Psychiatric Research with Hallucinogens:
What have we
learned?
Charles S. Grob, M.D.
Yearbook for Ethnomedicine and the Study of
Consciousness, Issue 3, 1994
©VWB -
Verlag für Wissenschaft und Bildung, 1995
Abstract
After a twenty-five year period of virtual prohibition,
formal psychiatric research with hallucinogenic drugs has resumed. This
article reviews the process by which hallucinogens came to be viewed as beyond
the pale of respected and sanctioned clinical investigation, and directs
attention to the importance of fully understanding the lessons of the past so
as to avoid a similar fate for recently approved research endeavors. The
shamanistic use of hallucinogenic plants as agents designed to facilitate
healing, acquire knowledge and enhance societal cohesion were brutally
repressed in both the Old and New Worlds by the progenitors of our own
contemporary Euro-American culture, often with complicity of the medical
professions. Knowledge of the properties and potentials of these consciousness
altering plants was forgotten or driven deeply underground for centuries. It
was not until the late 1800s that German pharmaceutical researchers
investigating the properties of peyote re-discovered the profound and highly
unusual effects of these substances. A dispute anticipating the virulent
controversies of the 1960s ensued, however, pitting proponents of this new
model of consciousness exploration against those who questioned the propriety
of their colleagues enthusiasm for self experimentation and penchant for
sweeping proclamations. The history of hallucinogen research in the 20th
century has revolved around this regrettable polarization, and as such has
impeded the evolution of the field.
Developments in the second half of the 20th century were catalyzed
by the remarkable discoveries of the Swiss research chemist, ALBERT HOFMANN.
In the wake of his synthesis of the extraordinarily potent psychoactive
substance, Iysergic acid diethylamide, a period of active investigation
ensued. Notable gains were accomplished utilizing the psychotomimetic model
for understanding mental illness and the low dose psycholytic approach for the
treatment of a variety of psychiatric conditions. However, it soon became
apparent that these models possessed inherent limitations when applied to the
orthodox psychiatric constructs then in vogue. The implementation of the high
dose psychedelic model, in spite of its apparent utility in treating resistant
conditions such as refractory alcoholism, presented even greater difficulties
in conforming to the boundaries of conventional theory and practice.
Acceptance of hallucinogens as reputable tools for investigation and agents
for treatment were dealt a further and near fatal blow when they became
embroiled in the cultural wars of the 1960s. Together with revelations of
unethical activities of psychiatric researchers under contract to military
intelligence and the CIA, the highly publicized and controversial behaviors of
hallucinogen enthusiasts led to the repression of efforts to formally
investigate these substances. For the next twenty-five years research with
hallucinogens assumed pariah status within academic psychiatry, virtually
putting an end to formal dialogue and debate.
We now have before us the opportunity to resurrect the long
dormant field of hallucinogen research. However, if we are to avoid
replicating the debacle of the past it is imperative that we learn from the
lessons of prior generations of researchers who saw their hopes and
accomplishments dissipate under the pressures of cultural apprehension and the
threat of professional ostracism. It is essential that we avoid repeating the
mistakes of the past. We are now beginning to take definitive steps to end the
protracted period of silence and inactivity, but we must be ever mindful to do
so tactfully and with respect for the anxieties that will inevitably be
provoked in our colleagues. We must strive to facilitate dialogue and even
active collaboration with those who in the past may have been loathe to even
acknowledge that this might be a field worthy of study. We must also adhere to
current and accepted models of research design, for to disregard the state of
contemporary scientific investigation would ultimately undermine our goals of
fully exploring the rich potentials of these substances. It will also be
critical to learn from the wisdom accrued over the ages by the aboriginal
practitioners of shamanic healing, for therein lies the benefits of thousands
of years of experience with hallucinogenic plants. For more than two decades
now the topic of hallucinogens as tools of clinical investigation and models
for healing within has been relegated to the dustbin of history.
Psychiatric research with hallucinogens has
resumed. After two decades of virtual prohibition, formal authorization from
federal regulatory agencies to conduct investigative studies in the United
States with these unique mind altering substances has been successfully obtained
(STRASSMAN, 1991). The bitter and acrimonious debate that raged through the
1960s and 1970s and into the 1980s has subsided. Scientific and health policy
makers have determined that these drugs, although possessing an inherent abuse
potential, do have a safety profile of acceptable magnitude when compared to
drugs currently the subject of formal research investigation as well as others
actively dispensed in clinical practice. The U.S. Food and Drug Administration
has therefore determined that formal and well controlled investigations designed
to assess the risk-benefit ratio of particular hallucinogenic substances may now
be pursued. However, for such studies to proceed successfully and for the much
heralded (and often vilified) potential of the hallucinogens to be explored, it
is imperative that we fully grasp the lessons of the past. For, to paraphrase
Santayana, if we fail to understand our history, we will be condemned to repeat
the patterns and reactions which will inevitably lead to yet another round of
repudiation and rejection of this unique class of psychochemically active
substances, along with its inherent and inestimable potential for learning and
healing.
Shamanistic Roots:
Hallucinogens, throughout the breadth
of time, have played a vital albeit hidden and mysterious role. They have often,
in aboriginal and shamanic contexts, been at the absolute center of culture and
world view (DOBKIN DE RIOS, 1984). Opening up the doors to the spiritual planes,
and accessing vital information imperative to tribal cohesion and survival,
hallucinogenic plants became what some scholars have considered to be the
bedrock of human civilization (WASSON, 1968; WASSON et al, 1978; HUXLEY, 1978).
Within the context of shamanic society, these awe inspiring botanicals were
utilized to facilitate healing, divine the future, protect the community from
danger and enhance learning (e.g. teaching hunters the ways of animals)
(CORDOVA-RIOS, 1971). However, with the advent of stratified and hierarchical
societies, such plant potentiators came to be viewed as dangerous to the
commonweal and controls were placed on direct and revelatory access to the
sacred (DOBKIN DE RIOS and SMITH, 1976). In some societies (e.g. Aztec
civilization) use of psychotropic plants was restricted to the select castes of
the religious priesthood. In others, including the progenitors of our own
contemporary Euro-American culture, absolute proscriptions on the use of plant
drugs for divine purposes were decreed.
