Alchemists Smile

The Ecstasy and the Agony

2009-08-11T08:05:00.000-07:00

The Ecstasy and the Agony
Matt Palmquist

MDMA holds promise as part of a therapy that helps post-traumatic stress patients confront and extinguish their fears. But ecstasy's recreational reputation has slowed research.

For people suffering from post-traumatic stress disorder — an anxiety condition that develops in the wake of extreme psychological stress or fear — often the only way forward is to confront the very memory that triggers the disorder. While group and cognitive therapies have shown promise, exposure-based therapies have become increasingly popular and successful. Exposure means confronting a distressing memory (a near-death experience, the loss of a loved one or a sexual assault, for example) to emotionally process it in a safe clinical environment — either through imagined scenarios or real-life exposure to reminders of trauma. The therapy is intended to help the patient "re-learn" a non-debilitating response to a trigger of fear. It's a phenomenon known as extinction learning.

Even with this approach, about 40 percent of patients continue to experience some level of post-traumatic stress after therapy. To reduce that number, scientists have been investigating a range of drug therapies in recent years to improve exposure therapy, which is not intended to "erase" a patient's memories but rather to help them process the painful stimulus as merely a memory, and not an event that will happen — or threaten them — again. The therapy requires patients to confront their anxieties, but researchers believe medication — including MDMA — can help by making the patient feel safer, more in control, more able to process emotions and less evasive or dispirited.

Earlier this year, a pair of Norwegian scientists published a paper in the Journal of Pharmacology titled "How could MDMA help anxiety disorders? A neurobiological rationale." Authors Pål-Ørjan Johansen and Teri Krebs, who are based at the Norwegian University of Science and Technology and receive funding from the Research Council of Norway, propose that the substance 3,4-methylenedioxymethamphetamine — also known as MDMA or as the street drug ecstasy — holds significant therapeutic promise for patients with post-traumatic stress disorder. As they write, "MDMA [ecstasy] has a combination of pharmacological effects that ... could provide a balance of activating emotions while feeling safe and in control."

To learn more about their studies of MDMA and post-traumatic stress disorder, Miller-McCune conducted an e-mail interview with the two researchers in Norway. They responded jointly.

Miller-McCune: Could you provide an overview of the ideas behind exposure therapy and how MDMA works to quell anxiety in that context?

Krebs & Johansen: A lot of people wonder: How is it possible that a few doses of MDMA, in combination with psychotherapy, could have lasting benefits for anxiety? Doesn't it just make people feel happy for a few hours? Aren't most psychiatric medications taken daily for a long time? There is a common misconception that psychotherapy is a really long process of vaguely defined "talking" and that it probably isn't that effective anyway. Actually, exposure therapy (in particular "prolonged exposure therapy," as developed by Dr. Edna Foa at the University of Pennsylvania) is short-term, structured, based on scientific behavioral principles of conditioning and extinction, and validated by many controlled studies. For most patients, exposure therapy has clinically significant effects on anxiety after a few hours, and for PTSD, exposure therapy has demonstrated long-term positive results after 10 to 12 hourlong weekly therapy sessions.

If MDMA could facilitate exposure, then it is entirely understandable that MDMA-augmented therapy could have lasting long-term effects on PTSD symptoms, after a few four- to six-hour therapy sessions with MDMA, within a course of short-term therapy. This needs to be demonstrated repeatedly in clinical trials, but it is biologically plausible. In the last 10 years, there has been a large amount of research on the molecular mechanisms of fear extinction with an objective of making exposure therapy easier, faster or more effective.

The main point that we want to get across: Fear extinction in exposure therapy requires a balance of activating emotions while feeling safe and in control. MDMA has effects that combine together many of the proposed mechanisms for enhancing fear extinction. Interestingly, MDMA appears to both facilitate exposure as well as augment extinction learning. Therefore, more research on these aspects of MDMA is clearly appreciated.

M-M: How was the therapeutic potential of MDMA first discovered? And what made you begin to think of using MDMA in this therapeutic context?

K & J: MDMA was first synthesized by Merck back in 1912, but it was never tested on humans. It was rediscovered in the late 1960s, and the therapeutic potential was immediately recognized by chemist Alexander Shulgin. Shulgin introduced MDMA to physicians who used MDMA to augment psychotherapy in the early '80s.

We have been in a kind of plateau the last decade; we need to develop new treatments beyond timid half-modifications of treatment models. ... We have acquired a lot of knowledge about the brain circuits of fear and fear extinction from animals. Recently we have started to move over the hump of being stuck in the same place. By translating principles from research on extinction and animal learning into clinical studies of exposure therapy, new strategies for combining pharmacological and exposure-based treatments have emerged.

