Addiction, Despair, and the Soul: Successful Psychedelic Psychotherapy, A Case Study (1)

By Richard Yensen , Ph.D.(2) and Donna Dryer, M.D., M.P.H. (3) 

Artículo detallando el uso de LSD en procesos terapéuticos que se realizaron en el Hospital de Maryland y por el Orenda Institute, Baltimore.

Arthur King was one of two patients whose story dramatically unfolded in the film. He is now 65 years old and retired from a successful career as an accountant. He has been married to his wife Jean for 46 years. They have three children and many grandchildren. The King's live within blocks of Art's childhood home, they own a modest two-story row house, in a working class section of Baltimore. We sat talking casually to Art and Jean King in their tidy living room. They exemplify the strength, work ethic and devoted family ties of working class people, the backbone of a great eastern United States industrial city.

In light of previous national television coverage of his treatment, Mr. King agreed to forego the confidentiality normally accorded a research patient. In 1965, he joined a federally sanctioned and funded research project studying the use of LSD as an adjunct to psychotherapy. The clinical research project explored LSD in a new treatment for neurosis and alcoholism. Albert Kurland headed the team of research clinicians. He was Research Director of Spring Grove State Hospital in Catonsville, Maryland. Mr. King also volunteered to have his treatment filmed by a news team working on a documentary film. The result was an award winning CBS television documentary, The Spring Grove Experiment . This powerful film, with it's compelling portrayal of the impact an LSD session can have in psychotherapy, had wide appeal. It's popularity spurred legislators and bureaucrats to fund the construction of a major research center. In 1969, the new multi-million dollar interdisciplinary Maryland Psychiatric Research Center opened its doors. It quickly became an outstanding institution for the emerging science of psychiatry.

LSD research in Maryland began earlier in 1953 (Cholden, Kurland, & Savage, 1955). Later projects that built upon the first exploration continued at Spring Grove and later at the Maryland Psychiatric Research Center (MPRC). This historic chapter of psychedelic research conducted in state institutions closed in 1976. The body of research that emerged from these 23 years of study remains the largest, most sustained and systematic research into therapeutic use of psychedelic drugs and psychotherapy yet attempted (Berendes, 1979; Cholden, Kurland, & Savage, 1955; Di Leo, 1975; Grof, 1976; Grof, Goodman, Richards, & Kurland, 1973a; Grof, Soskin, Richards, & Kurland, 1973b; Kurland, 1985; Kurland, Pahnke, Unger, Savage, & Goodman, 1968; Kurland, Pahnke, Unger, Savage, & Grof, 1971a; Kurland, Savage, Pahnke, Grof, & Olsson, 1971b; Kurland, Savage, Shaffer, & Unger, 1967a; Kurland, Shaffer, & Unger, 1966; Kurland, Unger, Shaffer, & Savage, 1967b; McCabe, Savage, Kurland, & Unger, 1972; Pahnke, 1969; Pahnke, Kurland, Goodman, & Richards, 1969a; Pahnke, Kurland, Goodman, & Richards, 1969b; Pahnke, Kurland, Unger, & Savage, 1970a; Pahnke, Kurland, Unger, Savage, & Grof, 1970b; Pahnke et al., 1970c; Rhead et al., 1977; Richards & Berendes, 1977; Richards, Grof, Goodman, & Kurland, 1972; Richards, Rhead, DiLeo, Yensen, & Kurland, 1977; Richards et al., 1979; Savage & McCabe, 1973; Savage, McCabe, Kurland, & Hanlon, 1973; Soskin, Grof, & Richards, 1973; Turek, Soskin, & Kurland, 1974; Yensen, 1975; Yensen et al., 1976).

CBS television journalists returned to Baltimore in 1990 to conduct a 25-year follow-up interview with Mr. King. They produced a fifteen minute film clip that demonstrated Arthur King's successful response to treatment. Sadly, some of the interviews were marred by attempts at sensationalism. The generally fair coverage of Mr. King became a segment in the television newsmagazine, 48 Hours. The show was oriented toward condemning psychedelic drug use of all sorts. It focussed almost exclusively on health risks and abuse. We hoped that a more balanced understanding of Mr. King's successful treatment might emerge from a series of interviews under less stressful and biased circumstances.

Interviews with Arthur and Jean King:
Reflections and Recollections of LSD Psychotherapy

Mr. King is a handsome man with a full head of gray hair. He mentions that he is a little overweight due inactivity from a knee injury. Usually he jogs several miles every day and keeps quite slim. Jean is a thin, strong-looking woman with carefully done gray hair, sharp features and a very warm demeanor. The Kings are enthusiastic about the value of psychedelic psychotherapy. As we spoke, they expressed their convictions that the LSD treatment had saved Mr. King's life and rescued their marriage.

We discussed the events leading to Mr. King's admission to Spring Grove State Hospital. The lifestyle of working class people came to the fore. The cultural context included alcohol consumption as a deeply embedded part of leisure time in this hard-working town. All of the men with whom Art associated drank. For Art and Jean, the dark side of this social scene almost cost them their marriage. It was in the early 1960's that Art's pattern of drinking became a concern. Jean reported that Art began drinking in his teens, and that he drank before work and after work. "One week he came home and said, 'I have no money.' He just drank up the whole check! Anybody who was in that bar he treated. It's something…I would never go through again. Never! It's not a pretty life."

Jean continued: "We were married in '52 and the treatment was in '65. A long time! I had three children and he is out having his good time drinking. That Christmas I had a long Santa Claus on the door and locked the storm door. Because I did not get to that door within a matter of one knock, he busted the whole glass out! And then when he wasn't drinking he was a different person, but I could not trust him. It was always, 'It won't happen again!' But I [could] never trust him when he [said], 'I'll come home tonight, we'll go to the movies and take the children.' I thought, I'm not telling these children because you're not coming home. No, I would never ever go through that again! We could have had a lot, when you sit and you think of all the money you spent on the drink. We could have had a lot!".