Repression of Shamanistic Traditions:
To fully understand
the enormous resistances to these drugs and the unique experiences they induce,
it would be revealing to examine some elements of our historical legacy. A
poorly appreciated period from Fourteenth through Seventeenth Century European
History has been the persecution of indigenous healers, predominantly woman,
during the reign of the Inquisition, particularly in Northern and Western
Europe. During a span of three hundred years several million women were accused
of practicing witchcraft and condemned to die. The Medieval scholar Jules
Michelet has explored the complicity between ecclesiastical and medical
authorities in the subjugation of non-sanctioned healing, commenting on the
attitude of the Church "that if a woman dare cure without having studied, she is
a witch and must die" (MICHELET, 1965). To have "studied" in this context is to
have faithfully adhered to the precepts and moral authority of the Church, and
to have forsworn receiving knowledge from Nature.
A rich
heritage of plant lore and applied healing had been passed down from pagan and
pre-Christian Europe, rivaling and often surpassing the demonstrated efficacy of
Church sanctioned medical practitioners. Hallucinogenic plants with magical as
well as healing properties were essential elements of this indigenous
pharmacopoeia. Members of the Solanaceae family with their alkaloids atropine
and scopolamine, including a great number of species of the genus Datura, as
well as mandrake, henbane and belladonna, had wide application as agents of
healing and transcendence (HARNER, 1973). In taking action against the
indigenous use of psychotropic plants, the Church sought to eliminate a
perceived threat to its oligarchic powers and reassert its monopoly on
legitimate access to the supernatural (O'NEIL, 1987). By casting the healer as a
witch and the hallucinogenic plants as tools of Satan, the Church succeeded not
only in eliminating competition to the elite physician class but also in
virtually eradicating knowledge of these vestiges of pagan and shamanic
consciousness.
A second historical period whose examination
may be pertinent to understanding our ingrained cultural resistances and
aversion to hallucinogens is the European conquest of the New World. Shortly
after arrival in Central and South America in the late Fifteenth and early
Sixteenth Centuries, the invading Spanish Conquistadors observed an impressive
array of psychoactive pharmacopoeia, including morning glory seeds (containing
the potent hallucinogen, Iysergic acid), peyote and psilocybin mushrooms.
These extraordinary plants were utilized by the native
inhabitants to induce an ecstatic intoxication and were an integral component of
their aboriginal religion and ritual. As plant hallucinogens were attributed to
have supernatural powers, they were quickly perceived by the European invaders
as weapons of the Devil designed to prevent the triumph of Christianity over
traditional Indian religion (FURST, 1976). An early Seventeenth Century Spanish
observer of native customs, Hernando Ruiz de Alarcon, wrote of the idolatries he
observed involving the consumption of the morning glory:
"Ololiuhqui is a kind of seed-like lentils produced by a type of
vine in this land, which when drunk deprive of the senses, because it is very
powerful, and by this means they communicate with the devil, because he talks
to them when they are deprived of judgment with the said drink, and deceive
them with different hallucinations, and they attribute it to a god they say is
inside the seed" (GUERRA, 1971).
Identifying the
threat not only to consolidating their power and control over the conquered
peoples, but also the danger of lower caste immigrant Spaniards developing
interest in native rituals and healing practices, The Holy Inquisition of Mexico
issued in 1616 a proclamation ordering the persecution and excommunication of
those who, under the influence of
"herbs and roots with which they lose and confound their senses,
and the illusions and fantastic representations they have, judge and proclaim
afterwards as revelation, or true notice of things to come..." (GUERRA, 1967).
To continue to engage in native practices and
utilize their traditional plant hallucinogens as agents of knowledge and healing
would risk indictment of heresy and witchcraft, and inevitably the
implementation of the cruelest punishments of the Inquisition, from public
flogging to being burned alive at the stake. Unable to accept the indigenous
utilization of such psychoactive substances as anything other than idolatry and
a threat to their goals of domination and exploitation, the European conquerors
denied them legitimacy, endeavoring to expunge their traditions and knowledge.
Only by going deeply underground and maintaining their world view and shamanic
practices in secret from the dominant Euro-American culture, has this knowledge
survived.
Early Research with Hallucinogens:
Interest in plant
hallucinogens lay dormant until the second half of the Nineteenth Century when
growing activities in the new fields of experimental physiology and pharmacology
sparked efforts at laboratory analyses of medicinal plants. In the late 1880's
German toxicologist LOUIS LEWIN, often called the "father of modern
psychopharmacology", received a collection of peyote samples from the
Parke-Davis Pharmaceutical Company. Succeeding at isolating several alkaloids
from the peyote, LEWIN was unable to determine the psychoactive component
through animal testing. Hesitating at experimenting on himself, LEWIN enlisted
the aid of a more intrepid colleague, ARTHUR HEFFTER, who ingested each of the
alkaloids until he identified the crucial one, which he named mescal (LEWIN,
1888).
Along with LEWIN'S published work, interest in plant
hallucinogens was encouraged by increasing dissemination of knowledge of the
Native American Indian use of peyote, a phenomena of increasing prevalence as
the century drew to a close. Obtaining a sample of peyote from the South-Western
plains, physician and founder of the American Neurological Association WEIR
MITCHELL, conducted an experiment using himself as the subject. Although
overwhelmed with the aesthetic power of the experience, describing that the
peyote revealed "a certain sense of the things about me as having a more
positive existence than usual, MITCHELL expressed alarm that such a profound
experience might not be successfully integrated within his contemporary context:
"I predict a perilous reign of the mescal habit... The temptation
to call again the enchanting magic of my experience will, I am sure, be too
much for some men to resist after they have once set foot in this land of
fairy colors where there seems so much to charm and so little to excite horror
or disgust" (MITCHELL, 1896).