M-M: What makes post-traumatic stress disorder a particularly viable condition to target with MDMA? Is it specifically because of the use of exposure therapy in treating the disorder?

K & J: Chronic post-traumatic stress disorder is an often-complex disorder that occurs in response to a traumatic event involving perceived personal threat, such as rape, torture, physical assault or combat. Most pharmacological interventions to PTSD are daily treatments involving long-term mechanisms presumed to correct biochemical abnormalities. In contrast, prolonged exposure therapy is a short-term treatment and, consistent with extinction models of fear inhibition, prolonged exposure therapy leads to long-term improvement. Applying psychotherapy to PTSD has gained substantial support and is today regarded as the treatment of choice. However, not all people benefit from the treatment.

People with PTSD often avoid triggers or reminders of the trauma and feel emotionally disconnected or are unable to benefit from the support of others — likely contributing to the development and maintenance of the disorder. A goal during exposure therapy for PTSD is to recall distressing experiences while at the same time remaining grounded in the present, according to Dr. Edna B. Foa. Emotional avoidance is among the most common obstacles in exposure therapy for PTSD, and within a particular session, a high emotional engagement predicts a better outcome.

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As illicit versions of MDMA hit the streets in the early 1980s, becoming especially popular in gay night clubs before spreading in the 1990s to underground music parties known as raves, researchers were also taking a renewed interest in its therapeutic potential, and the World Health Organization's Expert Committee decided to examine studies of the drug as an aid to treatment of a variety of mental afflictions. In 1985, the committee called MDMA an "interesting substance" and concluded: "While the Expert Committee found the reports intriguing, it felt that the studies lacked the appropriate methodological design necessary to ascertain the reliability of the observations. There was, however, sufficient interest expressed to recommend that investigations be encouraged to follow up these preliminary findings."

On July 1, 1985, however, MDMA became the first (and still only) drug classified as Schedule I under a new law that allowed the U.S. Drug Enforcement Agency to place an emergency ban on drugs it deemed dangerous to the public. When the government was sued by a group of psychologists, psychiatrists and researchers, Francis L. Young, an administrative law judge for the U.S. Department of Justice, analyzed the literature and concluded that, prior to its being proscribed, MDMA did have "a currently accepted medical use in treatment in the United States. ... [I]t is not presently being used in treatment because it has been proscribed."

Young went on: "In addition, other psychiatrists have been using MDMA in their practices over the past 10 years. Because MDMA cannot be patented, no pharmaceutical company has had the financial incentive to carry out the extensive animal and clinical tests required by the FDA for approval to market the drug on an interstate basis. Nevertheless, the overwhelming weight of medical opinion evidence received in this proceeding concurred that sufficient information on MDMA existed to support a judgment by reputable physicians that MDMA was safe to use under medical supervision. No evidence was produced of any instances where MDMA was used in therapy with less than wholly acceptable safety."

Although Young recommended that MDMA be placed in Schedule III — allowing it to be manufactured, used on a prescription basis and subject to further research — the DEA maintained its Schedule I ruling. It wasn't until 1993 that the Food and Drug Administration approved clinical trials on the effects of MDMA on human volunteers.

In her seminal work on the drug, Ecstasy: The Complete Guide, New York psychiatrist Dr. Julie Holland notes that the drug acquired its street name largely on the basis of its marketing potential, but that even early users acknowledged its empathetic, therapeutic aspects. "It is widely accepted that the name ecstasy was chosen simply for marketing reasons," she writes. "It is a powerful, intriguing name to attach to a psychoactive substance. The person who named the drug, an alleged dealer who wishes to remain anonymous, had this to say: 'Ecstasy was chosen for obvious reasons, because it would sell better than calling it empathy. Empathy would be more appropriate, but how many people know what it means?'"

M-M: Obviously, the public at large will associate MDMA with the recreational drug ecstasy. How do you distinguish between clinical use of MDMA in a controlled setting and the illicit use of ecstasy at raves or parties?

K & J: MDMA has many potential side effects, most notably increased blood pressure and heart rate, which must be considered when screening and monitoring clinical subjects. As with other pharmaceuticals, it is important to distinguish between the risks of controlled clinical use of MDMA in research and hospital settings, and illicit use of "ecstasy" of unknown purity and dosage taken in potentially unsafe circumstances without medical supervision.

It's important to discriminate between medical research and drug policy. One area cannot be used to promote the other, and vice versa. It is inconsistent with traditional medical ethics or outright unethical to block treatment development and research based on drug policy. Drugs with greater potential for dependence and harm than MDMA, such as amphetamines (Adderall) and benzodiazepines (Valium), are widely prescribed for long-term use.