Art commented: "And most of the guys that I drank with are all dead now."
We asked him about his attempts to stop drinking. He tried Alcoholics Anonymous and his doctor had given him Antabuse, a medication that makes you vomit if you drink alcohol. He found that he did not stick with either of these. He never had been hospitalized. He was working full-time as a prison guard and most of the men with whom he worked also drank.
Jean remembered that in 1965 Art had been vomiting everyday and was quite sick. She took him to their family doctor. The doctor said that Art needed to be committed to a hospital. "So we go to the University emergency room and two doctors came in and talked to him…then they came out and told me…they said, 'He definitely needs to be committed. He is going to have to go to Spring Grove State Hospital.' So he starts fighting with me. Because I took him there he thinks, you know, that this is all my fault! An intern came out and took him and we said good-bye and I thought, 'No more of this life. This is it. Once you walk through that door I'm gone.' But when he got to the door and he turned around and I looked at him something came over me and I said, 'I can't leave him!' So I stayed (in the marriage)."
Art was admitted to a ward that housed both mental patients and alcoholics. "So the ward did one thing. It dried me out. And one thing I noticed being around all those patients. You get kind of a feeling for the world. You kind of appreciate the world, the normal people you know." He stayed for more than a month on this ward. Art described the alcoholics on the closed ward: "You see because everybody had a game, you know, and for most of them they just wanted to dry out and go back out and drink, thinking that they could handle it. Everybody can handle it... But I wasn't trying to sign myself out or anything. I wanted to go along with the program." Art thought that was one aspect of why he was chosen for the LSD treatment project.
Arthur King was one of the first of 69 alcoholics from this ward chosen over the next two years to participate in the LSD psychotherapy study. Once Mr. King was selected to participate in the study, he began treatment with Dr. Sanford Unger. "We had a battery of tests. To draw a person, the inkblots, the semi I.Q. test I guess you call it. Also, I spent a great deal of time with Dr. Unger and he had asked me a history. You know, where I was born, what I did, where I grew up, what I did in the teen years." He also participated in group therapy sessions with other alcoholics in the study. These groups, Art said, "were usually run by attendants, mostly attendants, maybe a doctor would come in and everybody was asked to speak and talk. I never said anything...I didn't feel like saying a whole lot of things in front of all them people and I was kind of bored with what they were saying, because it was the same thing over and over. But sessions with Dr. Unger were very good because we hit it off right away. And he was very easy to talk to and I trusted him and that was the way the program had come down. Always leading up to the actual LSD experience...And what he did he also prepped you. Dr. Unger said whatever you see don't worry about it. Don't get excited. Reach to it; go face everything that you see when the day of the session comes. They took a great deal of time to prep you so that you were not terrified of the whole thing... That you would accept whatever you saw. If it looks bad, go with it. If it looks good, go with it, but don't fight it. Don't try to come out. Don't try to say that this is horrible. This is too much because all kinds of things show up and time disappears. You know you don't have any time so that is how the program kind of came out. I developed a rapport with Dr. Unger...I trusted him and knew that he was looking out for me and my benefit...I trusted him completely."

After several weeks of psychotherapy sessions Mr. King was ready for the session with LSD. "When they finally had the session I went across...to Cottage 13 which was up on a hill...He gave me, I think two pills, real bright blue pills...I was sitting there for a few minutes nothing was happening and the first thing I remember was the little photograph of Jean. She was moving around. Walking around on the photograph and then I see all these colors and I see all these things...I can't remember I have to refer to the notes. When I (looked at) a picture of my son, Gary, I said 'A hair's out of place' and I smoothed it down on the picture and it smoothed down...And then there was a rose and Dr. Unger said look at the rose. Then he would bring up something else and then he would say look at the rose and it would be all withered and dead."

Richard asked, "The rose would respond to what you were feeling?"
Art said, "Yeah. They had one single rose. And I don't know how to explain how to say what happened...But I did find out something which I never did go into with anybody and once I found that out everything changed."
Richard asked, "What was that?"
Art said, "I don't want to go into that. I never told Jean. I never told anybody."
Jean said, "Well let's hear about it."
Art: "No. No. That's my personal."
Richard: "There was something like an insight about your life?"
Art: "The way this thing works with the mind if you have something that bothers you, you put it in the back of your mind and you don't think about it. But it affects everything you do. ...You do certain things in your life based upon that problem and that clouds or shields or screens your philosophy, your way of life, your quality of life, and you filter everything through that. But once you see what it is, you find out it wasn't any real big deal... It was something that was carried forth and once I saw that, Christ, that's what's been worrying me, That ain't no big deal."
Richard: "You had never seen that before the session?"
Art: "No. Never looked in that area. Never spoke about the area with Dr. Unger. Never! It was something you were avoiding everywhere. Everywhere! Never had thought in my own mind that there was any kind of problem. But once I saw it everything was gone. Just in that one session one-day. ...I'm looking at it as an adult. There were times when you were very emotional. Yes. That was connected with what was...very unhappy…very! …Thinking about things in the past and very unhappy. Very, very miserable! But then I came to that point everything cleared up."
Richard: "So you came to a point where you were able to accept it?"
Art: "Yeah, but in very symbolic terms. Very symbolic terms rather than an out-and-out thing...And then afterwards I realized what happened...The next day. But in the middle of the session it cleared up and it was like a peace. It was so strange. Jean knew right then."
Jean: "It was like Dr. Unger and I had got right to the doorway...and Dr. Unger said, 'Look at him.' and I said, 'It's over!' I could see. Just like peace. That he was so at peace with himself."
Art: "And near the end of the session, Dr. Unger said, "Oh by the way, look at the rose.' And the rose was blooming! Of course there were other things. See they played music. The Lord's Prayer and everything is heightened. Everything is you know. Barbra Streisand is a great singer. With the LSD, Barbra is fantastic! She's in another universe!"
Art described more of the process of the session: "Dr. Unger would say certain things during that day--during that twelve hours. He was mostly watching something that he had no idea was going on [in my mind]. You know, in the sense of what I was seeing, but he knew when to come in and help and to drift me back to where he wanted to go, and I think that was part of the thing. I think that is where all that testing comes in the beginning and the conversations and everything else. Even like the inkblots and all...but it is like the key in this treatment is knowing, really knowing, the person that you are with. See it's not a mechanical thing. That's what I am saying. It's showing caring!"
Art continued: "You were feeling the time as if it were no time. When he said, 'Oh it's been twelve hours.' I said, 'What?' There was time, time disappears and everything in the universe, you feel a part of everything in the universe including live trees and animals and everything. You see the universe!" One of the consequences of the session for Mr. King was that his thoughts of his future changed significantly: "See I had a plan [when I left the hospital]... I'm not going to be a prison guard. I'm going to be an accountant...So I left the prison and I got a job as an accountant. I didn't make hardly any money...I went to school at night and did exactly what I said I would do. I said I'm going to be an accountant and then I'm going to be a supervisor." Another consequence of the LSD treatment was his continuing sense of serenity. Richard asked, "What about that feeling of peace? Did you ever find yourself reflecting back on that over the years?"
Art: "Yeah, for a long while after the session. I would kind of just do, as Dr. Unger would say, 'Sometimes you just got to be.' You don't have to be in Baltimore. You don't have to be a father. You don't have to be anything, you just have to sit in a certain time and just be!" We discussed why Mr. King thought his treatment was a success. He described five important aspects of the program that were essential for him: (1) He "dried out" for a month on the mental ward before the treatment ever began with Dr. Unger. (2) He knew Jean and his three boys had enough money to survive while he was in the hospital. He had accumulated enough sick leave on his job as a prison guard so that Jean received his paycheck during the entire hospital stay. Art felt he was not distracted by outside concerns. (3) He trusted what he called, "the proper people" and was serious about trying to get well. Because of his trust in Dr. Unger, he was able to surrender to the process. (4) His one session was a breakthrough for him. Although he never told us what he realized about his life-what changed his life-evidently the LSD allowed him to step outside his usual world-view. He looked back at something very difficult in his life and realized that it had become the filter through which he saw everything else. Art let his conflict go. He made a decision that this would no longer be a focus in his life. (5) Mr. King had a plan to change his life, when he returned home. This plan included further education and a better job. (6) He received a good education about alcoholism while he was in the hospital that allowed him to understand the destructiveness of alcohol in his life.

