THE THERAPEUTIC USE OF
LYSERGIC ACID DIETHYLAMIDE - 25
INDIVIDUAL AND GROUP THERAPY
D. B. Blewett, Ph.D. and N. Chwelos, M.D.
Approximate date of Printing 1958
Reviewed by Myron Stolaroff
Psychedelic drugs are currently very much misunderstood by our government and the public at large. A great deal of the misunderstanding derives from attempting to evaluate these substances in scientific terms which leave out the very essential factors required to understand and appropriately employ these substances. Probably the most essential factor not generally recognized is the transpersonal nature of human beings -- the fact that we are in our essence spiritual beings, a concept which the majority of scientists reject. Without this recognition of our true nature, the most important contributions of psychedelic chemicals can be overlooked or misinterpreted.
It is most fortunate that in the 1950's, one of the research teams studying the therapeutic potential of LSD had through their own experiences discovered the true nature of LSD, its action, and appropriate methods of employing it. Their work resulted in this handbook, which to this day remains one of the most informed documents on LSD therapy. This manual is a thorough investigation of the factors to be considered in successfully employing LSD in a therapeutic setting. It is an outstanding collection of information that should be of great value to those wishing to understand the nature of the LSD experience and how this remarkable drug can best be employed. In this review, I have chosen examples of important issues which I hope can convey the flavor of this document. For those pursuing these interests, I highly recommend a thorough reading of this manual, which can be read on the MAPS website by clicking here.
In their preface, the authors state the psychological effects of the new psychedelic or mind-manifesting drugs "are so profound as to lie beyond the customary comprehension or, often the imagination of people who have not experienced them. Their vast scope and tremendous psychological impact lend them a remarkable therapeutic potential. However, in large part this potential can be realized only to the extent that the therapist is aware of the nature and scope of the reaction he is dealing with and to the extent that he can use the various features and stages of the experience to the benefit of his patient.
"With this in mind, the authors have attempted to sort out the features and stages of L.S.D. experience in general, and indicate, insofar as possible, the extent and areas of individual variation. They have outlined in detail the techniques which they have found useful and appropriate at each stage and have indicated these areas in which they have encountered difficulty and the techniques evolved to avoid or overcome such problems (Preface page 1)."
The authors' recommendations are based on extensive and intensive studies conducted over several hundred sessions included normal, psychotic, neurotic, psychopathic and alcoholic individuals. Each author has taken L.S.D. over 100 times in a variety of settings and each has participated in more than 50 group sessions in groups of 2 to 6 with colleagues and patients.
"The psychedelic reactions induce an extension of awareness, an enhancement of perceptions and an increase in emphatic potential which open vast and important areas of functioning and experience to scientific investigation (Preface, page 2)."
Chapter 1 covers the rationale for using LSD. "The great value of LSD-25 lies in the fact that when the therapeutic situation is properly structured the patient can, and often does, within a period of hours, develop a level of self-understanding and self-acceptance which may surpass that of the average normal person. On the basis of this self-knowledge he can, with the therapist's help, clearly see the inadequacies in the value system which has underlain his previous behavior and can learn how to alter this in accordance with his altered understanding (Chapter 1, page 2)."
The Nature of the Drug Reaction is covered in Chapter 2. Despite the tremendous variety in individual reports, the authors point out nine factors that consistently appear. The list includes such things as "1. A feeling of being at one with the universe. . .4. Change in perception and time. . .6. . .the subject feels he develops profound understanding in the field of philosophy and religion. . .8. Increased sensitivity to the feelings of others." Each factor is supported by a transcribed statement of a subject (Chapter 2, page 4-5).
Characteristic types of reaction are described, which reduce to six general levels. These levels are primarily related to the subject's degree of self-acceptance, and represent the degree of surrender achieved.
The first two levels are reactions to resist and escape from the effects of the drug. The first is called a flight into ideals or activity. The second is a flight into symptoms, which seem correlated with the inability to direct attention outside oneself. The subject becomes preoccupied with body feelings and sensations which can become quite alarming and uncomfortable. The inability to free oneself produces even greater alarm, and can go as far as nausea, numbness of limbs, or violent headaches.