Inspired by reports
of MITCHELL'S self-experimentation, the prominent English physician HAVELOCK
ELLIS decided to pursue a similar encounter with the plant hallucinogen, which
he later reported as an experience of unparalleled magnitude, asserting that to
"once or twice be admitted to the rites of mescal is not only an
unforgettable delight but an educational influence of no mean value" (ELLIS,
1897).
Such unqualified praise of a drug with as
yet no proven medical application, however, provoked harsh censure from the
editors of the British Medical Journal who expressed grave concern of
peyote's injurious potential and reprimanded ELLIS for irresponsibly "putting
the temptation before the section of the public which is always in search of new
sensation (BRITISH MEDICAL JOURNAL, 1898). Such a vituperative response to
ELLIS' naive efforts at publicizing and perhaps promoting auto-experimentation
with magical plants is an early harbinger of the conflict which mired and
paralyzed the field of hallucinogenic research some seventy years later.
Interest in the unusual psychogenic effects of peyote and,
following its synthesis in 1919, mescaline, continued through the 1920's.
Activities included further exploration of the unique visions induced by the
drug by a variety of literary figures and scholars introduced to its exotic
phenomena, although when WILLIAM JAMES experienced a severe gastro-intestinal
reaction upon attempting to swallow a segment of peyote he is alleged to have
stated: "Henceforth, I'll take the visions on trust" (STEVENS, 1987). A
comprehensive survey of the effects of mescaline was published by KARL BERINGER,
a close associate of HERMANN HESSE and CARL JUNG, in his massive tome "Der
Meskalinrausch" (The Mescaline Inebriation) in 1927, followed a year later
by HEINRICH KLUVER's Mescal:
The "Divine" Plant and Its Psychological Effects, the first
attempt at formal classification and analysis of mescaline visions (KLUVER,
1928).
And heralding the next phase of
hallucinogen research, mescaline was touted by psychiatric researchers as a
putative biochemical model for major mental disturbances, particularly
schizophrenia (GUTTMAN and MACLAY, 1936; STOCKINGS, 1940).
Dr HOFMANN'S Serendipitous Discovery:
The modern era of
hallucinogen research began in the laboratory of Dr. ALBERT HOFMANN, a senior
research chemist for the Sandoz Pharmaceutical Company in Basel, Switzerland. In
mid April, 1943, HOFMANN was engaged in work with the rye ergot fungus,
Claviceps purpurea, in an effort to identify a new analeptic for the
treatment of migraine headache. Acting on a premonition that he had missed
something, he returned to and prepared a fresh batch of a compound he had
previously synthesized in 1938 while searching for a potential respiratory and
circulatory stimulant, but which had proved at that time to have what were
considered to be uninteresting results in animal testing. The chemical compound
he had decided to return to after this five year hiatus was the twenty-fifth
preparation of the Iysergic acid amide series, and had previously received the
designation of LSD-25.
While resynthesizing a modest quantity
of this compound for further study, HOFMANN complained of restlessness and
feeling dizzy and decided to return to his home to rest. He subsequently would
write that upon reaching home and lying down with his eyes closed he experienced
an "extreme activity of the imagination... there surged upon me an uninterrupted
stream of fantastic images of extraordinary plasticity and vividness and
accompanied by an intense kaleidoscope like play of colors. After about two
hours, the not unpleasant inebriation, which had been experienced while I was
fully conscious, disappeared" (HOFMANN, 1983).
Realizing that
he had accidentally absorbed during the re-crystallization process a small
quantity of the compound through his skin, HOFMANN set out three days later, on
April 19, 1943, to replicate the phenomena by self administering what he
considered to be an extremely small and cautious dose, 250 micrograms. Intending
to record his subjective experiences of what he had assumed to be a very low
dose of the peculiar substance, less than an hour later HOFMANN began to feel
the onset of what was to be a powerful and indeed frightening altered state of
consciousness, and again felt compelled to return to his home. HOFMANN would
later report
"On the way home, my condition began to assume threatening
forms... Everything in my field of vision wavered and was distorted as if seen
in a curved mirror. I also had the sensation of being unable to move from the
spot. Nevertheless, my assistant later told me that we had traveled very
rapidly... My surroundings had now transformed themselves in more terrifying
ways. Everything in the room spun around, and the familiar objects and pieces
of furniture assumed grotesque, threatening forms. They were in continuous
motion, animated, as if driven by an inner restlessness... Even worse than
these demonic transformations of the outer world, were the alterations that I
perceived in myself, in my inner being. Every exertion of my will, every
attempt to put an end to the disintegrations of the outer world and the
dissolution of my ego, seemed to be wasted effort. A demon had invaded me, had
taken possession of my body, mind and soul."
Shortly thereafter, HOFMANN would describe,
"the climax of my despondent condition had passed... the horror
softened and gave way to a feeling of good fortune and gratitude... now,
little by little I could begin to enjoy the unprecedented colors and plays of
shapes that persisted behind my closed eyes. Kaleidoscopic, fantastic images
surged in on me, alternating, variegated, opening and then closing themselves
in circles and spirals, exploding in colored fountains... Exhausted, I then
slept, to awake next morning refreshed, with a clear head, though still
somewhat tired physically. A sensation of well-being and renewed life flowed
through me." (HOFMANN, 1983).
Dr. HOFMANN'S
shocking experience of madness and transcendence, precipitated by an
infinitesimally low dose of what would soon be recognized as the most potent
psychoactive substance known to man, heralded the advent of a new era of
psychiatric research committed to uncovering the mysteries of the mind and
revealing the basis of mental illness.