What is Psychedelic Psychotherapy?

The practice and research of LSD psychotherapy are complex subjects. LSD therapy is not simply a symptom driven approach, but rather a carefully orchestrated treatment. A goal is to discover sources of conflict in a person's mind. Therapy then seeks to resolve the conflicts and build the person's motivation to live a better life. The treatment process is a complex orchestration of therapeutic milieu, technical skill, intuition, and sincere human relationship.

The way a treatment is understood greatly affects its practice and application. LSD psychotherapy falls into a conceptual category of abandoned for many years. This kind of therapy uses the effects of a consciousness-changing drug to amplify the healing relationship at the core of psychotherapy treatment. In World War II and after there was a treatment for war neurosis, or post-traumatic stress disorder, called narcoanalysis. In this once mainstream psychiatric approach, used in many Veteran's Administration hospitals, used the effects of two anesthetic drugs, sodium amytal or sodium pentothal. They were not used as anesthetics, but instead as "truth serums" or ways of opening the unconscious mind of the patient. Only patients well engaged in psychotherapy took these drugs. The drug sessions often enabled people to recall and vividly relive the forgotten or repressed events that were traumatic enough to make them become ill. This approach was often successful in ways that "talk therapy" could not match. The use of low doses (sub-anesthetic dosage) of anesthetic drugs for psychotherapy had some significant drawbacks including clouded consciousness and difficulty in recalling the experience without assistance. This led some therapists to record the therapy sessions and find other ways of helping recall.

It was not the "drug effect" of the "truth serum" or anesthetic that caused improvement. Instead, the cure was a complex reliving of traumatic memories within a context: the safety, insight and compassion provided by the healing relationship. This subtle distinction was often overlooked in scientific or clinical reports, which sounded like the cure was a result of the drug effect alone.

Narcoanalysis demanded a psychoanalytically informed therapist. Perhaps because of this, the narcoanalysis treatment is abandoned today and mostly forgotten. It is no longer taught in training programs. Narcoanalysis was lost in the waves of enthusiasm and optimism for symptom abating medicines (anti-psychotics anti-depressants and anxiolytics). These drugs led psychiatry to turn away from psychoanalysis and psychotherapy and toward biologically and behaviorally based approaches.

During and after the Vietnam War, when narcoanalytic therapy would have been the treatment of choice for traumatized soldiers, little or no real treatment occurred. It seems that forgetting about how to heal victims of trauma happens after every great war.
LSD's mind opening effects became known in 1943. It was not until 1950 that two American researchers, Busch and Johnson, noticed that it could have application in psychotherapy (1950). This application was an extension of the ideas used in narcoanalysis to embrace a totally new family of drugs.

This new family of drugs, the psychedelics, had unique and valuable properties. In therapy, they seemed to induce an experience, an inner journey of meaning, often with an upwelling of previously forgotten memories and experiences. There was clear recall for the experiences, especially when compared to anesthetics like Pentothal and Amytal. These new drugs seemed to ease patients' defensiveness while intensifying or amplifying the therapeutic relationship (transference).

In the 1953, two British psychiatrists practicing in Saskatchewan, Canada attempted to use LSD in the treatment of alcoholism. They sought to provide patients a frightening experience reminiscent of the dreaded delirium tremens (DT's). Rather than being scared into temperance, the patients who had only frightening experiences did not improve. Instead the researchers found that remarkable improvements took place in patients who reported that they had a peak or transcendental experience(5) . An event that showed the meaning of life to them and gave them insight into their, "dismal present and appalling future" (Osmond, 1969). The experience was, "So profound and impressive that [their] life experience in the months and years to follow becomes a continuing growth process" (Sherwood, Stolaroff, & Harman, 1962). Out of this experience Hoffer and Osmond developed what they later called psychedelic therapy for alcoholism.

