4. Use of LSD in Psychiatry

At 8 o'clock I took 60 mcg (0.06 milligrams) of LSD. Some 20 minutes later, the first symptoms appeared: heaviness in the limbs, slight atactic (i.e., confused, uncoordinated) symptoms. A subjectively very unpleasant phase of general malaise followed, in parallel with the drop in blood pressure registered by the examiners.

A certain euphoria then set in, though it seemed weaker to me than experiences in an earlier experiment. The ataxia increased, and I went "sailing" around the room with large strides. I felt somewhat better, but was glad to lie down.

Afterward the room was darkened (dark experiment); there followed an unprecedented experience of unimaginable intensity that kept increasing in strength. It w as characterized by an unbelievable profusion of optical hallucinations that appeared and vanished with great speed, to make way for countless new images. I saw a profusion of circles, vortices, sparks, showers, crosses, and spirals in constant, racing flux.

The images appeared to stream in on me predominantly from the center of the visual field, or out of the lower left edge. When a picture appeared in the middle, the remaining field of vision was simultaneously filled up with a vast number of similar visions. All were colored: bright, luminous red, yellow, and green predominated.

I never managed to linger on any picture. When the supervisor of the experiment emphasized my great fantasies, the richness of my statements, I could only react with a sympathetic smile. I knew, in fact, that I could not retain, much less describe, more than a fraction of the pictures. I had to force myself to give a description. Terms such as "fireworks" or "kaleidoscopic" were poor and inadequate. I felt that I had to immerse myself more and more deeply into this strange and fascinating world, in order to allow the exuberance, the unimaginable wealth, to work on me.

At first, the hallucinations were elementary: rays, bundles of rays, rain, rings, vortices, loops, sprays, clouds, etc. Then more highly organized visions also appeared: arches, rows of arches, a sea of roofs, desert landscapes, terraces, flickering fire, starry skies of unbelievable splendor. The original, more simple images continued in the midst of these more highly organized hallucinations. I remember the following images in particular:

A succession of towering, Gothic vaults, an endless choir, of which I could not see the lower portions.

A landscape of skyscrapers, reminiscent of pictures of the entrance to New York harbor: house towers staggered behind and beside one another with innumerable rows of windows. Again the foundation was missing.

A system of masts and ropes, which reminded me of a reproduction of a painting seen the previous day (the inside of a circus tent).

An evening sky of an unimaginable pale blue over the dark roofs of a Spanish city. I had a peculiar feeling of anticipation, was full of joy and decidedly ready for adventure. All at once the stars flared up, amassed, and turned to a dense rain of stars and sparks that streamed toward me. City and sky had disappeared.

I was in a garden, saw brilliant red, yellow, and green lights falling through a dark trelliswork, an indescribably joyous experience.

It was significant that all the images consisted of countless repetitions of the same elements: many sparks, many circles, many arches, many windows, many fires, etc. I never saw isolated images, but always duplications of the same image, endlessly repeated.

I felt myself one with all romanticists and dreamers, thought of E. T. A. Hoffmann, saw the maelstrom of Poe (even though, at the time I had read Poe, his description seemed exaggerated). Often I seemed to stand at the pinnacle of artistic experience; I luxuriated in the colors of the altar of Isenheim, and knew the euphoria and exultation of an artistic vision. I must also have spoken again and again of modern art; I thought of abstract pictures, which all at once I seemed to understand. Then again, there were impressions of an extreme trashiness, both in their shapes and their color combinations. The most garish, cheap modern lamp ornaments and sofa pillows came into my mind. The train of thought was quickened. But I had the feeling the supervisor of the experiment could still keep up with me. Of course I knew, intellectually, that I was rushing him. At first I had descriptions rapidly at hand. With the increasingly frenzied pace, it became impossible to think a thought through to the end. I must have only started many sentences.

When I tried to restrict myself to specific subjects, the experiment proved most unsuccessful. My mind would even focus, in a certain sense, on contrary images: skyscrapers instead of a church, a broad desert instead of a mountain.

I assumed that I had accurately estimated the elapsed time, but did not take the matter very seriously. Such questions did not interest me in the slightest.