Treatment with MDMA involves only a few doses in combination with psychotherapy taken in a controlled clinical setting with appropriate medical precautions — for example, pre-screening for heart problems. It's also important to note that MDMA is not being considered for daily use or take-home use. In research studies, including in the United States, MDMA has been given to hundreds of healthy volunteers, with no occurrence of serious problems requiring medical attention. There has been a lot of misunderstanding in the past; fortunately a lot of development in this area over the last 10 years has made the climate ready for change.

M-M: From reading your paper, it seems the key role MDMA plays is helping patients overcome "emotional avoidance" of the trauma they experienced in the past. What are the biological reasons that MDMA works so well in this context?

K & J: In order for extinction to begin at all, the PTSD client has to be able to bearably remember and describe the traumatic memory. This is difficult for most PTSD clients. Activation of the fear is required for extinction. Anxiety-reducing pharmaceuticals like benzodiazepines can be counterproductive during exposure therapy (because they can merely suppress the memory for a period of time).

MDMA is found to do several things: It increases the level of oxytocin related to pro-social behavior and bonding, it increases activity in prefrontal brain areas involved in fear inhibition, and it increases the levels of norepinephrine and acetylcholine, which are neurotransmitters involved in emotional arousal and consolidation of emotional memories, including extinction learning. Consistent with fear inhibition models and translational research, we suggest that MDMA co-administered with prolonged exposure therapy will improve the therapeutic alliance, increase emotional processing and lead to enhanced extinction of fear responses.

M-M: Why do you think MDMA's potential in this area has been under-appreciated? Is it because of the negative attention on ecstasy?

K & J: MDMA and treatment research has been caught up with drug policy. However, it is common for new treatments to take a couple of decades to be fully tested and accepted. There is a great deal of interest among clinicians and scientists in the therapeutic potential of MDMA. It has been a silent story for 20 years. Previously, the only published results were open-label case studies. Now we have randomized, placebo-controlled studies.

We will see more research on the possible therapeutic applications of MDMA. It has been under-appreciated that the neurobiological effects of MDMA fit well with the current understanding of emotional learning and evidence-based treatments for anxiety. There has been a lot of research on MDMA, including clinical studies in over 300 healthy volunteers, but almost all research has focused on the possible risks in a recreational setting.

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Krebs and Johansen would like to see more basic research on the impacts of MDMA on empathy, positive emotions and trust. That means studies in both animals and humans that more closely examine the acute effects of MDMA on behavior, endocrine levels and brain activity in response to emotional stimuli, particularly during the process of fear extinction wherein people can learn to suppress a reaction to fright by repeatedly confronting, in a safe environment, whatever memory or stimulus spurs their anxiety. But so far, there have only been a few studies, which have taken years to get approval, taking a close look at MDMA's therapeutic benefits.

The Multidisciplinary Association for Psychedelic Studies, a nonprofit group that funds therapeutic trials of MDMA, LSD, psilocybin and marijuana in accordance with FDA, European and international guidelines, has been working since its founding in 1986 to spur research into MDMA therapy. In February 2004, after approval from the FDA and on-site inspections of laboratories, the DEA gave its first consent to a study of MDMA and post-traumatic stress disorder by Dr. Michael Mithoefer, a psychiatrist in South Carolina. The $1 million project wound down last year, after what MAPS called an "outstanding demonstration of the safety and efficacy of MDMA-assisted psychotherapy in subjects with treatment-resistant PTSD."

MAPS has also initiated a study of MDMA-assisted psychotherapy in subjects with both anxiety and advanced-stage cancer at Harvard Medical School's McLean Hospital, led by Dr. John H. Halpern. There is also a study under way in Israel under the direction of Dr. Moshe Kotler, chair of the department of psychiatry at the Sackler School of Medicine at Tel Aviv University and former chief psychiatrist of the Israeli Defense Forces; a similar study has begun in Switzerland. The results of those studies should be released this year, while MAPS is working on initiating additional trials in Canada, Spain, France and Jordan.

But it's not all progress. MAPS' first study of MDMA's effects on post-traumatic stress disorder began in Spain in February 2000, but the study was halted in May 2002, in spite of sustained positive media attention throughout the country. As the doctor who led the study, Jose Carlos Bouso, wrote to the Spanish Medical Journal: "In May 2002, a news article appeared in the newspaper El Pais informing the public about the realization of that trial. The next day, our research team received an inspection from the General Direction of Pharmacy and Sanitary Products (Dirección General de Farmacía y Productos Sanitarios) belonging to the State of Madrid ... on May 13, 2002, the manager of the Hospital Psiquiatrico de Madrid decided to disassociate the Hospital from the study. Since then, because we have no other hospital in which to finish the study, the study cannot be restarted yet and it is now interrupted." Before the trial's close, six subjects had been treated without any lingering side effects, and there were hints of the program's efficacy.

