By Manuel Villaescusa, psychologist (mvillaescusa@wanadoo.es)
LSD: From Pioneering Psychiatric Tool to Prohibited Substance, and the Long Road Back
The history of LSD begins in 1938, when Swiss chemist Albert Hofmann synthesized lysergic acid diethylamide, a semi-synthetic derivative of ergot. The psychoactive potential of LSD did not become apparent until 1943, when Hofmann accidentally absorbed a microscopic dose through his skin, noting its consciousness-altering effects. This event led Hofmann to self-administer a 250-microgram dose, discovering that LSD was the most potent psychoactive compound ever discovered, active in the range of millionths of a gram. From the first scientific publication on the effects of LSD in humans in 1947 by Walter Stoll—son of the director of Sandoz, the pharmaceutical company where Hofmann worked, which marketed the substance under the name Delysid—until 1966, when the United States government declared LSD to have no scientific value, effectively banning its research (1), more than two thousand articles were published on the substance, making it the most studied compound of those 20 years. In the field of psychopharmacology, this research paved the way for the neuropharmacological revolution of our era, through which psychiatry transitioned from a discipline dominated by psychoanalysis to the current predominance of the biochemical model of the brain, with its effective pharmacological arsenal for treating mental illness. According to psychiatrist J. Halpern, LSD research led to a greater understanding of the neurotransmitter serotonin, as both compounds share a very similar molecular structure, opening the door to understanding the role of this neurotransmitter in the pathogenesis of depression and the development of modern selective serotonin reuptake inhibitor (SSRI) antidepressants. In parallel with this evolution, LSD also led to the development of new forms of psychotherapy. There were three main ways of working with this substance: the psychotomimetic, the psycholytic, and the psychedelic models.
(1) For the political motives behind this prohibition, see The General History of Drugs by A. Escohotado (Espasa Publishing).
The Psychotomimetic Model
The first model developed was the psychotomimetic. For its proponents, the LSD experience bore great similarities to the psychotic delirium of schizophrenic and paranoid patients, hence the name (psychotomimetic: mimicking psychosis). This model offered two main lines of research. On one hand, psychiatrists could ingest the substance to experience the delusional world of their patients in a controlled manner, increasing their understanding and empathic capacity. On the other, administering the substance to healthy experimental subjects produced, according to them, a time-limited “model psychosis” that could be studied to better understand mental illness. This model soon showed its limitations, as the differences between the states produced by LSD ingestion and psychotic delusions became increasingly evident. Sandoz sent abundant samples of its product to psychiatrists, presenting it as a useful tool for their training as therapists. The psychotomimetic model also produced interesting results, such as those developed by Humphrey Osmond, an English psychiatrist based in Canada who dedicated himself to researching the serotonergic neurotransmitter system and its possible role in the genesis of schizophrenia. Osmond considered LSD a highly valuable substance for the study of psychosis, which could also confirm his hypothesis that an endogenous neurotoxin or an imbalance in the neurotransmitters adrenaline and serotonin could cause this disease. From his position as director of a Canadian center for the treatment of alcoholism, he devised an experimental treatment consisting of administering a high dose of LSD to his patients, with the goal of simulating a bout of delirium tremens (1). Like many other psychiatrists, Osmond had noted that after suffering from delirium tremens, patients tended to improve and remain abstinent. His idea was to produce the same effects with LSD ingestion. The results were paradoxical: on one hand, the expected withdrawal reaction and behavioral change did occur—a high percentage of patients stopped drinking after undergoing an LSD session. However, the reason was not having gone through the hell characteristic of delirium tremens, but rather having experienced an epiphaneia instead: an intuitive understanding of the deep nature of reality through direct contact with the spiritual dimension, an experience that radically changed the subjects’ way of seeing the world and themselves within it. Aware of the therapeutic power of these experiences, Osmond set aside the psychotomimetic model and dedicated himself to developing the psychedelic model (revealing of the psyche, a neologism coined by Osmond himself).
(1) Delirium tremens is a delirium produced by alcohol withdrawal, which usually causes terrifying visions or sensations of insects burrowing under the skin and can lead to death.