The Psychotomimetic Model:
ALBERT HOFMANN'S discovery of
LSD soon led to a period of intense interest and activity designed to explore
its utility as a model of understanding and treating psychotic illness. Such a
direction was consistent with earlier investigations equating the mescaline
catalyzed altered state of consciousness with the subjective experience of
schizophrenic patients (GUTTMAN and MACLAY, 1936; STOCKINGS, 1940). TAYLEUR
STOCKINGS had described the similarities between the two states:
"Mescaline intoxication is indeed a true "schizophrenia" if we use
the word in its literal sense of "split mind", for the characteristic effect
of mescaline is a molecular fragmentation of the entire personality, exactly
similar to that found in schizophrenic patients... Thus the subject of the
mescaline psychosis may believe that he has become transformed into some great
personage, such as a god or a legendary character, or a being from another
world. This is a well-known symptom found in states such as paraphrenia and
paranoia" (STOCKINGS, 1940).
Noting the enormity
of perceptual disturbances induced by LSD, coupled with the sensation in some
subjects of losing their mind, as had transiently been the case with Dr.
HOFMANN, Sandoz in 1947 began actively marketing LSD to psychiatric researchers
and practitioners as a tool for understanding psychoses. Not only was LSD
experimentation in normal subjects proposed as a viable model for studying the
pathogenesis of psychotic illness, but psychiatrists were encouraged to
self-administer the drug so as to gain insight into the subjective world of the
patient with serious mental illness (STEVENS, 1987). For a young field
struggling to gain credibility as a medical science, this model of chemically
controlled psychosis emerged as a propitious sign for the future.
Preoccupation with the hallucinogen induced psychotimimetic model
continued through the 1950's. The psychotomimetic position was summarized by one
its leading proponents, Harvard psychiatrist MAX RINKEL:
"The psychotic phenomena produced were predominantly
schizophrenia-like symptoms, manifested in disturbances of thought and speech,
changes in affect and mood, changes in perception, production of
hallucinations and delusions, depersonalizations and changes in behavior.
Rorschach tests and concrete-abstract thinking tests showed responses quite
similar to those obtained with schizophrenics" (RINKEL and DENBER, 1958).
However, it became increasingly apparent that although an impressive array of
psychiatric researchers and theoreticians had elucidated and elaborated upon
the startling degree of resemblance between schizophrenia and the
hallucinogenic experience, a growing consensus was emerging that the
dissimilarities between the two states essentially obviated the value of the
chemical psychosis model (GRINSPOON and BAKALAR,1979). Speaking at the First
International Congress of Neuropsychopharmacology in 1959, the legendary
MANFRED BLEULER enunciated the central argument in opposition to the
psychotomimetic model. He stated that it was the gradual and inexorable
progression of a symptom complex which included disturbed thought processes,
depersonalization and auditory hallucinations, evolving into a generalized
functional incapacitation which was characteristic of schizophrenia. He
concluded with the demonstrative declaration that although the psychotomimetic
drugs may have strengthened our conceptual understanding of organic psychoses,
they have contributed nothing to the understanding of the pathogenesis of
schizophrenia" (BLEULER, 1959).
Hallucinogen Research and the Role of the CIA:
Following
the end of World War II, as relations with our former ally the Soviet Union
began to deteriorate and Cold War tensions heightened, a program was initiated
by the U.S. Central Intelligence Agency to develop a speech inducing drug for
use in interrogations of suspected enemy agents. Such a search was in part
stimulated by knowledge of prior, albeit unsuccessful, efforts by Nazi medical
researchers at the Dachau Concentration Camp to utilize mescaline as an agent of
mind control (MARKS, 1979). By the early 1950's the CIA had acquired from Sandoz
Pharmaceutical a large quantity of the highly touted psychotomimetic, LSD, and
had begun their own extensive testing program. Early experiments often involved
the furtive "dosing" of unwitting subjects, including employees of the CIA and
other intelligence organizations, soldiers and customers solicited by
prostitutes in the service of the CIA. Given the ill-prepared mental set of the
victim, the often adverse setting in which the "experiment" occurred and the
lack of therapeutic aftercare, it is no surprise that highly deleterious
outcomes, including suicide, did occur. Although knowledge of this irresponsible
and ethically suspect association between the CIA and hallucinogenic substances
remained suppressed for the next twenty years, knowledge of such activities was
ultimately obtained through the Freedom of Information Act (MARKS, 1979; LEE and
SCHLAIN, 1985).
Through the 1950's, as Cold War fears
escalated, the CIA began to develop an affinity for the psychotomimetic model
then in vogue. In order to further their own goals of investigating the mind
control potentials of hallucinogenic drugs, the CIA began to recruit and fund a
number of distinguished psychiatric researchers. Included among these was Ewen
Cameron, elected President of the American Psychiatric Association in 1953 and
first President of the World Psychiatric Association. Capitalizing on the CIA's
preoccupation with LSD's purported ability to break down familiar behavior
patterns, Cameron received funding to develop a bizarre and unorthodox method
for treating severe mental illness. The treatment protocol began with "sleep
therapy", where patients were sedated with barbiturates for a several month
period, and was followed by a "depatterning" phase of massive electroshock and
frequent doses of LSD designed to obliterate past behavior patterns. Patient's
were then once again heavily sedated, and subsequently subjected to a prolonged
"psychic driving" reconditioning phase where they received constant auditory
bombardment from speakers under their pillows repeating tape recorded messages,
with some patient's hearing the same message repeated a quarter of a million
times. Given the gross excesses in all modalities of this "treatment",
inevitably severe neuro-psychiatric deterioration was incurred by many of
Cameron's unconsented subjects (MARKS, 1979; LEE and SCHLAIN, 1985). Ultimately,
the efforts of the CIA and their contract psychiatrists came to naught as their
ill-advised collaboration with hallucinogens yielded little of value to support
either the CIA's mind control theories or the psychotomimetic investigations of
psychiatric researchers.