My state of mind was consciously euphoric. I enjoyed the condition, was serene, and took a most active interest in the experience. From time to time I opened my eyes. The weak red light seemed mysterious, much more than before. The busily writing research supervisor appeared to me to be very far away. Often I had peculiar bodily sensations: I believed my hands to be attached to some distant body, but was not certain whether it was my own.

After termination of the first dark experiment, I strolled about in the room a bit, was unsure on my legs, and again felt less well. I became cold and was thankful that the research supervisor covered me with a blanket. I felt unkempt, unshaven, and unwashed. The room seemed strange and broad. Later I squatted on a high stool, thinking all the while that I sat there like a bird on the roost.

The supervisor emphasized my own wretched appearance. He seemed remarkably graceful. I myself had small, finely formed hands. As I washed them, it was happening a long way from me, somewhere down below on the right. It was questionable, but utterly unimportant, whether they were my own hands.

In the landscape outside, well known to me, many things appeared to have changed. Besides the hallucinations, I could now see the real as well. Later this was no longer possible, although I remained aware that reality was otherwise.

A barracks, and the garage standing before it to the left, suddenly changed to a landscape of ruins, shattered to pieces. I saw wall wreckage and projecting beams, inspired undoubtedly by the memory of the war events in this region.

In a uniform, extensive field, I kept seeing figures, which I tried to draw, but could get no farther than the crudest beginnings. I saw an extremely opulent sculptural ornamentation in constant metamorphosis, in continuous flux. I was reminded of every possible foreign culture, saw Mexican, Indian motifs. Between a grating of small beams and tendrils appeared little caricatures, idols, masks, strangely mixed all of a sudden with childish drawings of people. The tempo was slackened compared to the dark experiment.

The euphoria had now vanished. I became depressed, especially during the second dark experiment, which followed. Whereas during the first dark experiment, the hallucinations had alternated with great rapidity in bright and luminous colors, now blue, violet, and dark green prevailed. The movement of larger images was slower milder, quieter, although even these were composed of finely raining "elemental dots," which streamed and whirled about quickly. During the first dark experiment, the commotion had frequently intruded upon me; now it often led distinctly away from me into the center of the picture, where a sucking mouth appeared. I saw grottoes with fantastic erosions and stalactites, reminding me of the child's book Im Wunderreiche des Bergkonigs [In the wondrous realm of the mountain king]. Serene systems of arches rose up. On the right-hand side, a row of shed roofs suddenly appeared; I thought of an evening ride homeward during military service. Significantly it involved a homeward ride: there was no longer anything like departure or love of adventure. I felt protected, enveloped by motherliness, was in peace. The hallucinations were no longer exciting, but instead mild and attenuated. Somewhat later I had the feeling of possessing the same motherly strength. I perceived an inclination, a desire to help, and behaved then in an exaggeratedly sentimental and trashy manner, where medical ethics are concerned. I realized this and was able to stop.

But the depressed state of mind remained. I tried again and again to see bright and joyful images. But to no avail; only dark blue and green patterns emerged. I longed to imagine bright fire as in the first dark experiment. And I did see fires; however, they were sacrificial fires on the gloomy battlement of a citadel on a remote, autumnal heath. Once I managed to behold a bright ascending multitude of sparks, but at half-altitude it transformed itself into a group of silently moving spots from a peacock's tail. During the experiment I was very impressed that my state of mind and the type of hallucinations harmonized so consistently and uninterruptedly.

During the second dark experiment I observed that random noises, and also noises intentionally produced by the supervisor of the experiment, provoked simultaneous changes in the optical impressions (synesthesia). In the same manner, pressure on the eyeball produced alterations of visual perceptions.

Toward the end of the second dark experiment, I began to watch for sexual fantasies, which were, however, totally absent. In no way could I experience sexual desire. I wanted to imagine a picture of a woman; only a crude modern-primitive sculpture appeared. It seemed completely unerotic, and its forms were immediately replaced by agitated circles and loops.

After the second dark experiment I felt benumbed and physically unwell. I perspired, was exhausted. I was thankful not to have to go to the cafeteria for lunch. The laboratory assistant who brought us the food appeared to me small and distant, of the same remarkable daintiness as the supervisor of the experiment.