In their interview with Miller-McCune, Krebs and Johansen said: "The biological basis of empathy and positive emotions is currently very interesting for neuroscientists. Many scientists would like to study MDMA, in humans and laboratory animals, but they are unsure how to approach this. We hope that our rationale will provide a framework for future studies and a nice reference for grant authorities. It's a promising treatment, being developed internationally, including at Harvard Medical School. Our overall goal is to reduce fear and increase acceptance around the concept of therapeutic use of MDMA."

Hallucinogenic Drugs in Psychiatric Research and Treatment:Perspectives and Prospects

2009-08-11T08:00:00.000-07:00

Hallucinogenic Drugs in Psychiatric Research and Treatment:
Perspectives and Prospects
Rick J. Strassman, M.D.
The Journal of Nervous and Mental Disease, Vol. 183, No. 3, pp. 127-138.
©1995 Williams & Wilkins

Clinical research with hallucinogens has resumed after a generation's hiatus. To place these new studies in context, this article reviews the history of hallucinogens' use and abuse, discusses their pharmacological properties, and highlights previous human studies. Research with Iysergic acid diethylamide and related hallucinogens with thousands of patients and control subjects was associated with acceptable safety when subjects were carefully screened, supervised, and followed up. Data were generated regarding hallucinogens' psychopharmacology, overlap with endogenous psychoses, and psychotherapeutic efficacy. Current American and European studies emphasize systematic psychopharmacology, in addition to psychotherapy protocols. Human hallucinogen research will help define unique mind-brain interfaces, and provide mechanistic hypotheses and treatment options for psychiatric disorders. It is critical that human hallucinogen research in the l990s make use of state of the art methodologies, or consensually define when modifications are required. Training and supervisory issues also must be explicitly addressed.

Hallucinogenic substances found in fungi, plants, and animals have been used on all continents, and in a wide variety of cultures, both highly advanced and preliterate (Dobkin de Rios, 1984). Mescaline, from the peyote cactus, has been used in clinical research protocols from the 1890s to the present (Mitchell, 1896). The thousand-times more potent effects of LSD-25 were discovered in 1943 by Albert Hofmann, 5 years after its synthesis (Stoll, 1947). The beginning of modern "biological psychiatry" can be said to have started as much with the appreciation of LSD's "psychotogenic" effects as the contemporaneous discovery of the one-thousandth as potent "antipsychotic" effects of chlorpromazine.
The study of hallucinogenic drugs in humans was, and remains, important for several reasons. First, they elicit a multifaceted clinical syndrome, affecting many of the functions that characterize the human mind, including affect, cognition, volition, interoception, and perception. Characterizing hallucinogens' properties will enhance understanding of important mind-brain relationships, particularly relevant in this, the Decade of the Brain. Second, naturally occurring psychotic syndromes share features with those elicited by these drugs. Understanding effects and mechanisms of action of hallucinogens may provide novel insights and treatments into endogenous psychoses. Third, increasing use and abuse of hallucinogens over the last several years, particularly LSD, by young adults may produce a similar spate of adverse psychiatric sequelae seen with the first wave of their illicit use in the 1960s. Treatment of these adverse effects consume scarce public resources and safe, selective, and efficacious treatments of acute and chronic negative effects of these drugs are needed. Finally, the enhancement of the psychotherapeutic process, sometimes in treatment refractory patients, reported by early studies, has relevance to current emphasis on time-limited psychotherapeutic interventions.

Nomenclature
Many terms have been used to describe the effects of these drugs, including psychedelic (mind manifesting), psychodysleptic (disturbing the mind), phantasticant, psychotogen, oneirogen (producing dreams), entheogen (generating religious experience), phanerothyme (making feelings visible), psychotomimetic, and schizotoxin (Grinspoon and Bakalar, 1979; Stafford, 1992). Psychedelic represents the nonmedical, recreational, and illicit use of these drugs, while hallucinogen refers to these compounds within a medical-legal context.
The "classical" hallucinogens belong to several chemical families: phenethylamines (e.g., mescaline), indolealklyamines (e.g., psilocybin and N,N-dimethyltryptamine [DMT]), and lysergamides (e.g., LSD and morning glory seeds) (Nichols et al., 1991). 3,4-Methylene-dioxymethamphetamine (MDMA) ("X," "XTC") is a methoxylated amphetamine (phenethylamine), and produces effects that overlap those of classical compounds (Lister et al., 1992). Low doses of the dissociative anesthetics, phencyclidine and ketamine (Siegel, 1978), and antimuscarinic agents (Ketchum et al., 1973) also share subjective properties with the hallucinogens. However, hallucinogens do not produce anesthesia at high doses, as do the former compounds, nor is there a clouding of consciousness at "psychedelic" doses, as with the latter.
A clinically useful manner of representing hallucinogens refers to their temporal properties: onset, peak effect, and duration of action. An "ultra-short-acting" drug's onset is less than 1 minute, peak effects occur within 5 minutes, and duration is 30 minutes or less. Intravenous DMT is an example (Strassman et al., 1994). A "short-acting" hallucinogen's onset is between 5 and 15 minutes, peak effects are within 15 to 60 minutes, and duration is 1 to 2 hours (e.g., intramuscular N,N-diethyltryptamine; Faillace et al., 1967). "Intermediate-acting" hallucinogens include the orally active tryptamine psilocybin (Rinkel et al., 1960). Onset is within 15 to 30 minutes, peak effects are at 1 to 3 hours, with duration up to 6 hours. "Long-acting" hallucinogens include oral LSD and mescaline (Hoch et al., 1952), with onset at 30 to 90 minutes, peak effects at 3 to 5 hours, and duration of 8 to 12 hours. "Ultra-long-acting" compounds include the poorly characterized African plant drug ibogaine (Fernandez, 1982). Duration of action may last 18 to 24 hours.