In the beginning of the Spring Grove psychotherapy research efforts, the team attempted a direct application of the psychedelic (literally soul or mind-manifesting(6) ) technique. This technique, as practiced at Spring Grove, used a single large dose of a psychedelic drug with a specialized environment, eyeshades, headphones and specially selected music. Conventional interpretive psychotherapy was primarily a preparation for the LSD session. This method involves a preparatory period. The therapist explores the background of the patient with a goal of establishing rapport and preparing the patient for a single overwhelming high dose psychedelic session. When LSD is used in this manner, the dose ranges from 250 micrograms to 800 micrograms and the session lasts from 8 to 12 hours.

Throughout the research endeavors specially trained therapeutic teams conducted all psychedelic sessions. The primary therapist and a co-therapist of the opposite sex were in constant attendance throughout the day of the drug session. The morning and early afternoon of the drug session involved listening to music over stereo headphones with eyeshades. Covering the eyes blocked out external visual stimuli and allowed a contemplative inner focus. Musical programs were evolved and eventually a music therapist joined the staff full time. She developed motivational sequences of music designed to support the process of psychedelic therapy. Western classical orchestral and choral music sequences were played to support and express the expansiveness, profundity, the sense of sacredness and awesome qualities of the psychedelic experience. The technique aimed for a breakthrough to transcendental experience (Bonny & Pahnke, 1972).

Emotional support and companionship rather than interpretation were provided by the therapy club. In the afternoon the patient typically would sit up for brief periods to explore visual stimuli, for example pictures of family members, natural scenery or carefully selected art. Props were used to great effect in psychedelic therapy. A single, long stemmed red rose was part of every session. During the afternoon, time was set aside to gaze deeply at the rose under the effects of LSD. Family pictures played a role, in the morning or afternoon, to provoke insights about family dynamics. Patients were encouraged to look at themselves in a mirror. They often actually saw the effects thinking about their past use of alcohol had on their self-image. In the days following the drug session, therapy focussed on consolidation of insights and positive motivations for change. A goal was to integrate the peak experience into everyday life and personality.

Alcoholism Studies at Spring Grove

The project in which Arthur King participated in began at Spring Grove State Hospital in 1963. A modest building, known as "Cottage 13," on the hospital grounds housed the small research team. The facility, originally built for housing hospital staff, was unpretentious and integrated unobtrusively into one of the oldest mental hospitals in the United States. At the time Spring Grove was known for its progressive treatment. Cottage thirteen was a white clapboard two story cottage with four rooms and a bath on each floor. Two rooms were outfitted with sound systems and designated as treatment rooms for the psychedelic drug sessions.
There was an earnestly optimistic atmosphere. The clinical staff of the State Hospital collaborated fully in the selection and support of patients undergoing the new therapy. Their natural expectation was that in time they would be trained to use this exciting and dramatically effective new treatment. The sense of enthusiasm, confidence and hope was contagious. A devoted team from the State Hospital Alcoholic Rehabilitation Unit affirmed the work with LSD. Although in the early work a no-treatment group was proposed as a control group, these plans had to be abandoned. Both the patients and the staff of the State Hospital saw the psychedelic treatment as so valuable and effective that they objected adamantly, on ethical and humanitarian grounds, to withholding the treatment from any patient who qualified. The research team acceded to these demands in a decision that preserved morale and working alliance while apparently sacrificing scientific precision (Kurland et al., 1966; Unger, 1969).

The dynamic set and setting were a consequence of both conscious and unconscious factors among the therapy team. An interpersonal environment was designed purposely so that all factors of enthusiasm by the staff might contribute to the patient's profound mystical breakthrough and fundamental life change. The research team's morale was excellent. They were spending all their time doing this new and exciting treatment. They saw that they even had something to offer the hopeless!

The startling level of improvement using the experimental treatment in alcoholics was best displayed when compared to statistics gathered on patients' improvement in routine hospital treatment. In the study that began in 1963, 69 patients improved significantly on all the scales of the MMPI, except the Hypomania scale. The conclusions were that no patients were harmed and some patients showed substantial improvement. In this very challenging patient population (including many Skid Row dropouts) 23 patients (or 33.3% of the sample) were abstinent at the six-month follow-up. The result of the conventional approach to treatment at the Alcoholic Unit was only 12% rehabilitation (Kurland et al., 1971b p. 92; Kurland et al., 1967b).

Logically the next step would be a more rigorous study with a control group. Considering Kurland's earlier research, which showed that a true double-blind procedure(7) was impossible to maintain, they designed a study with a low dose of LSD as the control condition. They thought a low dose would produce the physiological effects, mood alterations, and perceptual changes unique to LSD without causing a full-blown psychedelic reaction. The use of a 50 microgram dose of LSD as a control would allow better understanding of how a large dose and mystical breakthrough might compare to the emotional cleansing and conflict resolution that might happen with a smaller dose. Treatment would be by the same highly motivated team for both groups. The researchers thought that only the high dose group would achieve mystical experiences and show the most dramatic improvement.

This study included 135 patients who were randomly assigned to either high dose (450 micrograms) or low dose (50 micrograms) LSD treatment. A battery of psychological tests was administered before acceptance in the program and one-week after the drug session. The patient's progress was monitored at 6, 12 and 18 months after completing the therapy program.

One week after the session both treatment groups displayed statistically significant improvement in their test scores. An independent team of social workers made the follow-up ratings. They said that 44 percent of the high dose group was "essentially rehabilitated" at six months. Only 25 percent of the low dose group met this criterion at the same point. Abstinence was 53 percent for the high dose group and 33 percent for the low dose group at six months. This finding was significant statistically (p<.05). At one year post-therapy, there was no significant difference between the two groups. One and a half years after treatment, psychedelic psychotherapy had been successful with over half of the alcoholics treated in this program (high and low dose patients combined). Alcoholics receiving conventional therapy had only a 12% improvement rate.