The Psycholytic Treatment Model:
Early experimentation in
Switzerland following ALBERT HOFMANN'S discovery in the 1940's had discerned a
phenomena quite different than that of the much heralded yet bizarre
psychotomimetic mental experience. In subjects given a relatively low dose of
LSD, there appeared to occur a release of repressed psychic material,
particularly in anxiety states and obsessional neuroses. By allowing this
otherwise repressed and threatening material to flow effortlessly into
consciousness, investigators surmised that low dose LSD treatment could
facilitate the psychotherapy process (STOLL,1947). Application of the low dose
model in Europe as well as the United States ascertained that psycholytic
treatment had particular value with patients with rigid defenses mechanisms and
excessively strict superego structures. By facilitating ego regression,
uncovering early childhood memories and inducing an affective release,
psychiatrists claimed to have achieved a breakthrough in reducing the duration
and improving the outcome of psychotherapeutic treatment (CHANDLER and HARTMANN,
1960). Problems arose with the psycholytic paradigm, however, as critics noted
that the content of regressed material released from the unconscious was
extremely sensitive to the psychiatrist's own analytic orientation, in most
cases Freudian or Jungian. Questions arose over whether the phenomena observed
in the psychotherapeutic sessions, including the often positive treatment
outcome, were not simply attributable to the presence of heightened powers of
suggestibility. Moreover, with psycholytic treatments, care had to be taken to
utilize sufficiently low dosages of the hallucinogen that the patient's ego
would not be overwhelmed to the point where verbal analysis would be inhibited.
When in the course of psycholytic psychotherapy higher dosages were utilized,
the resultant experience could no longer be contained within the intended
theoretical framework, thus necessitating delineation of an entirely new
paradigm.
The Psychedelic Treatment Model:
Psychiatrists utilizing
the higher dose model, on their patients as well as self-experimenting on
themselves, quickly realized that they had accessed an entirely new and novel
dimension of consciousness. As Dr. HOFMANN had experienced during his own
exploration, this unexpected level of awareness could alternately be rapturous
or terrifying. The first psychiatrist to explore this paradigm was the Canadian
researcher HUMPHREY OSMOND. Utilizing first mescaline, and later LSD, OSMOND
devoted his studies to the treatment of alcoholism, a notoriously difficult and
refractory condition. Noting that some alcoholics were only able to cease their
pathological drinking behaviors after they had experienced a terrifying,
hallucinatory episode of delirium tremens during alcohol withdrawal, OSMOND set
out to replicate this state through utilization of a high dose hallucinogen
model. Observing that what distinguished his treatment successes from his
treatment failures was whether a transcendent and mystical state of
consciousness was attained, OSMOND recognized the strong resemblance to states
of religious conversion, bringing to mind WILLIAM JAMES' old axiom that "the
best cure for dipsomania is religiomania". Dissatisfied with the prevailing
jargon, and arguing that his model demonstrated that hallucinogens did much more
than "mimic psychosis", OSMOND introduced at the 1957 meeting of the New York
Academy of Sciences the term psychedelic, explaining that the "mind manifesting"
state did not necessarily produce a predictable and pathological sequence of
events, but rather could catalyze an enriching and life changing vision. And in
presaging the cacophonous debate that would shortly fall upon the infant field
of hallucinogen research, OSMOND concluded that the psychedelic model not only
allowed us to escape "Freud's gloomier moods that persuaded him that a happy man
is a self-deceiver", but would soon come to the aid of humanity's imperiled
existence and "have a part to play in our survival as a species" (OSMOND, 1957).
The Prohibition of Hallucinogen Research:
With the
evolution to the psychedelic model, hallucinogens moved beyond the bounds of
control of the medical elite (NEILL, 1987). No longer could they be confined to
investigations of a model psychosis, nor could they be contained within the
framework of conventional psychiatric therapies with implicit prescribed roles
for doctor and patient. By blurring the boundaries between religion and science,
between sickness and health, and between healer and sufferer, the psychedelic
model entered the realm of applied mysticism. As word of the astounding
phenomenon induced by the psychedelic model spread into the culture at large,
the inevitable backlash occurred. Horrified that this extraordinary
investigative probe had been appropriated from their control, the leaders of the
psychiatric profession directed harsh criticism at their irrepressible and
increasingly evangelistic colleagues. ROY GRINKER, the first editor of the
prestigious Archives of General Psychiatry, in a 1963 editorial castigated those
psychiatric researchers who had become preoccupied with administering "the drug
to themselves, and some, who became enamored with the mystical hallucinatory
state, eventually in their 'mystique' became unqualified as competent
investigators" (GRINKER, 1963). And a year later, in the Journal of the American
Medical Association, GRINKER charged researchers with "using uncontrolled,
unscientific methods. In fact, these professionals are widely known to
participate in drug ingestion, rendering their conclusions biased by their own
ecstasy... The psychotomimetics are being "bootlegged", and as drugs now under
scientific investigation they are being misused" (GRINKER,1964). In moving
beyond the boundaries of conventional scientific inquiry, the hallucinogens had
"become invested with an aura of magic" (COLE and KATZ, 1964), and thus could no
longer be provided the status and protection of their elite profession. The
covenant had been broken. The hallucinogens, along with the proponents of their
continued exploration, were cast out, becoming pariahs in a land and a time that
increasingly viewed them as threats to public safety and social order.
By the mid-1960's, the secret was out. Growing interest in
hallucinogens had catalyzed, and was catalyzed by, profound cultural shifts.
Along with the social upheaval surrounding opposition to an increasingly
unpopular war in South-East Asia, hallucinogens assumed a central role in a
movement that began to question many of the basic values and precepts of
mainstream Euro-American culture. The populace, fueled by sensational media
accounts, grew to identify hallucinogens as a prime suspect in inciting the
accelerating state of cultural havoc. And along with the drugs themselves,
adherents of the experimental and treatment models became increasingly
identified as part of the problem. Such circumstances were in no way improved by
the rash pronouncements from the radical wing of what had rapidly become
identified as an hallucinogen-inspired political movement. The leaders of one
notorious research group in particular drew public ire and aroused anxiety and
panic by such proclamations as:
"Make no mistake: the effect of consciousness-expanding drugs will
be to transform our concepts of human nature, of human potentialities, of
existence. The game is about to be changed, ladies and gentleman... These
possibilities naturally threaten every branch of the Establishment. The
dangers of external change appear to frighten us less than the peril of
internal change. LSD is more frightening than the Bomb!" (LEARY and ALPERT,
1962).