The Psychedelic Model
LSD effects were no longer considered comparable to a psychotic delirium; instead, the substance was attributed the capacity to lead to altered states of consciousness similar to those reached by mystics of various spiritual traditions—states that bring about profound therapeutic changes in those who experience them. From psychotomimetic, LSD became mysticomimetic. This model gained popularity among American psychiatrists and psychotherapists and was used successfully in numerous cases (1). Among these psychiatrists, the Czech Stan Grof and the Mexican Salvador Roquet stand out for the quantity and quality of their work. Although they were not American, both worked and had a great impact in the United States.
(1) One of the most famous was the actor Cary Grant, who managed to overcome deep-seated alcoholism through psychedelic sessions, becoming a staunch defender and promoter of the substance in the Hollywood scene.
Stan Grof and Basic Perinatal Matrices
With a psychoanalytic background, Stan Grof began working with LSD in Prague in the late 1950s, although his career later developed in the United States, where he still works and resides today. Thanks to his extensive experience with altered states of consciousness, Grof developed a model of the psyche that takes into account the perinatal stages of human development and the transpersonal dimension of consciousness. Based on the observation of psychedelic experiences with high doses of LSD, Grof classified them into four large groups corresponding to the four phases of birth, calling them Basic Perinatal Matrices (BPM).
The first group of experiences corresponds to the gestation phase prior to the first uterine contractions, or BPM 1. If the individual’s embryonic existence had developed without disturbances, this phase of union with the mother corresponds to oceanic experiences, visions of vast, limitless regions, and/or journeys to paradise. If, conversely, the individual had suffered a troubled gestation, apocalyptic visions of contaminated waters with a sense of threat or poisoning, the presence of evil beings or demonic figures, etc., could occur. The second group of experiences, or BPM 2, corresponds to the phase of the first uterine contractions, when the cervix is still closed. This phase of antagonism with the mother is associated with sensations of being sucked or devoured, anxiety and claustrophobia, descent into the depths of the underworld, and visits to the realm of death or hell. Those who pass through this phase may feel a profound existential despair without finding an exit in time or space. The third group of experiences, or BPM 3, corresponds to the birth phase where the cervix opens and contractions push the fetus through the birth canal. This phase of synergy with the mother corresponds to visions of battles or bloody violence, scenes of orgies or rapes, torture, mutilations, or human sacrifices. Intense sexual impulses and an accumulation of energy seeking an explosive outlet can be felt—a mixture of sexual excitement and pain, of agony and ecstasy. It is a phase where the struggle between life and death is experienced. The fourth and final phase, BPM 4, corresponds to birth, the separation from the mother. The tension between life and death is resolved, experiencing sensations of liberation, expansion, love, and forgiveness. It is the resurrection that follows annihilation, a theme very frequent in psychedelic experiences as well as present in the initiation rites of cultures and religions throughout history.
According to Grof, as one passes through these different phases during psychedelic sessions, their contents are processed and integrated until the sessions only produce experiences of bliss and ecstasy, which signals the successful end of therapy. When the use of LSD in psychotherapy and scientific research was banned, Grof developed holotropic breathwork, a non-pharmacological method of modifying consciousness that allows access to the lysergic experience through a state of cerebral hypoxia produced by special breathing exercises—a method he continues to use today.
Salvador Roquet’s Psychosynthesis
Another fundamental exponent of the psychedelic current was the Mexican psychiatrist Salvador Roquet. Initiated into the use of entheogens by shamans such as the famous María Sabina, he dedicated himself to applying these techniques in his clinical practice. In his own words, his task was to “take advantage of the extremely rich possibilities offered by the ethnobotany of my country, assimilating and integrating ancient indigenous practices into modern psychiatric science, with the respect that both deserve.” In addition to local psychoactive plants (mushrooms, peyote, ololiuqui, datura), he worked with LSD, MDMA, and ketamine. Roquet developed a way of working with visionary substances in which he took advantage of the patients’ state of deep suggestibility to produce profound deconstructions of their personality, thus offering the possibility of restructuring in a healthier and more adaptive way. There are great differences between Roquet’s and Grof’s ways of working. Grof usually used pleasant and soothing sound stimuli, such as new age music, thus facilitating healing experiences of bliss and mystical ecstasy. Roquet, on the other hand, used sensory overstimulation techniques—several projectors simultaneously displaying images with a strong emotional charge, speakers emitting different music and chaotic sounds at the same time, stimuli changing in a disorderly and frantic manner—seeking an experience of chaos that would break the neurotic structure of the participants’ personalities to then be able to access a higher-order restructuring free of fears and defenses. Although there are differences in their procedures, there are similarities in the goals of both techniques: both tend to facilitate the death/rebirth process, transcending the rigid and limited ego to access a more loving presence that is open to others. From his first sessions in 1967 until the closure of his clinic by Mexican authorities in 1974, Roquet conducted 720 sessions with more than 1,700 patients, claiming a favorable response rate to treatment in 85% of cases, a very high percentage in psychiatric practice. Accused of having caused four cases of psychosis in the course of his therapies—a false accusation according to him—Roquet was imprisoned for 9 months, only released thanks to the pressure of testimonies from American psychiatrists who were his students and his patients. He was never able to carry out a free and open practice with psychedelics again.