The clinical staff overlooked an important element. The team did not fully appreciate the positive impact of its own enthusiasm and esprit de corps so intentionally and carefully cultivated. Inspiration in the team grew, it was fueled by sharing the mystical breakthroughs of patients undergoing high dose LSD sessions and the positive behavior changes of many participants. This further stimulated the already exemplary value placed on human life by the researchers themselves. They were a deeply motivated group of therapists because of the experiences that accrued while doing LSD psychotherapy. The 50-microgram control group improved more than expected. A few patients even had full-blown mystical experiences on this threshold dose of LSD. Others did significant work on their inner conflicts because of the nearly ideal therapeutic circumstances. At the conclusion of the study, the staff broke the blind. They were chagrined at the results, but felt that they had been true to their values and tried their best with all patients. The very hypothesis of this carefully designed study, turned out to be the major problem: Because the "control" was itself LSD, it was a much greater activator of the therapeutic relationship even at a low dose than anyone knew. The low dose became another experimental condition rather than a control and the impact of the positive attitude of the staff on the treatment was underestimated. Though the combination of these drug and non-drug factors gave uncertain scientific results, the human results were exceptional.

Another possible conclusion was that psychotherapy alone was far more effective with alcoholics than suggested by any other study in the literature. This seems unlikely because both the experimental and the "control" groups showed greater improvement than past studies of routine hospital treatment. The search for an adequate control did not meet with success in this study. The role of non-drug factors in positive outcome proved to be far more powerful than even this research group had anticipated (Kurland et al., 1971b).

Challenges to the Acceptance and Availability of Psychedelic Psychotherapy

The study and use of psychedelics in psychotherapy has been profoundly repressed by: current paradigms in psychiatry and psychology, the biological symptom-suppression revolution in psychiatry, the prohibitionist drug war, and changes in the insurance industry that limit patients' access to care.

Concepts and Paradigms
The power of concepts or paradigms to organize and limit thinking in scientists and professionals is displayed in the current obsession for quick one-step biological solutions to almost every form of mental distress or disorder. The symptom reducing or eliminating anti-anxiety, antidepressant and anti-psychotic medications have shifted the focus of psychiatric training from dynamic psychotherapy and psychoanalysis to psychopharmacology. Massive funding available for research in this area is a collusion between government and the pharmaceutical industry. As valuable as symptom-relieving drugs may be, when used appropriately, they are not sufficient to address the complexities of addiction and conflicted human personality. The psychedelics are an entirely new family of medicines that can amplify the healing properties of a psychotherapy relationship and transport patients into life changing realms of consciousness. Although these medicines are no more panaceas than the symptom suppressors, they are worthy of exploration and development. Psychedelics must be studied in ways appropriate to understanding the nature of their action. Consciousness expanding drugs are uniquely sensitive to the attitudes and beliefs of the doctors using them and to the setting in which they are given.

The War on Drugs
There is a 17 billion dollar dark cloud on the horizon of freedom in the United States. The federal budget for the "war on drugs" has grown 3,200% since 1970. More that 400,000 citizens are in jail on illegal drug convictions (Shenk, 1999). The prohibitionist drug war brought us an attitude toward drugs of abuse that is strangely reflected in etymology. The Greeks had a word for it: phármakon meant drug, pharmakós, however meant scapegoat! Our public policy toward drugs of abuse reflects these original paronomastic confusions. With the exceptions of alcohol and tobacco, our laws scapegoat drugs for the social ills that foster their abuse (Escohotado, 1999). Drug abuse and addiction are sequels to despair. Such despair is often, though not always, rooted in the hopelessness of social inequities. The government lavishes billions imprisoning drug dealers, interfering with the internal politics of drug producing countries and intercepting shipments of illegal drugs. This policy casts a totalitarian shadow both at home and abroad. At the same time the challenge to provide education and opportunity rather than punishment for the disadvantaged is avoided.

In 1962 and 1965 ever more oppressive restrictions were placed on legitimate scientific research with LSD and other psychedelic drugs. In a May 1966 congressional hearing Senator Robert Kennedy asked how drugs that were worthwhile six months before suddenly became deplorable. The frightening answer to his question was that LSD had escaped the laboratory and captured the bodies, minds and hearts of America's rebellious youth (Mangini, 1998; Shenk, 1999). After hearing the evidence Kennedy gave a courageous admonition: "Perhaps to some extent we have lost sight of the fact that (LSD) can be very, very helpful in our society if used properly" (Subcommittee on Executive Reorganization, 1966 p. 63).

In 1968 the American Journal of Psychiatry carried an article about the devastating impact of negative publicity and federal restrictions on legitimate LSD research (Dahlberg, 1968). The paper documents a disgraceful psychiatric witch hunt. Ongoing research projects were canceled and bona fide researchers were attacked as "kooks". Previously approved projects were denied supplies of LSD by the National Institute of Mental Health (Pollard, 1966).

By 1970 LSD became an outlaw. It was lumped with heroin and placed by the Drug Enforcement Administration into the new Schedule I category: drugs that have no recognized medical use and have high abuse potential. This act ignored and denied hundreds of articles documenting the value of psychedelics as adjuncts to psychotherapy (i.e., Abramson, 1960; Abramson, 1966; Abramson, 1967; Busch & Johnson, 1950; Butterworth, 1962; Caldwell, 1968; Cohen, 1964; Grinspoon & Bakalar, 1979; Grinspoon & Bakalar, 1981; Grinspoon & Bakalar, 1983; Grinspoon & Bakalar, 1986; Grof, 1976; Grof, 1980; Hausner, 1968; Hausner & Dolezal, 1966; Hausner & Dolezal, 1968; Hicks & Fink, 1969; Kurland et al., 1971b; Kurland et al., 1967a; Kurland et al., 1967b; Leuner, 1962; Leuner, 1968; Masters & Houston, 1966; Sankar, 1975; Yensen, 1985).

Financial Constraints
In the United States the insurance industry has evolved into "health Maintenance organizations" (HMO's) and "Managed Care" plans. These new entities manage patients' access to health care and define eligibility for reimbursement according to a new series of often-secret rules. It is clear to most at this point that this system serves to limit patients' access to care. Managed care has effectively cut the delivery of both inpatient and outpatient care in the private sector. A national study of privately insured individuals looked at 3.9 million mental health care claims from 1993 to 1995. The researchers concluded: "For patients using outpatient services only, those diagnosed with substance abuse experience the largest decrease in costs (23.5%)" (Leslie & Rosenheck, 1999). The August 1999 Consumer Reports published a survey of 19,000 people insured by HMO's. People with serious health problems had more trouble getting care than did people without serious health problems. Both groups had trouble getting care. Problems occurred from as little as 5% of the time to as much as 30% of the time (Kagan, 1999). Many people find that, when you need it, the existing health care delivery system doesn't deliver. Salaries of HMO executives soar above the norm for other chief executives in the country. Intervention in the definition of illness and delivery of care has had a profound impact on psychotherapy and addiction treatment reimbursement. The tendency is to define treatment as what is reimbursed by a ruthlessly budget-minded insurance industry. By comparison, the Veteran's Administration reports decreases in inpatient care paralleled by an increase in outpatient service delivery. The public sector is accountable to its constituents whereas the private sector views information as proprietary and private.