The next two levels are states that have given rise to the labels hallucinogen and psychotomimetic. "It is characterized by confused thinking and perceptual distortion. The individual attempts to rationalize what is happening to him but visual imagery and ideas flood into his awareness at so high a speed that he cannot keep up with them (Chapter 2, page 7)." The fourth level is characterized mainly by paranoid thinking.
The final two levels are characterized as psychedelic. "In the psychedelic reactions the person is no longer concerned with escaping from or explaining the drug effects but accepts them as an area worthy of exploration. They might be termed stabilized experiences in that the distressing effects of the drug tend to be minimized and the individual is enabled to gain remarkably in terms of increased insight and understanding. These are levels at which the therapeutic possibilities of the drug are most fully realized. (page 9-10)." In the sixth level, "the experience is accepted as offering a new and richer interpretation of all aspects of reality (page 10)."
All of the above levels are discussed with great detail and cover many variations. In summary, "some individuals seem to attain the psychedelic level rapidly in the first experience and, if they lapse at all into denial, confusion or paranoid thinking, do so but briefly and infrequently. Still other individuals may spend as many as a half a dozen sessions being frightened or ill or paranoid or otherwise distressed before they attain the psychedelic experience. The methods utilized by the therapist play a critical part in determining both the level which the subject can attain and the ease with which it is accomplished (page 11)."
In Chapter 3, the authors review the first synthesis of LSD-25 in 1938 and the progression of research by a number of investigators as the potential for therapeutic application was discovered. By the late 1950's, the literature on LSD-25 had mushroomed remarkably with three bibliographies sited. While numerous promising applications were uncovered, the authors are convinced that the greatest potential application is in realizing the remarkable degree of insight and self-understanding that is available. "While the drug does permit a review of those repressed or suppressed areas which are the well-springs of unacceptable behavior, these effects are but the seeds of its full growing. Vastly more important is the new level of identity at which the individual can arrive. He learns that he can be truly himself, perhaps for the first time in his life, and sham and pretense become unnecessary to him. He finds that he can control his own feelings independent of his circumstances or surroundings, a knowledge that frees him from fear and uncertainty of himself or of others. He learns that to him, the world is what he feels it to be (page 14)."
The focus of the manual is to aid subjects in achieving this important level. This method grew out of the early work of Hubbard, who had developed his technique of the overwhelming dose experience through working with large numbers of subjects. Hubbard developed techniques of focusing the experience, such as using music, paintings, and other stimuli. In addition to discussing Hubbard's contributions, the authors make a strong case for using large doses of LSD, in lieu of starting with small doses and working up, which can permit the subject to maintain control and reinforce his false belief systems. The authors also stress the importance of therapists having first hand experience with LSD-25 before administering to subjects. In fact, all staff members who come in contact with subjects can be much more supporting and understanding if they have first experienced LSD-25.
Chapter 4 reviews work done with both individuals and groups, describing important elements and outcomes from these different procedures. Chapter 5 discusses how the work resulting from individual and group sessions can contribute to the furthering of scientific research in this field. In Chapter 6 the requirements for a good setting in conducting this work are described. Set and setting have now been widely recognized by informed investigators as very important factors affecting the outcome of the psychedelic experience. Useful tools, equipment and supplies are described in Chapter 7. Chapter 8 reviews Indications and Contra-indications in selecting subjects; a great deal more needs to be known to extend the range of coverage. It is clear that LSD works best with persons of higher intelligence, while those who are rigid, compulsive, suspicious, or withdrawn are like unlikely to respond well. In developing the prescribed methods, work was done mainly with alcoholics and psychopaths and some neurotics. "It is important that the experience should be explained as fully as possible to the subject and...he should be willing to accept the treatment voluntarily (page 23)" without coercion.
Chapter 9 reviews the preparation of the subject. A partial list of some important factors: It is especially important that rapport be established in advance between the therapist and the subject. The subject is requested to write a biography prior to treatment, as well as prepare a list of questions dealing with problems for which he is seeking answers. It is very helpful for the subject to write a report of the experience following treatment. This chapter reviews other suggestions that will aid the subject in being prepared, at ease, and having some idea of what to expect under various circumstances.
Important things to remember:
"During the experience accept the novel feelings as real and true. You can question them and apply the usual forms of logic to them at your leisure in the days that follow but for the few hours that the drug is operative simply accept and enjoy them.