In response to escalating fears that
hallucinogens had become an out of control menace to public safety and cultural
stability, the government moved to restrict access to these potent agents of
change. Psychiatric leaders, gravely concerned by the threat to public mental
health, and perhaps to their professional image as well, vehemently urged
government regulating agencies to tighten their controls. ROY GRINKER,
illustrious psychiatrist and President of the American Medical Association,
issued an urgent warning to his colleagues that greater damage lay ahead unless
usage of these hazardous chemical agents were contained. Going beyond merely
calling for the psychiatry profession to take action against this growing peril,
which would include denouncing the renegades within its own ranks, GRINKER
castigated the government for having been woefully lacking in vigilance and
having neglected its duty:
"The Food and Drug Administration has failed in its policing
functions. The drugs are indeed dangerous even when used under the best of
precautions and conditions (GRINKER, 1964).
Driven into action by increasingly lurid media and law enforcement accounts of
widespread hallucinogen use among the young, amidst dire warnings that this
insidious threat would erode the values and work ethic of future generations,
government regulators had no choice but to act. In 1965 the Congress passed the
Drug Abuse Control Amendment, which placed tight restrictions on hallucinogen
research, forcing all research applications to be routed through the FDA for
approval. In April, 1966, succumbing to mounting adverse publicity, Sandoz
Pharmaceutical ceased the marketing of what their esteemed research chemist
ALBERT HOFMANN would come to call "my problem child ' (HOFFMAN,1983). Also
during the spring of 1966, Senator Robert Kennedy called for Congressional
Hearings on the problem. Kennedy, whose wife Ethel had reportedly received
psychiatric treatments with LSD, expressing concern that potentially vital
research was being obstructed, questioning:
"Why if they were worthwhile six months ago, why aren't they
worthwhile now?... I think we have given too much emphasis and so much
attention to the fact that it can be dangerous and that it can hurt an
individual who uses it... that perhaps to some extent we have lost sight of
the fact that it can be very, very helpful in our society if used properly"
(LEE and SCHLAIN, 1985).
Kennedy's pleas went
unheeded, as over the next few years more and more stringent restrictions were
imposed on hallucinogen research, culminating in the Bureau of Narcotics and
Dangerous Drugs (the predecessor to the Drug Enforcement Agency) decision to
place the hallucinogens in the Schedule I class, reserved for dangerous drugs of
abuse with no medical value. Research ground to a virtual halt. Government,
civic and medical leaders had all responded to their call to duty, permanently
expunging, they hoped, what President LYNDON JOHNSON had declared in his State
of the Union address in January, 1968, "these powders and pills which threaten
our nation's health, vitality and self-respect" (STEVENS, 1987).
Discounting Hallucinogen Research:
Hallucinogens, in the
guise of an experimental probe into the mysterious world of mental illness, had
burst on the scene during the infancy of psychiatric research. It had not only
unleashed a firestorm of controversy as a highly touted therapeutic
intervention, but had greatly contributed to the development of the exciting new
specialty of laboratory neurochemistry research. Access to these unique agents
for animal research has been permitted to continue unimpeded, and they have
contributed greatly to our understanding of neurotransmitter systems, brain
imaging techniques and behavioral pharmacology (JACOBS, 1984; FREEDMAN, 1986).
And yet, human research with hallucinogens has, until now, vanished from the
scene. Discounted for ever having held value or potential, it is as if they had
never been with us. A source of embarrassment and shame, hallucinogen research
became a non-issue, virtually disappearing from the professional literature and
educational curriculums. By the early 1970's, psychiatric researchers and
academicians had perceived that to continue to advocate for human research with
hallucinogens, or even to be identified with past interest in their therapeutic
potential, might seriously jeopardize their future careers. Difficult decisions
had to be made. From the mid 1960's onward, a split began to appear in the ranks
of psychiatric hallucinogen researchers. For those who would maintain their
enthusiasm for the potentials of these singular substances, a path of
professional marginalization would follow. For those who would take a stand
against their perfidious threat, accolades and professional advancement would be
forthcoming. For most, however, it was to be a process of quietly disengaging,
often from what had been a passionate interest, and re-directing their careers
towards tamer and less disputable areas. With very few exceptions (GRINSPOON and
BAKALAR, 1979; GRINSPOON and BAKALAR, 1986; STRASSMAN, 1984), a veil of silence
had descended over the putative role of hallucinogen research in psychiatry.
The Future of Hallucinogen Research in Psychiatry:
Where
are we to go with this most unusual class of psychoactive substances? Some would
say it is best to let sleeping dogs lie, that the hallucinogens only brought
discord and controversy to the ranks of psychiatry and their re-examination can
only lead to further turmoil and acrimony. Psychiatry has moved far beyond the
time where hallucinogens were viewed as being on the cutting edge of research
investigation. Many psychiatrists graduating from training programs in the last
decade are not even aware of the role hallucinogens once did play in the arena
of legitimate research. The conventional point of view is that these drugs are
potential substances of abuse, nothing more. Within mainstream, academic
psychiatry forums for discussion of the relative merits of resuming inquiries
into this area have been restricted. What was once a roar of often vituperative
debate has receded to barely a whisper.
Perhaps this
twenty-five year period of quiescence and retreat into relative obscurity has
been necessary to finally give the question of hallucinogens a fair hearing. We
have seen in a prior epoch of investigation a playing field painfully polarized
between ardent advocates and fervent foes of the hallucinogens' putative role as
agents of discovery and healing. The truth has always rested somewhere in
between the dichotomous poles of panacea and toxin. The protagonists of the
past, whose careers and integrity so often appeared to be interwoven with the
content and outcome of their fierce debate, are exiting the arena. Rumblings of
renewed interest are being heard within the halls of academic psychiatry. A new
dialogue is slowly starting to emerge. Hopefully, the lessons of the past will
be appreciated, and utilized to forge a partnership and collaboration where
divergent perspectives will be given a fair and open hearing, and the true
potential of the hallucinogens may finally be illuminated.