Prevalence of Use
Hallucinogen use in the United States remained relatively constant from the late 1960s to the late 1980s (Pope et al., 1990). However, data from the National Institute on Drug Abuse (NIDA) show an increase in any LSD use by high school seniors "within the last 12 months" from 4.8% to 5.6% from 1988 to 1992. While the magnitude of this rise is slight, it stands in contrast to the abuse of other drugs. For example, the proportion of seniors who had used any cocaine dropped from 7.9% to 3.1% during the same period (Johnston et al., 1993). Thus, the proportion of respondents who reported any use of LSD was almost twice as high as the proportion reporting any cocaine use by high school seniors in 1992. The 1990 NIDA statistics reveal that lifetime prevalence rates for hallucinogens were about the same as those for cocaine, and 7 to 8 times higher than for heroin. LSD ranked first in the categories of "most intense" and "longest" high among respondents. Between 13 and 17 million individuals in this country have used a hallucinogen at least once (NIDA, 1991).

Legal Status
Hallucinogens reside in Schedule I of the Controlled Substances Act of 1970, which is reserved for drugs with "high abuse potential," "lack of established safety even under medical supervision," and "no known use in medical treatment" (Anonymous, 1970). Compounds with "substantially similar" structure or function also are Schedule I drugs, as a result of the passage of the Controlled Substances Analog Bill of 1986 (Anonymous, 1986).
The use of mescaline-containing peyote by the Native American Church has been debated for nearly a century (La Barre, 1989). Native American Church members may possess and ingest peyote in several states, and non-Native Americans may use it in Church ceremonies in some. In response to increasing judicial restrictions on peyote use, the Religious Freedom Restoration Act became law in 1993 (Anonymous, 1993). Interpretation of this law with respect to hallucinogenic "sacraments" by traditional non-Western (Rivier and Lindgren, 1972) and other "neo-religious" groups will be of interest.

Basic Neuropharmacology
The nearly simultaneous discoveries of serotonin (5HT) and LSD undoubtedly have had an impact on the preeminent role of this neurotransmitter in explicating hallucinogens' effects and mechanisms of action. Noradrenergic (Horita and Hamilton, 1969), dopaminergic (Ahn and Makman, 1979), and cholinergic (Cervoni et al., 1963) systems have also been investigated, but have received less attention.
Gaddum and Hameed (1954) and Woolley and Shaw (1954) first suggested that LSD antagonized the effects of 5-HT in lower animals. Soon thereafter, Freedman (1961) showed that LSD decreased particulate binding of 5-HT in the axon, raising brain levels of 5-HT and lowering those of its metabolite 5-hydroxyindoleacetic acid. 5-HT mechanisms have been demonstrated for electrophysiological (Aghajanian et al., 1968), pharmacological (Conn and Sanders-Bush, 1986), and behavioral (Glennon et al., 1985) effects of hallucinogens.
The animal model of "hallucinogenesis" most used is drug discrimination, wherein animals are trained to distinguish between a hallucinogen, usually LSD, and saline. Animal responses to a test drug as if it were LSD suggest that the "interoceptive" or "discriminative" cue is similar to LSD's (Glennon et al., 1983). However, several nonhallucinogens are LSD-like in this model, such as quipazine (Cunningham and Appel, 1987) and lisuride (Nielson, 1985), while psilocybin is not (Koerner and Appel, 1983), which emphasizes the need for human studies.
Hallucinogens were important in stimulating the burgeoning field of 5-HT receptor subtypes (Peroutka and Snyder, 1979). Current data emphasize effects upon the 5-HTlA and 5-HT2A,C subtypes (Glennon et al., 1985; Spencer et al., 1987), alone or in combination (Arnt and Hyttel, 1989).
Tolerance (Freedman et al., 1958) and cross-tolerance (Appel and Freedman, 1968) to behavioral effects of hallucinogens is seen rapidly, and is accompanied by downregulation of 5-HT2 sites (McKenna et al., 1989).