"To the extent that you trust yourself and trust me the experience will be pleasant and our understanding and fellowship very close. To the extent that you are growing suspicious and withdrawing the experience is becoming unpleasant and confusing. In this experience you control your own feelings and you can stop the development of these unpleasant aspects by simply concentrating on the level of trust we can have in each other and the bond of affection and understanding which the experience can generate (page 26-27)."
Chapter 10 covers some general procedural considerations. The subject is asked to have a good breakfast. There will be an early start, since the experience can last 12 to 14 hours. Residual symptoms are not likely to be disturbing by bedtime. Lying awake for an hour or two before falling asleep can be usefully employed by reviewing the experience. Recurring symptoms should be accepted and enjoyed; fighting against them or trying to abolish them can intensify rather than diminish them. An out-patient should have another person awake in his home until the subject falls asleep. The subject should not drive until at least 24 hours after ingesting the drug. The subject is always free to call the therapist if needed.
Dosage is covered in Chapter 11, which ranges from 100 to 1,000 micrograms of LSD. 100 micrograms is suitable for people with problems not too severe and who are flexible. The majority coming for treatment require 300 to 600 micrograms. After the first dose which is felt to be appropriate, supplements of 200 to 300 micrograms may be added at intervals of l-1/2 to 2-1/2 hours if the subject is not responding.
Chapters 13 through 21 describe stages in the experience, and provide what is probably the most valuable information in the manual. The stages covered are Pre-onset in Chapter 13, the Onset of Symptoms in Chapter 14, Self-examination in Chapter 15, the Empathic Bond in Chapter 16, a General Discussion in Chapter 17, Diminishment of Symptoms in 18, The Meal in 19, Termination in Chapter 20, and After Contact in 21. In the Pre-onset stage attention is given to maintaining interest on the part of the subject and avoiding apprehension. The varieties of possible reactions are discussed along with appropriate methods of handling them. "In general the therapist should aim, during this period, at giving the subject such support and assurance as will relieve his anxiety; at making the subject aware of the developing changes induced by the drug and at keeping him from feeling that these changes are threatening, alarming or in any way unusual for people taking the drug. The therapist can call upon his own experiences at this time and use them as a source of reassurance to the subject (page 32)."
The next stage, Onset of Symptoms, is probably the most critical time for the subject, as it is most likely to be the time of most discomfort. A great variety of changes can happen, which are new and often difficult to resolve. It is at this stage of the experience that subjects who attempt to escape or to fight off the effects of the drug get into difficulties. For therapeutic results, it is important that the subject make his way through this stage. Music can be particularly helpful. The therapist should help the subject remain relaxed and receptive to change. Should discomfort hold on, the therapist should advise that in time the discomfort will relent. It helps to focus on the pleasant aspects of the experience. Resisting pain generally increases it, so that acceptance can accelerate relief. A valuable benefit for the subject is learning how to encounter and gain relief from the uncomfortable episodes.
The stage of Self Examination is the crux of the therapeutic experience. "It is upon the basis of the self-acceptance and self-knowledge which he begins to achieve at this stage that the subject can, with the support of the therapist, gradually come to see into and evaluate the motives which have underlain his previous behavior (page 35)." It is also at this point where psychotomimetic reactions develop as a result of the subject attempting to rationalize the ideas and feelings he is experiencing. Excellent suggestions are given for dealing with the variety of possibilities which may develop. "The therapist cannot solve these problems for the subject. What he can do is to offer the subject encouragement or intelligent criticism from time to time.
"The therapist, at this stage, should not hesitate, when he is convinced it will be helpful to the subject, to be insistent that the subject face up to and examine his problems. . . . The subject's problems, at this time, are evident to him without a list. Because of the amazing human propensity for rationalization and because the chief therapeutic value of the level of awareness induced by LSD is that it permits a person to see through his own system of rationalization, the therapist should not accept any attempt on the subject's part to avoid responsibility for his own predicament (page 36)."
"In this stage a mirror is often an aid to the subject in achieving a level of self-acceptance and the therapist should encourage him first in seeking the better aspects of the personality of the man in the mirror and subsequently in realizing and accepting all aspects of the infinite variations (page 37)."