As
the sleeping giant of hallucinogen research emerges from its twenty-five year
slumber, it will perceive that the world of psychiatry has vastly changed from
when it was put to rest. The once reigning rulers of psychoanalysis have receded
to positions of relative obscurity as the field has become progressively
dominated by the adherents of biological reductionism. The insights gleaned from
the individual case study, once the standard of psychoanalytic investigation,
have been devalued and supplanted by the rigorous methodological research design
of modern psychiatry. In the future, the putative value of hallucinogens in
psychiatry can no longer rest on claims deriving from anecdotal case studies, as
inspiring as they may be, but rather must evolve out of the findings of
well-structured, controlled, scientific investigation. To achieve relevance and
be accepted as a reputable field of study, hallucinogen research must satisfy
the standards of contemporary psychiatric research. To maintain an iconoclastic
insistence that the very nature of these substances transcends standard research
design would be to prolong their marginalization and deny the opportunity to
finally explore their potential utility.
The knowledge base of
biological psychiatry and the neurosciences has exploded over the last two
decades, facilitated in part by probes and techniques developed with
hallucinogen research in animals (JACOBS, 1984; FREEDMAN, 1986). The potential
for further advances in our understanding of the mechanisms of brain function
has been recognized and enunciated at a technical meeting of the National
Institute of Drug Abuse (NIDA) in July, 1992, which concluded that it is now
time to move beyond pure animal research into the realm of human investigation.
We are now on the threshold of initiating studies utilizing state of the art
research techniques, including sophisticated brain imaging scans, neuroendocrine
challenge tests and receptor binding studies, in human subjects. The strategy of
pursuing such biological investigations will likely not only yield valuable new
information in the neurosciences, but facilitate the re-legitimization of human
research with hallucinogens and ultimately become prelude to the re-exploration
of their effects on perception, cognition and emotion.
One of
the most controversial arenas of hallucinogen research during the 1950s and
1960s, and persisting as an alluring hope, has been its putative role in
alleviating mental suffering. During a mere fifteen year period over a thousand
clinical papers were published in the professional literature discussing the
experiences of 40,000 patients treated with hallucinogens (GRINSPOON and
BAKALAR, 1979). While many of these reports were presented in the form of
descriptive case studies, and are attributed little value by contemporary
research standards, they can help point the way for future investigations. A
wide variety of psychopathological phenomena were subjected to intervention with
hallucinogens, often leading to encouraging reports of positive clinical
outcome. Unfortunately, examining these stimulating accounts in retrospect
reveals notable flaws in their design, including primitive and by today's
standards deficient measures designed to evaluate therapeutic change, lack of
outcome follow-up and unwillingness to utilize appropriate control subjects. As
the debate over hallucinogens intensified, it also became apparent that from
both warring camps investigators' biases (whether conscious or unconscious) were
confounding their results. From our current vantage point it is often difficult
to ascertain the true significance of this past research other than to
appreciate that sufficient clinical change appears to have been catalyzed that
further investigation is merited. And as we prepare to delve into the question
of the hallucinogens application to treatment models, it will be essential that
we control for the flaws that made a previous generation of research suspect.
State of the art research methodology must be utilized, including proper
attention to set and setting, control populations and measures of short and long
term treatment outcome. An atmosphere of active collaboration among
investigators with contrasting perspectives needs to be established, avoiding at
all costs the schism which led to the collapse of earlier efforts.
The Relevance of the Past:
We are on the threshold of
initiating explorations which may have considerable ramifications for our
future. There is much at stake and much to learn. But in order to take full
advantage of this opportunity we must fully understand our past, including that
which we know of from cultures distant to our own place and time. Plant derived
hallucinogens once played a vital albeit poorly appreciated role in our
prehistorical lineage (FURST 1976; DOBKIN DE RIOS, 1984). While psychiatry has
traditionally held a disparaging and pathologizing view towards shamanic belief
systems and practices (DEVEREUX, 1958), evidence supplied by transcultural
anthropological investigators (JILEK, 1971; NOLL, 1983) demonstrate that
shamanic practices may actually be conducive to high levels of psychological
health and functioning. To move beyond the commonly held psychiatric viewpoint
that shamanism is nothing more than primitivism and the prehistorical wellspring
of mental illness, would allow for receptivity to learning from a paradigm which
has incorporated for thousands of years the utilization of hallucinogens as a
vital facet of belief systems and healing practices (BRAVO and GROB, 1989). If
we are to optimally assess the true clinical efficacy and safety of the
hallucinogens, it is imperative that we be conscious of the critical
extrapharmacological variables which we know to be integral to the shamanic
model. Ample attention and sensitivity must be given to the preparation for the
hallucinogen experience, the powerful expectation effects directed toward
predetermined therapeutic goals, the formalized structure of the session and the
integration of the altered state experience in the days, weeks and months
following the experience. The failure to adhere to any of these aspects of the
shamanic paradigm would be to deny hallucinogen research the full opportunity to
test its true value.
What removes the shamanic world view so
far from our own, and consequently presents the greatest challenges when
attempting to incorporate its insights into contemporary research methodology,
is the belief that the plant hallucinogens are sacraments of divine origin.