The Psycholytic Model
While the psychedelic model was being developed in the United States, a different way of working with LSD was emerging in Europe: the psycholytic model. This model did not work with high psychedelic doses of LSD (250–1500 micrograms) in a few sessions, but rather employed lighter doses (75–150 micrograms) over a greater number of sessions. The goal was to dissolve (psycholytic: dissolving the psyche) the resistances presented by patients in the therapeutic process, thus allowing access to repressed traumatic memories, the understanding of ignored internal conflicts, and the accentuated expression of transference processes (1) in the therapist-patient relationship. The psycholytic model can be understood as a development of psychoanalytic therapy, a “psychoanalysis on acid.” One of its main creators was the German psychiatrist Hans Carl Leuner, who developed a model based on psychoanalysis using states of consciousness produced by mild doses of LSD, characterized by high suggestibility and receptivity to internal and external stimuli. Like Grof, when the clinical use of LSD was banned, Leuner had to find an alternative way to produce modifications of consciousness in his patients, in this case through hypnotic techniques and visualizations. His therapy, called Guided Affective Imagery, is still used in Germany today and incorporates the therapeutic discoveries Leuner made in his work with visionary substances.
(1) Transference: a characteristic phenomenon of psychoanalytic therapy where the patient projects onto the therapist feelings that correspond to key figures from their childhood, e.g., father or mother.
Conclusions
The different types of LSD therapy were applied with promising results in the following fields: alcoholism, depression, anxiety and pain in terminal patients, personal development and creativity, mysticism and spirituality, social reintegration of offenders, treatment of neurosis in individual and group therapy, sexual dysfunction, and psychosomatic diseases. The substance, administered to tens of thousands of people, proved to be very safe if used in the proper setting and with a minimum of patient preparation. However, scientific studies validating the therapeutic efficacy of LSD were not successfully produced; the methodological flaws in the research protocols of that time mean that these results today have only indicative or anecdotal value. Recently, criticisms of several of those studies have been published, demonstrating the invalidity of their results (R. Doblin, 2004). Although its lack of toxicity and addictive potential has been widely demonstrated, rigorous research into the therapeutic potential of LSD is still to be developed. Unfortunately, until now, highly questionable political reasons have blocked scientific progress. It is now a widely shared opinion that the prohibitionist drug policy adopted by Western governments has caused and continues to cause havoc at a social level, becoming part of the problem instead of part of the solution. Fortunately, at an academic level, almost 40 years after its prohibition, research with visionary substances is beginning to resurface today. In the United States, the same agencies responsible for enforcing prohibition are now approving research protocols with psilocybin and MDMA. No research work with LSD has been approved yet, but the change in attitude of the DEA (1) in recent years suggests that the end of this era of obscurantism may be near. American psychiatrist Richard Yensen was the last scientist with permission to use LSD in humans, and perhaps he will now be the first to regain it. A study of his to administer LSD to terminal patients is pending approval, with the goal of making psychic and physical pain more bearable by improving their attitude toward illness and death.
Imagine how biologists would feel if they had been forbidden from using the microscope for 40 years, or doctors from using antibiotics, and now their use was finally being authorized again little by little. That is how those who did not forget the transformative potential of these substances feel today, having maintained their interest in them despite their unpopularity and discredit. It is possible to find a middle ground between the extreme of prohibitionist narrow-mindedness that rejects any utility of psychedelics and the other extreme—the utopian illusion of the hippie movement that considered them panaceas for liberating the masses and creating a new order. The middle ground consists of the freedom to investigate and try to better understand the effect of these substances on our psyche and the potential they offer, continuing the interrupted path toward ever-greater knowledge.
(1) DEA: Drug Enforcement Administration, the government agency responsible for enforcing laws regarding psychoactive substances.