Sometime around 3:00 P.M. I felt better, so that the supervisor could pursue his work. With some effort I managed to take notes myself. I sat at the table, wanted to read, but could not concentrate. Once I seemed to myself like a shape from a surrealistic picture, whose limbs were not connected with the body, but were rather painted somewhere close by....

I was depressed and thought with interest of the possibility of suicide. With some terror I apprehended that such thoughts were remarkably familiar to me. It seemed singularly self-evident that a depressed person commits suicide....

On the way home and in the evening I was again euphoric, brimming with the experiences of the morning. I had experienced unexpected, impressive things. It seemed to me that a great epoch of my life had been crowded into a few hours. I was tempted to repeat the experiment.

The next day I was careless in my thinking and conduct, had great trouble concentrating, was apathetic. . . . The casual, slightly dream-like condition persisted into the afternoon. I had great trouble reporting in any organized way on a simple problem. I felt a growing general weariness, an increasing awareness that I had now returned to everyday reality.

The second day after the experiment brought an irresolute state.... Mild, but distinct depression was experienced during the following week, a feeling which of course could be related only indirectly to LSD.

The Psychic Effects of LSD

With the discovery of LSD, hallucinogen research received a new impetus. The novelty of LSD as opposed to mescaline was its high activity, lying in a different order of magnitude. The active dose of mescaline, 0.2 to 0.5 g, is comparable to 0.00002 to 0.0001 g of LSD; in other words, LSD is some 5,000 to 10,000 times more active than mescaline.

LSD's unique position among the psychopharmaceuticals is not only due to its high activity, in a quantitative sense. The substance also has qualitative significance: it manifests a high specificity, that is, an activity aimed specifically at the human psyche. It can be assumed, therefore, that LSD affects the highest control centers of the psychic and intellectual functions.

The psychic effects of LSD, which are produced by such minimal quantities of material, are too meaningful and too multiform to be explained by toxic alterations of brain function. If LSD acted only through a toxic effect on the brain, then LSD experiences would be entirely psychopathological in meaning, without any psychological or psychiatric interest. On the contrary, it is likely that alterations of nerve conductivity and influence on the activity of nerve connections (synapses), which have been experimentally demonstrated, play an important role. This could mean that an influence is being exerted on the extremely complex system of cross-connections and synapses between the many billions of brain cells, the system on which the higher psychic and intellectual functions depend. This would be a promising area to explore in the search for an explanation of LSD's radical efficacy.

The nature of LSD's activity could lead to numerous possibilities of medicinal-psychiatric uses, as W. A. Stoll's ground-breaking studies had already shown. Sandoz therefore made the new active substance available to research institutes and physicians as an experimental drug, giving it the trade name Delysid (D-Lysergsaure-diathylamid) which I had proposed. The printed prospectus below describes possible applications of this kind and voices the necessary precautions.

Delysid (LSD 25)
D-lysergic acid diethylamide tartrate

Sugar-coated tablets containing 0.025 mg. (25 mircog.)
Ampoules of 1 ml. containing 0.1 mg. (100 microg.) for
oral administration

The solution may also be injected s.c. or i.v. The
effect is identical with that of oral administration
but sets in more rapidly.

PROPERTIES

The administration of very small doses of Delysid (1/2-2 microg./kg. body weight) results in transitory disturbances of affect, hallucinations, depersonalization, reliving of repressed memories, and mild neurovegetative symptoms. The effect sets in after 30 to 90 minutes and generally lasts 5 to 12 hours. However, intermittent disturbances of affect may occasionally persist for several days.

METHOD OF ADMINISTRATION

For oral administration the contents of 1 ampoule of Delysid are diluted with distilled water, a 1% solution of tartaric acid or halogen-free tap water.

The absorption of the solution is somewhat more rapid and more constant than that of the tablets.

Ampoules which have not been opened, which have been protected against light and stored in a cool place are stable for an unlimited period. Ampoules which have been opened or diluted solutions retain their effectiveness for 1 to 2 days, if stored in a refrigerator.

INDICATIONS AND DOSAGE

a) Analytical psychotherapy, to elicit release of repressed material and provide mental relaxation, particularly in anxiety states and obsessional neuroses.