There are a variety of responses that vary greatly among subjects, and helpful advise is given for helping the subject make the most of each situation. "To the extent that the person can achieve insight and self-acceptance he will find the experience becoming pleasant and rewarding. Conversely, to the extent that he cannot accept himself he will find the experience unpleasant and will feel hostility toward others in the experience whom he fears will reject him because of what they sense about him. This factor of pleasantness or discomfort in the experience tends to teach him, directly, the value of self-acceptance. . . At first, more or less by accident and subsequently by deliberate experiment, the subject learns that the correlates of acceptance are pleasant and of rejection are painful. When he accepts himself, he no longer fears what others will think of him (page 38)."
Chapter 16 deals with the forming of the empathic bond that can form in a group experience, the value of such a bond, the manner in which it can form and obstacles that prevent it from developing.
In Chapter 17, the value of developing discussion in the closing stages of the experience is presented. This value is even greater when a group is involved, as there is a greater variety of topics and individual reactions. It is very useful for the subject, having been exposed to a great deal of new understanding, to see how his new learning fits into specific situations. He can now relate to others who have shared similar profound experiences that he has just experienced for the first time. For example, "The objectivity toward the usual self-concept which depersonalization occasions [which has taken place during his experience], permits him to examine his relationship to others without any defensive screening. He begins to learn that self concern, implying as it does a feeling of some insufficiently in the self, is synonymous with anxiety and tends not only to isolate him from others but also to make him distinctly uncomfortable.
"Complete self-acceptance on the other hand, which implies complete faith in his infinite nature, not only permits him to feel very closely with others and to understand them more completely than he ever has before, but also produces in him feelings of content and well-being.
"He comes to the realization that faith and anxiety are mutually exclusive. They cannot be experienced at the same time. Chwelos in discussing this area of experience in a published journal states of the subject:
"'He then sees that lack of faith, or acceptance that he is essentially infinite, is the exact counterpart of anxiety--. He also sees that guilt is disrupting in that it is a denial of the infinite self which is the same for everyone. This equalizing tends to remove any form of pride, prejudice, guilt or anxiety. The person then sees that faith, which is the acceptance of himself as infinite, and love, which is the acceptance that everything around him, is equal to him in substance, is the clue to a smooth, pleasant, useful LSD experience. The patient then ceases the tragedy of desiring to be other than he is in essence and realizes that he can only be other than he is in terms of his acts. The energy thus released from attempting to alter his basic nature will now be used to alter his acts in a way which can make his life more peaceful and satisfying and his outlook more compassionate.'
"Almost certainly the most valuable knowledge which the subject may attain in the experience is the realization that his feelings are very largely under his control. Generally speaking, our culture accepts the view that one's feelings are determined by circumstance. In the experience, however, the subject learns that his feelings are determined by their direction. Self-concern makes him feel badly, outwardly directed feelings of affection and trust make him feel good (page 42)."
The therapist can help the patient work through these extremely complex ideas. This can be greatly facilitated by asking meaningful questions. A list of important questions appear near the end of this chapter. It is also important that the subject review the list of questions he prepared prior to the experience. Many find that by this stage of the experience they have already found the answers. "LSD, by removing the need to rationalize, lets him see beyond the question into the underlying motives. He should be encouraged to make certain that he sees the answers clearly and understands how to use this insight. If the subject requests help the therapist should offer any aid he can in discussing such questions (page 44)." Further procedures are suggested to the subject in making good use of his descent, and beginning to apply what he has learned in discussion with others and even while having a meal out with his attendants.
Chapter 21 outlines appropriate follow-up procedures for the client, and in the case of alcoholics, recommends taking advantage of the resources provided by Alcoholics Anonymous.
The concluding Chapter 22 discusses the difficulty of accurately assessing the results of treatment. Appendix A provides a number of scales to assist in this endeavor. Appendix B covers results to date. Available data is presented in a number of forms and comparison tables. The final Appendix C presents numerous possibilities for further research.
It is my considered opinion that this manual provides a wealth of information which when properly understood, can be applied to numerous applications resulting in considerable benefit to mankind.
Treasurer, the Albert Hofmann Foundation
Editor of the Albert Hofmann Foundation Website
Author, Thanatos to Eros: Thirty-five Years of Psychedelic Exploration and The Secret Chief: Coversations with a Pioneer of the Underground Psychedelic Therapy Movement
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