reluctance of the individual to surrender his aggressive goal direction. Such a loss of future aims, depriving aggression of its most powerful impetus, produces an enforced passivity, which has been demonstrated to produce fear and panic (8). Goal direction is made difficult by the lessening of the ability to anticipate. If that is diminished, the drive for future aims is jeopardized, and the surrender to immediacy, to the moment, made mandatory. It is just this surrender to the immediate sensory input, without further elaboration and attenuation by considerations of the future or past, which frightens patients. The logical therapeutic response to such fear of surrender is the demonstration of the fact that such a surrender is not dangerous, but can be quite pleasureful. Any attempt to maintain the patient's defenses against submission will increase his fear and panic. He is, to a certain extent, artificially deprived of control of the impact of his sensory life and fantasies and has difficulties contending with such a flood of impressions. The fear, probably not originating in this sensory input, comes from his attempt to control it with obviously inadequate means.
Statements about the transientness of the experience or about the fact that it is only a "drug reaction" should be avoided; and suggestions which emphasize the reality of the situation seem contraindicated. They attempt to re-enforce the defenses of the patient, and implicitly accentuate the danger to the patient, should he lose them. Such emphasis on "reality" may serve as reassurance to the therapist, but does little to alleviate the patient's fear. A courageous and fearless encouragement to engage in the experience and to surrender to it relieves the patient's apprehension and may avert panic. We feel that this is the only way to combat this rather disturbing side reaction.
It is noteworthy that not one patient, though they were critically ill, had any adverse medical reaction, and the administration of LSD was well tolerated.
In addition to the work exploring LSD as an analgesic, two pilot studies were made. The first concerns the use of LSD as a preanesthetic agent. This was a natural development, because one of the most striking features of the LSD reaction is the loss of aggressive feelings, the acceptance of passivity, and the consequent ease in surrendering control, which is required for easy anesthetic induction. The same case against the value of anticipation in a preoperative situation may be made as can be made against the value of anticipation of death. And in consequence, the same arguments can be made for the use of LSD as preoperative medication. This loss of aggressive feelings and willingness to surrender may be one of the prime causes of fear and panic reaction associated with the induction phase of anesthesia, fainting, hypnosis, or even in normal sleep induction. This is especially true in individuals who rely on strong conscious control for regulation of their behavior. Other customary premedications (meperi-dine, morphine, or scopolamine) are used for their soporific dulling action. LSD does not dull the sensorium, but mediates passive acceptance of even threatening events. The desirability of avoiding postoperative analgesia was a second reason for considering LSD as preanesthetic agent.
So far we have a series of ten cases, demonstrating the safety of the procedure and its potential therapeutic use. The ten patients were all females in good health except for fibro-adenomata, who underwent total abdominal hysterectomies.
One hundred mcm. LSD was given two hours before surgery as the only premedication except atropine. Results can be seen on Figure 8. All patients tolerated the procedure well. Some laughed while the mask was applied and, still laughing, fell asleep. After recovery the patients were asked if they would want LSD again, should further surgery be necessary; no reluctance was expressed.
The second pilot study concerned the effect of LSD on four patients with phantom limb pain. There had been a report in the Japanese literature (9 ) claiming good results with LSD in the treatment of this condition, and it seemed plausible to us, but our results were negative. No lasting pain relief was noted. Even during the acute LSD reaction we did not note any significant results.
One sidelight might be meaningful. One patient, an am* putee above the knee, stated that under LSD he noted an approximation of the pain to the stump. The pain had been in the non-existing heel, and gradually moved up to about two inches below the stump.
This phenomenon lends itself to further investigation. It is evident that the three incidences of attenuation of anticipation produced by the psychedelic experience reported here are only examples of a much wider area of potential application of the LSD reaction in the therapeutic field. This report may serve as stimulus to explore the therapeutic value of a diminishing of anticipation in other areas.
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HYPNOTISM is by no means a new art. True, it has been developed into a science in comparatively recent years. But the principles of thought control have been used for thousands of years in India, ancient Egypt, among the Persians, Chinese and in many other ancient lands. Miracles of healing by the spoken word and laying on of hands are recorded in many early writings.