The initial dose is 25 microg. (1/4 of an ampoule or 1 tablet). This dose is increased at each treatment by 25 microg. until the optimum dose (usually between 50 and 200 microg.) is found. The individual treatments are best given at intervals of one week.

b) Experimental studies on the nature of psychoses: By taking Delysid himself, the psychiatrist is able to gain an insight into the world of ideas and sensations of mental patients. Delysid can also be used to induce model psychoses of short duration in normal subjects, thus facilitating studies on the pathogenesis of mental disease.

In normal subjects, doses of 25 to 75 microg. are generally sufficient to produce a hallucinatory psychosis (on an average 1 microg./kg. body weight). In certain forms of psychosis and in chronic alcoholism, higher doses are necessary (2 to 4 microg./kg. body weight).

PRECAUTIONS

Pathological mental conditions may be intensified by Delysid. Particular caution is necessary in subjects with a suicidal tendency and in those cases where a psychotic development appears imminent. The psycho-affective liability and the tendency to commit impulsive acts may occasionally last for some days.

Delysid should only be administered under strict medical supervision. The supervision should not be discontinued until the effects of the drug have completely orn off.

ANTIDOTE

The mental effects of Delysid can be rapidly reversed by the i.m. administration of 50 mg. chlorpromazine.

Literature available on request.

SANDOZ LTD., BASLE, SWITZERLAND

In LSD inebriation the accustomed world view undergoes a deep-seated transformation and disintegration. Connected with this is a loosening or even suspension of the I-you barrier. Patients who are bogged down in an egocentric problem cycle can thereby be helped to release themselves from their fixation and isolation. The result can be an improved rapport with the doctor and a greater susceptibility to psychotherapeutic influence. The enhanced suggestibility under the influence of LSD works toward the same goal.

Another significant, psychotherapeutically valuable characteristic of LSD inebriation is the tendency of long forgotten or suppressed contents of experience to appear again in consciousness. Traumatic events, which are sought in psychoanalysis, may then become accessible to psychotherapeutic treatment. Numerous case histories tell of experiences from even the earliest childhood that were vividly recalled during psychoanalysis under the influence of LSD. This does not involve an ordinary recollection, but rather a true reliving; not a reminiscence, but rather a reviviscence, as the French psychiatrist Jean Delay has formulated it.

LSD does not act as a true medicament; rather it plays the role of a drug aid in the context of psychoanalytic and psychotherapeutic treatment and serves to channel the treatment more effectively and to shorten its duration. It can fulfill this function in two particular ways.

In one procedure, which was developed in European clinics and given the name psychotytic therapy, moderately strong doses of LSD are administered in several successive sessions at regular intervals. Subsequently the LSD experiences are worked out in group discussions, and in expression therapy by drawing and painting. The term psycholytic therapy was coined by Ronald A. Sandison, an English therapist of Jungian orientation and a pioneerof clinical LSD research. The root -lysis or -lytic signifies the dissolution of tension or conflicts in the human psyche.

In a second procedure, which is the favored treatment in the United States, a single, very high LSD dose (0.3 to 0.6 mg) is administered after correspondingly intensive psychological preparation of the patients. This method, described as psychedelic therapy, attempts to induce a mystical-religious experience through the shock effects of LSD. This experience can then serve as a starting point for a restructuring and curing of the patient's personality in the accompanying psychotherapeutic treatment. The term psychedelic, which can be translated as "mind-manifesting" or "mind-expanding," was introduced by Humphry Osmond, a pioneer of LSD research in the United States.

LSD's apparent benefits as a drug auxiliary in psychoanalysis and psychotherapy are derived from properties diametrically opposed to the effects of tranquilizer-type psychopharmaceuticals. Whereas tranquilizers tend to cover up the patient's problems and conflicts, reducing their apparent gravity and importance: LSD, on the contrary, makes them more exposed and more intensely experienced. This clearer recognition of problems and conflicts makes them, in turn, more susceptible to psychotherapeutic treatment.

The suitability and success of LSD in psychoanalysis and psychotherapy are still a subject of controversy in professional circles. The same could be said, however, of other procedures employed in psychiatry such as electroshock, insulin therapy, or psychosurgery, procedures that entail, moreover, a far greater risk than the use of LSD, which under suitable conditions can be considered practically safe.