Arthur King's story illustrates the shortsighted nature of this approach to treatment. It highlights changes in government funding for inpatient addiction treatment and research also shifts toward symptom oriented approaches that are superficial and seldom adequate.

The Relationship Between Peak Experience and the Despair of Addiction

Addiction in its many forms is a reaction of the individual who is in emotional or physical pain and is convinced that it is not possible to get genuine relief from that pain. This helplessness and hopelessness leads to the morass of despair. The total frustration at finding real solutions to the pain or conflict leads directly to a willingness to accept momentary relief or escape from an otherwise inescapable situation. The substance or behavior to which the person becomes addicted is this substitute for a real solution.

Peak experiences are profound experiential portals that lead out of the angry, empty trap of despair and false gratification. Instead of the illusion of escape that a mood-altering drug might induce biochemically, a peak experience is a fundamental shift in consciousness, a shift that profoundly motivates positive change. The Spring Grove team defined this shift as the goal of therapy, a peak experience that includes the following elements:
1) Unity-the sense that "all is one."
2) Transcendence of the time-space boundaries associated with ordinary reality.
3) Deeply felt positive mood.
4) The sense that this experience is ultimately true or more real than real.
5) An experience that the opposites of daily life, rather than conflictual, become instead complementary, two sides of the same coin.
6) A sense or feeling of sacredness or of the preciousness of life prevails.
7) A feeling that the experience is beyond words.
8) The experience is transitory.
9) Though transitory the experience has profound positive effects in the life of the person having it and is unforgettable (Pahnke, 1963; Stace, 1960).

In psychedelic treatment (as in narcoanalysis) it is not the "drug effect" of the LSD that causes improvement. Instead healing occurs through the complex reliving of memories and through having a peak experience. This happens in a context of safety, insight and compassion provided by the psychotherapists' healing relationships with their patients.

This is why having an LSD trip at a party is a risky endeavor that is unlikely to produce lasting positive changes. Although we have to admit that peak experiences are always possible when psychedelic drugs are consumed. Unless peak experience is nurtured by an appropriate relationship, developed in a protected environment and integrated through careful psychotherapy it may languish in forgetfulness or misunderstanding. The dreaded "bad trip" is a signal that the drug taker is entering a realm of profound alienation, for which they are not prepared. In a proper environment, such reactions can lead to subsequent peak experiences when managed by trained professionals experienced in this form of therapy. In many of his books Stanislav Grof, a member of the Spring Grove/MPRC team, has presented a detailed map of the relationship between difficult experiences and later breakthroughs to transcendent peak experiences (Grof & Grof, 1977; Grof & Grof, 1986; Grof, 1976; Grof, 1980; Grof, 1984; Grof, 1985; Grof, 1994; Grof & Bennett, 1993; Grof & Grof, 1980; Grof & Halifax, 1977; Yensen & Dryer, 1996).

Any truly effective approach to dealing with addiction will combat despair because the despair that drives addiction is rooted in the lack of hope for genuine change. The truly remarkable quality of psychedelic therapy is its demonstrated ability to foster motivation and hope in the otherwise destitute. The experiential axis for change in motivation and lifestyle is the peak experience. Though transitory this glimpse of a "Beyond Within(8)" serves as a touchstone of meaning and motivation that can last a lifetime. Although Arthur King is an example of a very positive response to psychedelic therapy, many patients benefited from a single peak experience in ways that are more modest. Some patients in the original studies relapsed after months or years of sobriety. In later years at the Maryland Psychiatric Research Center, we thought that these individuals would benefit from more therapy and additional LSD sessions (Yensen & Dryer, 1995). Because of the controversial and experimental nature of psychedelic therapy such reasonable clinical approaches were forbidden (Mangini, 1998).

The Real Value of Truly Effective Treatment

How much is the successful treatment of a man like Arthur King worth to his family, neighbors and community? Surely, the true accounting is not merely a matter of money saved or spent on therapy in a short-term view, but calls for analysis over a lifetime. A person made whole again radiates well being into the society. Rather than continuing on the path toward destroying his family and becoming a burden to society, Arthur King became a contributor, a devoted employee, father, husband and now grandfather.

Effective treatment of the personal and spiritual crises in addiction seems the only adequate solution for society and the individual's problems with addiction. Although the experimental treatment received by Arthur King was costly in a short-term analysis it is still quite a bargain when evaluated over a lifetime of success. It was made up of powerful, thoughtful and skillful individual therapeutic attention within a positive environment, one that evoked and supported the desire to change in Art King. All of this was focussed, amplified and enhanced during a twelve-hour LSD session with a therapist co-therapist (male & female) team in constant attendance. Arthur King received 35 hours of individual psychotherapy, which included one high dose (450 micrograms) LSD session. What would such treatment cost today if delivered in the public sector? At a fee of $60 per hour for the psychologist (35 hours = $2,100), $25 per hour for the nurse (15 hours = $375) and $8,400 for one month in a public hospital, his treatment would cost $10,875 in 1999 dollars(9).

For addiction the most widely practiced treatments are based on spiritually oriented self help groups like the 12-step programs of Alcoholics and Narcotics Anonymous. Bill Wilson created Alcoholics Anonymous after hearing, in the midst of his own alcoholism, about an alcoholic friend who was a patient of the famous psychoanalyst Carl Jung. Dr. Jung expressed the view that only a mystical or religious experience, a genuine conversion, could be powerful enough to change the course of a serious addiction (Pursch, 1997).