However, it is this reverential and spiritual utilization of psychoactive
substances which so pointedly distinguish the practices of tribal and shamanic
peoples from our own contemporary profaned and pathologized context of drug
abuse. Hallucinogens in the shamanic world have traditionally played a critical
role in rites of initiation, providing personal regeneration and radical change,
and are perceived as essential to the process of growth and maturity and the
acquisition of meaning (GROB and DOBKIN DE RIOS, 1992; ZOJA, 1989). They are not
misused or abused, and are not agents of societal chaos and destruction. Their
use is fully sanctioned and integrated into the mainstream of society, and
commonly utilized in ritually prescribed and elder facilitated ceremonies. The
hypersuggestible properties of the hallucinogens, utilized within an highly
controlled set and setting, achieves a powerful effect reinforcing cultural
cohesion and commitment. These apparent beneficial effects of shamanic
hallucinogen use contrast markedly with the destructive outcomes often observed
in our own contemporary contexts (DOBKIN DE RIOS and GROB, 1993).
An Illustrative Model:
One of the most exciting areas of
investigation from the past era of hallucinogen research was the treatment of
severe, refractory alcoholism. In the 1950s psychiatric researchers had
identified the similarities between the spectrum of the LSD experience and the
phenomenology of delirium tremens (OSMOND, 1957; DITMAN and WHITTLESEY,1959). As
alcoholism was notorious for its lack of responsiveness to conventional
treatment approaches, great interest and energies were directed towards this
area of study. Highly impressive short term results of treatment with
hallucinogens (CHWELOS et al, 1959; MACLEAN et al, 1961; VAN DUSEN et al, 1967)
gave impetus to a surge of enthusiasm that a dramatic and effective intervention
had finally been found. Additional support was forthcoming from BILL WILSON, the
founder of Alcoholics Anonymous, who revealed that his own carefully supervised
experiences with LSD had not only been an highly valuable personal experience,
but also fully compatible with the tenets of the movement he had started (GROF,
1987). However, as the level of discord within the psychiatric profession and
the degree of alarm in the public heightened, resistance to accepting the
hallucinogen model for alcoholism intensified. As mainstream psychiatry could no
longer stand idly in the face of threatened radical upheaval, so the Board of
Trustees of Alcoholics Anonymous felt compelled to reject their creator BILL
WILSON'S proposed endorsement.
It soon became apparent that
the methodological shortcomings of the research alleging to demonstrate
unequivocally positive results in the treatment of alcoholism would undermine
progress in the field. Poorly controlled research design, with questionable
measures of change and inadequate follow-up, led to charges that hallucinogen
advocates had been blinded by their own enthusiasm and had misinterpreted and
misrepresented their findings. Opponents of the hallucinogen treatment model
would subsequently conduct their own clinical trials, designed to refute what
they perceived as dangerous and exaggerated claims of therapeutic success (SMART
et al, 1966; HOLLISTER et al, 1969; LUDWIG, LEVINE and STARK, 1970). These
studies, which purported to demonstrate an entire lack of treatment efficacy of
models utilizing hallucinogens, were received by the psychiatric establishment
with great relief. In fact, the LUDWIG, LEVINE and STARK study provided such
reassurance to a profession so shaken by its own iconoclasts, as well as
satisfying contemporary formal medical research standards with such aplomb, that
it was awarded the prestigious Lester N. Hofheimer Prize for Research from the
American Psychiatric Association. Nevertheless, the investigations designed to
provide the last word on the "failed" hallucinogen treatment model have
themselves come under scathing attack. Not only have the investigators lack of
appreciation of set and setting, failure to adequately prepare their patients
for the experience and refusal to allow for follow-up integration been
identified (GRINSPOON and BAKALAR, 1979), but the capricious nature of medical
research has itself been implicated, "At a time when LSD was popular, LEVINE and
LUDWIG (1967) had reported positive results. .. When LSD fell out of favor and
the positive results became politically unwise, they obtained negative results.
Unconsciously or consciously they built into their study a number of
antitherapeutic elements that guaranteed a therapeutic failure (GROF, 1980).
The discussion of the potential role of hallucinogens in the
treatment of alcoholism, and by inference its application to other psychiatric
disorders as well, would not be complete without an examination of the role of
the plant hallucinogen, peyote, in the treatment of Native American Indians.
Evidence exists that peyote was in widespread use in Central America and revered
as a medicine and religious sacrament as early as 200 B.C. (FURST, 1976). After
the American Civil War, the use of peyote moved north of the Rio Grande River
and quickly spread to dozens of native tribes throughout the United States and
Canada. During the 1870s and 1880s a peyote vision religion developed in
reaction to the inexorable encroachment of non-native peoples onto the Indian
lands and the associated, deliberate destruction of native culture. With the
defeat and subjugation of the Native American people, alcoholism became
epidemic. Although until recently faced with unrelenting political repression by
the U.S. government, the Native American Church, a syncretistic church combining
elements of traditional Indian religion and Christianity and utilizing peyote as
its ritual sacrament, has been recognized by anthropologists and psychiatrists
as being the only effective treatment for endemic alcoholism (SCHULTES, 1938, LA
BARRE, 1947, BERGMAN, 1971, ALBAUGH and ANDERSON, 1974). KARL MENNINGER, a
revered figure in the development of American Psychiatry in the 20th Century,
has stated:
"Peyote is not harmful to these people; it is beneficial,
comforting, inspiring, and appears to be spiritually nourishing. It is a
better antidote to alcohol than anything the missionaries, the white man, the
American Medical Association, and the public health services have come up
with." (BERGMAN, 1971).
Integral to the positive
treatment outcome with peyote has been its sacramental utilization within the
ritual context of mystical-religious experience. The Native American Church is a
clear contemporary example of the successful application of the shamanic model
to the treatment of severe, refractory illness. Although the Native American
Church applies to a circumscribed and relatively homogenous population, it
provides a valuable lesson on the importance of the shamanic model and the need
for attentiveness to set and setting, intention, preparation and integration, as
well as group identification. If we are to develop optimal research design for
evaluating the therapeutic utility of hallucinogens, it will not be sufficient
to adhere to strict standards of scientific methodology alone. We must also pay
heed to the examples provided us by such successful applications of the shamanic
paradigm. It will only be then, when we have wedded our state of the art
research designs to the wisdom accrued from the past, that we will adequately
appreciate what role hallucinogens may have in our future.
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