Human Psychopharmacology
Measurement of Hallucinogen Effects in Humans
Initial human studies with hallucinogens relied upon careful clinical observation, using psychoanalytic (Savage, 1952) or behavioral (Cheek and Holstein, 1971) perspectives, in normal subjects (Snyder et al., 1967) and psychiatric patients (Hoch et al., 1952). In addition, hallucinogen effects on previously validated psychological scales, such as the MMPI (Belleville, 1956), assessed change scores within individuals and allowed comparisons between hallucinogen-induced syndromes in normal subjects with other well-characterized psychopathological states.
Three rating scales were developed specifically for LSD effects in the 1960s. "Normative" data for all three scales were generated from effects in unexperienced hallucinogen users who were not told what the effects of LSD might be, making the data difficult to interpret, particularly when an attempt is made to determine their reinforcing properties in those who use them recreationally.
The Abramson et al. (1955) scale emphasized somatic, cognitive, and perceptual effects of LSD, while the Linton-Langs scale (Linton and Langs, 1962) assessed effects predicated on a psychoanalytic theory of consciousness. The Addiction Research Center Inventory (Haertzen et al.,1963), the standard rating scale for assessing effects of drugs of abuse, used LSD as one of several mind-altering compounds. Its LSD scale is known as the dysphoria scale, reflecting its emphasis on unpleasant effects (Haertzen and Hickey, 1987).
We have developed a new instrument, the Hallucinogen Rating Scale (HRS), that differs from these previous scales. It was drafted by interviewing experienced hallucinogen users, and modified during pilot studies with DMT in an additional cohort of well-prepared, educated, well-functioning, experienced hallucinogen users (Strassman et al., 1994).
The HRS also differs from other rating scales in its emphasis on a "mental status examination" clustering of items. In the Abramson et al. scale, derivative factors, such as paranoid ideation and generalized inhibitory effects, are used. The Linton-Langs scale also uses this manner of grouping items: feeling less inhibited and suspiciousness are examples. In the Addiction Research Center Inventory, similarities or differences between a test drug and "reference" drugs are made, without determining the nature of these similarities or differences. In the HRS, items are grouped into six "clinical clusters": somaesthesia (somatic/interoceptive/visceral cues), affect, perception, cognition (thought content and processes), volition (willful ability to interact with one's mental and physical self and the environment), and intensity (a global measure of robustness of response). These clinical clusters provided better resolution of subtle dose effects for DMT than multiple biological measurements in initial dose-response studies. Principal components factor analysis, choosing six factors to correspond to the clinical clusters, also proved superior to biological variables in differentiating among DMT doses, but generated a less heuristically useful grouping of individual items (Strassman et al., 1994).

Route of Administration
Whether LSD and longer-acting compounds produce their effects directly, or require secondary, "downstream" mechanisms, has been debated, because of the delay in onset of effects of LSD even with intravenous administration (Aghajanian and Bing, 1964). However, Hoch (1956) described nearly instantaneous onset of LSD effects with intraspinal administration, and intravenous DMT effects also are immediate (Strassman et al., 1994). Thus, access of drug to relevant brain sites, lipid solubility, clearance, and other pharmacokinetic factors determine the time course of drug effects, rather than secondary processes. However, there may be systems downstream from 5-HT receptor agonism that require extremely short time domains for activation.

Tolerance
LSD and other classical compounds elicit behavioral tolerance (Isbell et al., 1956) and cross-tolerance (Abramson et al., 1960a) after several daily doses. The exception is DMT, for which no behavioral tolerance has been demonstrated (Gillin et al., 1976), and which elicits a fully hallucinogenic response in LSD-tolerant subjects (Rosenberg et al., 1964).