Ironically, LSD was shut out of Alcoholics Anonymous although Bill Wilson received a series of therapeutic LSD sessions from 1955 to 1959. Because of the profound experiences he had with LSD, Mr. Wilson approached the board of directors of AA and asked them to consider endorsing LSD psychotherapy as a treatment for alcoholism. The board refused, perhaps aware of clouds of controversy over street use of this powerful psychedelic (Anonymous, 1984 pp. 370-371).

Possible Futures- a path for real research and treatment?

Many of these pressures are likely to change with time and public outcry. One can only hope that the pendulum will swing back. Society deserves a more thorough approach to the treatment of addiction and social factors contributing to it. Research could explore the promising results that occur with psychedelic therapy when it is successful. These studies would build upon past knowledge of why and how this therapy is successful and how to maximize that effect.

The authors, in collaboration with Albert Kurland, submitted such a study to the Food and Drug Administration. In 1991 the study was approved under FDA administrative procedures. Since that approval many hurdles had to be overcome. The authors were, for the first time, unable to secure LSD for an FDA approved study from the U.S. Government. Additional permission was necessary to import the necessary LSD from Switzerland. Without warning, in October of 1997 as clinical work was about to begin, the permission was placed on clinical hold. We are currently addressing many safety and scientific design concerns raised by a new FDA administration. The new bureaucracy appears unaware of both earlier approval and the historical precedents of safety set by our research team, which traces its origins to the original Spring Grove Research Department.

Psychedelics have much to offer society in the realms of treatment for: terminal agony and despair, addiction and neurosis (Berendes, 1979; Cohen, 1964; Cohen, 1965; Cohen, 1984; Di Leo, 1981; Fisher, 1970; Fox, 1967; Grinspoon & Bakalar, 1979; Grinspoon & Bakalar, 1981; Grof, 1976; Grof, 1980; Grof et al., 1973a; Grof & Halifax, 1977; Hicks & Fink, 1969; Horton, 1973; Kast, 1966a; Kast, 1966b; Kast, 1967; Kast & Collins, 1964; Kurland, 1985; Kurland et al., 1968; Kurland et al., 1971a; Kurland et al., 1971b; Kurland et al., 1967a; Ling & Buckman, 1963; McCabe et al., 1972; Osmond, 1973; Pahnke, 1963; Pahnke, 1969; Pahnke et al., 1969a; Pahnke et al., 1970a; Pahnke & Richards, 1966; Richards & Berendes, 1977; Richards et al., 1972; Richards et al., 1977; Richards et al., 1979; Riedlinger & Riedlinger, 1994; Roquet, Favreau, Ocaña, & de Velasco, 1975; Savage & McCabe, 1973; Savage et al., 1973; Schulz, 1976; Servadio, 1973; Turns & Denber, 1966; Unger et al., 1968; Yensen, 1985; Yensen, 1988a; Yensen, 1988b; Yensen, 1992; Yensen, 1998). Beyond illness, psychedelics have demonstrated promise in the area of creativity (Di Cyan, 1971; Harman, McKim, Mogar, Fadiman, & Stolaroff, 1966; Krippner, 1985; Leuner, 1973; Osmond, 1957; Richards & Berendes, 1977; Zegans, Pollard, & Brown, 1967). The potential riches of enlightened psychedelic research and practice await a well-educated rational society. One with a mature approach oriented more toward effective life changing treatments than short-term economy.

Major Studies at Spring Grove State Hospital and Maryland Psychiatric Research Center

Cholden, Kurland & Savage, 1955
20 inpatients with chronic schizophrenia LSD
100-500µg Intramuscular Injection
up to 14 administrations given daily.
Conclusions
1) LSD can be given I.M. over protracted period without untoward effects
2) Tolerance is seen on the 2nd day and after 4-6 days is gone
3) Gross behavior is useful indicator of tolerance
4) There is no cross tolerance between LSD and mescaline
5) Clinical responses of schizophrenics were categorized
6) The reactions may in part be determined by the milieu

Kurland, Unger, Shaffer, Savage, 1967
69 chronic alcoholic inpatients
LSD 200-900 µg orally
1 administration
18 month follow-up study
Conclusions
1) Safe treatment modality as shown by pre- and post- EEG's on 20 patients
2) Specialized training is necessary for safe an effective treatment
3) One-third maintained abstinence up to 6 months
4) Reversal of pattern of pathological functioning as seen on MMPI's

Pahnke, Kurland, Goodman, Richards, 1969
22 metastatic cancer inpatients
LSD 200-500µg
Conclusions
Pilot study and case histories: 6 showed dramatic improvement, 8 showed good improvement, 8 remained unchanged of 22 Improvement: decreased depression, anxiety, fear of death; increased relaxation, greater ease in medical management, closer interpersonal family relationships with more openness and honesty on a 13 point scale

Tjio, Pahnke, Kurland, 1969
32 psychiatric inpatients, 5 drug abusers & 8 normals
LSD 21 high dose=250-400 µg; 11 low dose=50 µg
Conclusions
Mean pre-LSD rate of chromosomal aberrations in the 32 patients (4.28%) and the 5 LSD users (2.81%) are comparable to each other and to the values obtained from 2 normal control subjects sampled for 8 to 10 consecutive days (2.65%). Pre- to post-LSD differences for both the 32 patients (+1.63%) and the 5 LSD users (+0.76%) are not statistically significant. Mean chromosomal aberration rates for the 32 patients and 5 LSD users (including both pre-and post-means), 8 experimental normal LSD subjects (post-LSD), and 2 normal controls (no LSD) only vary from 2.65% to 5.91%.

Pahnke, Kurland, Unger, Savage, Wolf, Goodman, 1970
6 metastatic cancer patients
LSD 200µg to 300 µg orally or intramuscular
Conclusions
Case histories; showed decrease in need for pain medication and improvement in global change for all 6 patients

Pahnke, Kurland, Unger, Savage, Grof, 1970 JAMA
Experimental Use of Psychedelic Psychotherapy
overview

Kurland, Savage, Pahnke, Grof & Olsson 1971
135 chronic alcoholics
LSD 50µg or 450µg orally
one session
6, 12, and 18 mo follow-up
Conclusions
6 month follow-up 53% rehabilitated high dose group vs. 33% in low dose group p=.05. This initial gain was attenuated at end of 18 months although overall levels of improvement was considerably better for both groups than usual improvement for other alcoholics in the same setting without LSD-assisted psychotherapy.

