Use Of The Activating Effect Of Lsd On Chronic And Fixated Symptoms

This approach was inspired by the clinical experience that LSD has an intensifying and mobilizing effect on manifest and latent psychopathological symptoms. The principle of activation or "provocation" therapy with LSD was theoretically developed and employed in practice by the Austrian researcher Jost. (41) This concept was based on clinical observations of an interesting relationship between the nature and course of the psychotic process and prognosis of the disease. It has been a well-known clinical fact that acute schizophrenic episodes with dramatic, rich and colorful symptoms have a very good prognosis. They frequently result in spontaneous remission, and therapy of these conditions is usually very successful. Conversely, schizophrenic states with an inapparent and insidious onset, a few stagnating and torpid symptoms, and a stationary course have the poorest prognosis and are very unresponsive to conventional treatments.

After analyzing a great number of trajectories of psychotic episodes, Jost came to the conclusion that it is possible to find a certain culmination point in the natural course of psychosis beyond which the disease shows a trend towards spontaneous remission. In schizophrenia, these culmination points are usually characterized by hallucinatory experiences of death or destruction, disintegration of the body, regression and transmutation. These negative sequences are then followed by fantasies or experiences of rebirth.

The assumption of such a culmination point in the spontaneous course of the illness could explain, according to Jost, some puzzling observations made during electroshock therapy. As ECT seems to accelerate the spontaneous development of the disease along the intrinsic trajectory, it makes a great deal of difference at which point it is applied. If the electroshock is administered before the psychosis reaches the culmination point, it produces dramatic manifestations and intensifies the clinical picture. If it is given after the culmination point has been reached, this results in a rapid sedation of the patient and remission of the symptoms.

In their practical approach, Jost and Vicari (42) intended to accelerate the spontaneous development of the disease by a combination of chemical and electrophysiological means to mobilize the autonomous healing forces and processes within the organism. They administered LSD and when the clinical condition was activated by its effect, they applied electroconvulsive therapy. The authors described substantial shortening of the schizophrenic episode, reduction in the number of electroshocks required to reach clinical improvement, and often a deeper remission.

Sandison and Whitelaw, (92) two British researchers and pioneers in LSD research, used a similar principle of applying a conventional treatment technique in patients whose clinical condition was activated by LSD. However, instead of administering ECT, they used the tranquilizing effect of chlorpromazine (Thorazine). In their study, psychotic patients from various diagnostic groups were given LSD and two hours later intramuscular injection of the tranquillizer. Although the results seemed promising, the authors themselves later discarded the idea that the administration of chlorpromazine played a positive role in this procedure.

In general, the idea of provocational therapy with LSD has not found a broader acceptance in clinical practice and has remained limited to the attempts described above. However, Jost's theoretical speculations contain several interesting ideas that can prove very fruitful if used in a more dynamic and creative way. The basic principle of activating fixated symptoms by LSD can be used in the context of intensive psychotherapy; a single LSD session can often help overcome stagnation in a long-term psychotherapeutic process. Also, Jost's concepts of an intrinsic trajectory of the psychotic process and the value of its acceleration are in basic agreement with certain modern approaches to schizophrenia discussed in the writings of R. D. Laing, (52) John Perry, (80) Julian Silverman, (94,95) and Maurice Rappaport. (84) Similarly, the observations regarding Jost's concept of the culmination moment of the schizophrenic process and the specific experiences associated with the breaking point make new sense if they are viewed in the context of dynamic matrices in the unconscious rather than from the point of view of Jost's mechanical model. We will discuss this issue in detail in connection with the perinatal matrices and the therapeutic significance of the ego death and rebirth experience.

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