Human Hallucinogen-Neurotransmitter Interactions
Serotonin. Bromo-LSD, a potent 5-HT antagonist in lower animals (Cerletti and Doepfner, 1958), although psychoactive in humans at much higher doses than LSD (Isbell et al., 1959b), antagonized LSD effects in both normal subjects (Ginzel and Mayer-Gross, 1956) and psychiatric patients (Turner et al., 1959). Cyproheptadine, a 5-HT2A c antagonist (Hoyer and Schoeffter, 1991), prevented the subjective effects of DMT in two of three normal volunteers (Meltzer et al., 1982). 5-Hydroxytryptophan loading studies attempted to surmount the 5-HT antagonism of LSD in humans, but did not demonstrate clinically relevant effects (Pare and LaBrosse, 1963). Chronic monoamine oxidase inhibition reduced LSD's effects in humans (Resnick et al., 1964), perhaps relating to downregulation of 5-HT sites. MAO inhibition also reduced DMT effects (Sai-Halasz, 1963). This latter phenomenon may relate to inhibition of DMT metabolism (Sitaram et al., 1987). Reserpine, if administered at adequate dosage and duration, enhanced responses to LSD in humans (Isbell and Logan, 1957; Resnick et al., 1965), supporting a functional "upregulation" of relevant mechanisms.
Both meta-chlorophenylpiperazine (Kahn and Wetzler, 1991) and 6-chloro-2-(1-piperzinyl)pyrazine (MK-212) (Murphy et al., 1991) share pharmacological characteristics with the classical hallucinogens, and elicit "hallucinogenic" effects in patients with schizophrenia (Krystal et al., 1993) or alcoholism (Lee and Meltzer, 1991), but not in normal subjects (Murphy et al., 1991). Higher doses in normal subjects may produce more typical responses.
Dopamine. LSD has agonist effects at postsynaptic receptors (Burt et al., 1976), and DMT has dopamine-releasing properties (Haubrich and Wang, 1977). While chlorpromazine was suggested to be a "specific antidote" to LSD effects (Isbell and Logan, 1957), it may enhance LSD's effects if given during the acute intoxication (Abramson et al., 1960b; Schwartz, 1967). Similarly, haloperidol pretreatment enhanced the neuroendocrine and subjective effects of DMT in one subject (Meltzer et al., 1982). In addition, methamphetamine (a dopamine agonist) ameliorated acute LSD effects (Hoch, 1956). Thus, affinities of hallucinogens for dopamine receptors, relative to primarily dopaminergic or antidopaminergic compounds, may determine the end result of manipulating dopaminergic neurotransmission on responses to hallucinogens. Other. Little data exist regarding manipulating cholinergic (Isbell et al., 1959a) and adrenergic (Murphree, 1962) systems on hallucinogen effects in humans, and require further study.

Hallucinogens and Schizophrenia
The association between ingestion of hallucinogens and onset of acute schizophrenic episodes is discussed below (see Adverse Effects). One of the initial indications for LSD in clinical research was for elicitation of a time-limited "psychotomimetic" syndrome. However, the degree of overlap has been vigorously debated (Hollister, 1962; Langs and Barr, 1968; Vardy and Kay, 1983; Young, 1974). The criticism that visual effects were relatively uncommon in functional psychoses has been tempered by the high incidence of these symptoms in later studies (Bracha et al., 1989). It appears that acutely ill, positive-symptom patients show more "psychedelic" symptoms than do chronic, undifferentiated, negative-symptom predominating patients, particularly in the prodromal state (Bowers and Freedman, 1966).
Hallucinogens also were administered to psychotic patients and comparisons were made between drug effects and preexisting symptoms (Cholden et al., 1955). These studies were limited by the highly anecdotal nature of ratings of "subjective" effects. Some studies reported that hallucinogens produced different symptoms than those patients were normally experiencing (Fink et al., 1966; Turner et al., 1959), while others reported an exacerbation of preexisting psychopathology (Hoch et al., 1952; MacDonald and Galvin, 1956). A relatively consistent finding was that "burned out," predominantly negative symptom-laden patients showed blunted responses to hallucinogens (Boszormenyi and Szara, 1958; Hoch et al., 1952). This latter finding supports lower levels of 5-HT2 sites in the cortex of schizophrenics (Mita et al., 1986). It also prompted a search for "endogenous schizotoxins," in which case "tolerance" to naturally occurring psychotomimetics would confer resistance to exogenously administered agents in patients.
The short-chained tryptamines, DMT and 5-methoxyDMT, were leading candidates for endogenous hallucinogens (Corbett et al., 1978; Franzen and Gross, 1965). Requisite enzymes for DMT biosynthesis were found in human blood (Wyatt et al., 1973), brain (Saavedra and Axelrod, 1972), and lung (Axelrod, 1962). Although correlations were seen between acute symptomatology and DMT excretion in patients (Murray et al., 1979), interest waned because peripheral DMT levels were not consistently different between normal and psychotic subjects (Gillin et al., 1976). However, peripheral levels do not accurately reflect either concentrations at discrete brain areas, nor differential sensitivity to comparable levels between normal subjects and patients with psychoses. Lack of tolerance to its psychological effects, given either twice daily for 5 days (Gillin et al., 1976) or every 30 minutes four times, strengthens its importance as a putative schizotoxin.