Richards, Grof, Goodman, Kurland, 1972
31 cancer patients
LSD 200-500 µg orally or intramuscular
one session
Conclusions
25% had peak experiences and less fear of death afterwards 29% dramatically improved, 41.9% moderately improved, 29% unchanged

McCabe, Savage, Kurland, Unger, 1972
96 inpatient neurotics
LSD 31 high dose (350µg), 32 low dose (50µg), 33 group therapy alone
Conclusions
High dose psychedelic therapy was superior to conventional therapy on specific "symptom" areas as defined by the MMPI, e.g.. depression, obsessive-compulsive syndrome, social introversion, manifest anxiety, ego strength, neurotic overcontrol. On the POI "Spontaneity" and "Self-regard" consistently show greater increments after both forms of psychedelic therapy and "self-actualized values" are more frequently increased after high-dose LSD administration.

Savage, McCabe ,Kurland, Hanlon, 1973
same 96 inpatient neurotics as above
more complete data analysis
Conclusions
High dose>Conventional treatment p<.05 for MMPI items Depression, Social Introversion, Ego Strength, Benaric Items p<.01 for Validity, Correction, Factor, Social Desirability. for POI items p<.05 for Self-actualizing value, and Self-Acceptance and p<.01 for Spontaneity and Self-regard for PEP items p<.05 Distress, Distrust, Social Desirability, Future p<.01 for Insight
Low Dose better than Conventional Treatment p<.01 only for PEP Distrust and Distress and POI Self-Regard and p<.05 for MMPI scales Correction, Factor, Social Desirability, PEP scales Future and Insight and POI Spontaneity.

Soskin, Grof, Richards, 1973
18 inpatient alcoholics
15-30 mg of DPT intramuscular
Conclusions
Therapist Rating Scale DPT > placebo p<.01 for items: Recall of Memories and Experiences, Emotional Expressiveness, depth of Self-Exploration and p<.05 for Psychodynamic Resolution.

Grof, Soskin, Richards, and Kurland, 1973
51 inpatient alcoholics
15-150 mg DPT intramuscular
one to six two-hour sessions
72 DPT and 64 placebo therapy interviews on a double-blind basis
Conclusions
Percentage rehabilitated at 6 month follow-up: global adjustment=46.8% and abstinence=53.2% at p<0.001 and significant improvement (compared to pre-treatment) on occupational adjustment (p<.01), residential adjustment (p<.02), interpersonal adjustment (p<.001).

Savage and McCabe, 1973
37 narcotic addicts in a halfway house
200-500 µg LSD orally
one session
Conclusions
25% remained abstinent vs. 5% abstinent at 12 month follow up with p<.05

Turek, Soskin, Kurland, 1974
10 mental health professionals
MDA 40-150mg orally
one session Pilot Study
Conclusions
Analyzed blood pressure, digit symbol subtest, digit span subtest, handwriting, Psychedelic Experience Questionnaire, Modified Linton-Langs Questionnaire and the Subjective Drug Effects Questionnaire. MDA invites inner exploration vs. LSD which demands it. Might be helpful in treatment of obsessive and depressive traits.

Yensen, Di Leo, Rhead, Richards, Soskin, Turek, Kurland, 1976
10 neurotic outpatients
MDA 75-200 mg orally
2-4 sessions
Conclusions
Significant improvements on POI, MMPI, BPRS, WPRS, and Social History Questionnaire at pre- to post and 6 months post therapy

Rhead, Soskin, Turek, Richards, Yensen, Kurland, Ota, 1977
33 inpatient alcoholics received DPT, compared to 46 Conventional Treatment (CT), 24 Routine Hospital Treatment (RHT)
DPT 15-150mg intramuscular injection
1-6 sessions
Conclusions
Not much difference due to drop-out rates and other complexities discussed in this paper.

Richards,, Rhead, Di Leo, Yensen, Kurland, 1977
34 cancer patients
75-127.5 mg DPT intramuscular injection
one session
Conclusions
Predictors of peak experiences analyzed (peakers=14, non-peakers=17)

Richards, Rhead, Grof, Goodman, Di Leo, Rush, 1979
30 cancer patients
75-127.5 mg DPT intramuscular injection
one session
Conclusions
ECRS scales of Depression and Anxiety were p<.05 pre- vs. post- Mini-Mult showed decreased distress, e.g. D p<.006, Hy p<.006, Pt p<.004, Pa p<.01, Sc p<.001, Ma p<.02; POI: Time competency p<.03, Inner Directedness p<.01, Self-Regard p<.02, Self-Acceptance p<.005, Capacity for Intimate contact p<.02.

Berendes, 1979 12 neurotic outpatients
20-30 mg psilocybin or 200-300µg LSD or 70-120 mg DPT
one session in the context of ongoing psychoanalytic psychotherapy
Conclusions
Analytic description of shifts in therapy and transference leading up to, during, and after the session.

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(1)To be published in a book edited by Andrew Tatarsky about successful alternative treatments for addiction.
(2)Director, Orenda Institute, 2403 Talbot Road, Baltimore, MD 21216-2130 USA. Email: ryensen@orenda.org.
(3)Medical Director, Orenda Institute. Email: ddryer@orenda.org.
(4)Columbia Broadcasting System.
(5)"The momentary awareness of joy or fulfilment akin to ecstasy, of a higher and different quality from ordinary life, experienced by some people;" Oxford English Dictionary CD-ROM second edition.
(6) The Oxford English Dictionary defines Psyche as: "The soul, or spirit, as distinguished from the body; the mind" Delos from the Greek means to make manifest or to reveal. The OED defines psychedelic as: "Of a drug: producing an expansion of consciousness through greater awareness of the senses and emotional feelings and the revealing of unconscious motivations (freq. symbolically);" Oxford English Dictionary CD-ROM second edition.
(7) A study method where neither the doctor nor the patient/research subject knows who is receiving the drug under study.
(8) (Cohen, 1964).