"The Therapeutic Value of Lysergic Acid Diethylamide in Mental Illness"
By R. A. Sandison, A. M. Spencer, and J. D. A. Whitelaw.
Journal of Mental Science 100, 491 (1954)

Review by Adrian Pocobelli

This early article sought to determine the usefulness of LSD in the therapeutic treatment of the mentally ill. The study examined 36 "psychoneurotic" patients who were treated with LSD over a one-year period. Patients suffered from obsessional reactions (6 cases), classical obsessional neurosis (3), tense depressive reactions in young patients (4), older depressive patients (2), older depressive patients with epilepsy (1), anxiety neurosis with great mental tension (12), psychopathic personality with depressive features (2), conversion hysteria (4), homosexuality (1), and schizoid personality (1). Of these cases, 20 had received a "considerable amount of treatment of various kinds" before being given LSD.

Treatment and therapy were administered in a hospital setting. Before receiving LSD, a patient was given "simple psychotherapy under pentothal to introduce him to the idea of drug-assisted psychotherapy." During the ensuing week, patients were given LSD on "two or three occasions." The researchers started the LSD treatment at 25 mcg and gradually increased the dosage in subsequent treatments until the patient developed an "adequate reaction." Once this had been achieved, the drug was continued at "approximately weekly intervals." After a period of 2 to 4 weeks, the patient's reaction would be evaluated and a decision would be made whether he or she could continue the treatment as an outpatient, or should remain in hospital during the subsequent treatments. It was only after the patient's reaction to the treatment had been determined in a hospital setting that he or she would be allowed to take LSD at home. In the cases of outpatients, the researchers believed it was desirable for the patient to stay in the hospital the night following each treatment.

Responses often varied according to the affliction of the patient. The researchers found that the results in the case of classical obsessional neurotics, for example, were quite positive. Of three cases, two had recovered after an average of 40 treatments: "In view of the notoriously poor prognosis of this condition it is considered that LSD would represent a major therapeutic advance if it were effective only in this type of neurosis." On the other hand, the result for conversion hysterics "was not satisfactory, but as the three patients studied were treated early in the series the amount of treatment given may have been insufficient." A table chart lists the complete results of the study.

Interestingly, the researchers observed "that there appeared to be no relationship between the duration of the illness and the number of treatments required. Patients who had been ill for up to 10 years required only a small number of treatments." As well, the study showed that "unlike other treatments, LSD was almost as effective in [patients] who had been ill for up to 10 years, as it was in more recent cases." According to the researchers, the patients who had received previous treatment "would at best been left with chronic neurotic disabilities had they not received LSD therapy." Of these 20 patients, 14 recovered, 3 showed moderate improvements, 2 were not improved and in one it was too early to assess results: "Limited experience suggested that pre-frontal leucotomy and recent ECT rendered treatment more difficult." The researchers also helped patients reintegrate back into society: "About one half of these cases required extensive rehabilitation involving the establishment of a new set of conditioned social responses."

The researchers stressed the importance of trained professionals administering LSD, underlining their point for emphasis: "When used as an adjunct to skilled psychotherapy, LSD was of the greatest value in the obsessional and anxiety groups accompanied by mental tension. LSD should be used only by experienced psychotherapists and their assistants." They also believed that the treatments should be continued "for some considerable time" before deciding that it is of no value in any particular case: "Unless contraindications (e.g. the threat of psychosis) are present, one should persevere for at least 6 weeks and for 6 to 8 treatments before stopping. Many [patients] only started to produce material of value after 4 to 5 treatments. In some cases it may be necessary to continue treatment for 6 to 12 months." The researchers concluded that their study, like Frederking's previous findings, confirms "that LSD can be used therapeutically in mental disease."

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