Because forgotten or repressed experiences, under the influence of LSD, may become conscious with considerable speed, the treatment can be correspondingly shortened. To some psychiatrists, however, this reduction of the therapy's duration is a disadvantage. They are of the opinion that this precipitation leaves the patient insufficient time for psychotherapeutic working-through. The therapeutic effect they believe, persists for a shorter time than when there is a gradual treatment, including a slow process of becoming conscious of the traumatic experiences.

Psycholytic and especially psychedelic therapy require thorough preparation of the patient for the LSD experience, to avoid his or her being frightened by the unusual and the unfamiliar. Only then is a positive interpretation of the experience possible. The selection of patients is also important, since not all types of psychic disturbance respond equally well to these msthods of treatment. Successful use of LSD-assisted psychoanalysis and psychotherapy presupposes speclflc knowledge and experience.

In this respect self-examination by psychiatrists, as W. A. Stoll has pointed out, can be most useful. They provide the doctors with direct insight, based on firsthand experience into the strange world of LSD inebriation, and make it possible for them truly to understand these phenomena in their patients, to interpret them properly, and to take full advantage of them.

The following pioneers in use of LSD as a drug aid in psychoanalysis and psychotherapy deserve to be named in the front rank: A. K. Busch and W. C. Johnson, S. Cohen and B. Eisner, H. A. Abramson, H. Osmond, and A. Hoffer in the United States; R. A. Sandison in England; W. Frederking and H. Leuner in Germany; and G. Roubicek and S. Grof in Czechoslovakia.

The second indication for LSD cited in the Sandoz prospectus on Delysid concerns its use in experimental investigations on the nature of psychoses. This arises from the fact that extraordinary psychic states experimentally produced by LSD in healthy research subjects are similar to many manifestations of certain mental disturbances. In the early days of LSD research, it was often claimed that LSD inebriation has something to do with a type of "model psychosis." This idea was dismissed, however, because extended comparative investigations showed that there were essential differences between the manifestations of psychosis and the LSD experience. With the LSD model, nevertheless, it is possible to study deviations from the normal psychic and mental condition, and to observe the biochemical and electrophysiological alterations associated with them. Perhaps we shall thereby gain new insights into the nature of psychoses. According to certain theories, various mental disturbances could be produced by psychotoxic metabolic products that have the power, even in minimal quantities, to alter the functions of brain cells. LSD represents a substance that certainly does not occur in the human organism, but whose existence and activity let it seem possible that abnormal metabolic products could exist, that even in trace quantities could produce mental disturbances. As a result, the conception of a biochemical origin of certain mental disturbances has received broader support, and research in this direction has been stimulated.

One medicinal use of LSD that touches on fundamental ethical questions is its administration to the dying. This practice arose from observations in American clinics that especially severe painful conditions of cancer patients, which no longer respond to conventional pain-relieving medication, could be alleviated or completely abolished by LSD. Of course, this does not involve an analgesic effect in the true sense. The diminution of pain sensitivity may rather occur because patients under the influence of LSD are psychologically so dissociated from their bodies that physical pain no longer penetrates their consciousness. In order for LSD to be effective in such cases, it is especially crucial that patients be prepared and instructed about the kind of experiences and transformations that await them. In many cases it has proved beneficial for either a member of the clergy or a psychotherapist to guide the patient's thoughts in a religious direction. Numerous case histories tell of patients who gained meaningful insights about life and death on their deathbeds as, freed from pain in LSD ecstasy and reconciled to their fate, they faced their earthly demise fearlessly and in peace.

The hitherto existing knowledge about the administration of LSD to the terminally ill has been summarized and published by S. Grof and J. Halifax in their book The Human Encounter with Death (E. P. Dutton, New York, 1977). The authors, together with E. Kast, S. Cohen, and W. A. Pahnke, are among the pioneers of this application of LSD.

The most recent comprehensive publication on the use of LSD in psychiatry, Realms of the Human Unconscious: Observations from LSD Research (The Viking Press, New York, 1975), likewise comes from S. Grof, the Czech psychiatrist who has emigrated to the United States. This book offers a critical evaluation of the LSD experience from the viewpoint of Freud and Jung, as well as of existential analysis.