canada was the Association for Psychedelic Therapy. During the decade of most intense interest in LSD research several international conferences were organized for the exchange of experiences, observations and theoretical concepts in this field (Princeton, 1959; Goettingen, 1960; London, 1961; Amityville, 1965; Amsterdam, 1967; and Bad Nauheim, 1968).
The efforts to use LSD in the therapy of mental disorders now span a period of almost three decades. It would be beyond the scope of this presentation to describe all the specific contributions to this unique chapter of the history of psychiatric treatment, as well as give due attention to all the individual scientists who participated in this avenue of research. The history of LSD therapy has been a series of trials and errors. Many different techniques of therapeutic use of LSD have been developed and explored during the past thirty years. Approaches that did not have the expected effect or were not supported by later research were abandoned; those that seemed promising were assimilated by other therapists, or developed further and modified. Instead of following this complicated process through all its stages, I will try to outline certain basic trends and the most important therapeutic ideas and concepts. Three decades of LSD therapy is a sufficiently long period for accumulating clinical observations and verifying research data. We can, therefore, attempt a critical review of the clinical experience in this area, summarize the current knowledge about the value of LSD as a therapeutic tool in psychiatry, and describe the safest and most effective techniques for its use.
Various suggestions concerning the therapeutic use of LSD were based on the specific aspects of its action. The frequent occurrence of euphoria in LSD sessions with normal volunteers seemed to suggest the possibility that this drug could be useful in the treatment of depressive disorders. The profound and often shattering effect of LSD on psychological as well as physiological functions, amounting to an emotional or vegetative shock, seemed to indicate that it could have a therapeutic potential similar to electroshocks, insulin treatment, or other forms of convulsive therapy. This concept was supported by observations of striking and dramatic changes in the clinical symptomatology and personality structure of some subjects after administration of a single dose of LSD. Another aspect of the LSD effect which seemed to be promising from the therapeutic point of view was the unusual ability of this drug to facilitate intensive emotional abreactions. The therapeutic success of abreactive techniques such as hypnoanalysis and narcoanalysis in the treatment of war neuroses and traumatic emotional neuroses encouraged explorations of this property of LSD. One additional interesting possibility of therapeutic use was based on the activating or "provocational" effect of LSD. The drug can mobilize and intensify fixated, chronic and stationary clinical conditions that are characterized by just a few torpid and refractory symptoms, and it was hypothesized that such chemically induced activation might make these so-called oligo-symptomatic states more amenable to conventional methods of treatment. By far the most important use of LSD was found in its combination with individual and group psychotherapies of different orientations. Its effectiveness is based on a very advantageous combination of various aspects of its action. LSD psychotherapy seems to intensify all the mechanisms operating in drug-free psychotherapies and involves, in addition, some new and powerful mechanisms of psychological change as yet unacknowledged and unexplained by mainstream psychiatry.
In the following sections, I will describe the most important areas of therapeutic experimentation with LSD, give actual treatment techniques and concepts, and discuss their empirical or theoretical bases. Special attention will be paid to an evaluation of how successfully individual approaches have withstood the test of time.
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