Psychotherapy Research
Relatively few studies used LSD as a "psychopharmacotherapeutic" agent in humans, i.e., daily dosing regimes. Daily LSD elicited robust antidepressant responses in depressives in an uncontrolled study, while tolerance to its psychedelic effects developed rapidly (Savage, 1952). These data are consistent with similar
effects of chronic LSD and antidepressants on 5-HT receptor function (Buckholtz et al., 1990; Stolz et al., 1983). Beneficial responses to daily dosing in some autistic children also were seen (Bender, 1966; Freedman et al., 1962; Simmons et al., 1966).
The first suggestion that LSD may hasten psychotherapy was made in the early 1950s (Busch and Johnson, 1950), and series of cases soon followed (Eisner and Cohen, 1958). LSD was believed useful in recovering early memories, enhancing associative processes, reducing repression, intensifying affective responses, and magnifying aspects of the transference (Chandler and Hartman,1960; Hollister et al., 1962; Snyder et al.,1968). These early protocols utilized relatively low doses (25 to 100 mcg) within the context of ongoing psychoanalytic psychotherapy. This was termed the psycholytic approach, and utilized multiple sessions over months or years. These studies were hampered by lack of adequate control groups and impartial raters, small sample size, and primarily anecdotal data. However, their emphasis on repeated sessions merits attention when assessing results from "psychedelic" research protocols. This latter approach, described below, may have limited efficacy by depending inordinately upon one or two highly charged sessions, without the benefit of "working through" available in the psycholytic model.
The psychedelic approach, favored by North American researchers, involved administration of a single, or at most a small number of, high dose (300 to 1500 mcg) LSD session(s) after a relatively short course of psychotherapy (Pahnke et al., 1970). This psychotherapy encouraged the patient to undergo a "psychedelic experience," which had many aspects of a religious epiphany. As many "spontaneously recovered" drug abusers report similar spiritual-mystical experiences (Ludwig, 1985), this approach was turned to substance abuse treatment (Hollister et al., 1969; Savage and McCabe, 1973). Uncontrolled, often anecdotal reports from psychedelic studies also demonstrated some promise in the treatment of sociopathy (Shagass and Bittle, 1967), prisoner recidivism (Leary and Metzner, 1967-68), and the pain and despair associated with terminal illness (Grof et al., 1973; Kast and Collins, 1964).
Substance abuse treatment studies were numerous, and while initial reports were enthusiastic (Kurland et al., 1967; MacLean et al., 1961; Smith, 1958), studies using control groups and longer follow-up demonstrated less impressive results (Cheek et al., 1966; Hollister et al., 1969; Johnson, 1969). However, a review of 31 studies involving 1100 alcoholics concluded that meaningful generalizations could not be reached because of the inconsistent designs and criteria for improvement (Abuzzahab and Anderson, 1971).
In summary, many of the initial studies suggesting enhancement of psychotherapy with hallucinogens were hampered by lack of methodological rigor. However, placebo/control treatments are problematic. For example, when 50 1lg of LSD were used as "active placebo" against 450,ug of LSD in an alcoholism treatment study using the psychedelic model, minimal differences in outcome among groups were discerned (Kurland et al., 1971). That many of the low-dose group also underwent a "peak experience" emphasizes the importance of assessing the interplay between pharmacology, psychotherapy, and subjective experience. Minimum requirements for future studies should include independent raters of effects and outcome, identical (nondrug) treatment in the control group, and adequate follow-up (at least 1 year) (O'Brien and Jones, 1994). The choice of inactive and/or active placebo must be given careful consideration. Finally, a hybrid of the psychedelic and psycholytic models, in which more frequent high-dose sessions are used, may provide additional flexibility and allow more psychotherapeutic work to take place than either model alone.

Adverse Effects
The profoundly altered mental status elicited by hallucinogens requires astute clinical management, including thorough screening and preparation of prospective patient or volunteer subjects, careful supervision of drug sessions, and consistent and responsive follow-up which may require psychotherapeutic intervention.
Early clinical investigators provided reassuring safety data. A survey of American clinical research documented in normal volunteers a rate of attempted suicide of 0/1,000, completed suicide of 0/1,000, and "psychotic reactions over 48 hours" of.8/1,000. Corresponding figures in patients were 1.2/1,000,.4/1,000, and 1.8/1,000 (Cohen, 1960). These data were derived from over 5,000 subjects who had received LSD or mescaline more than 25,000 times, single individuals taking between 1 and 80 doses, using LSD doses from 25 to 1,500 mcg. A British survey reported comparable results (Malleson, 1971).
Once hallucinogens escaped from the laboratory, however, emergency rooms and clinics were quickly impacted by adverse effects in unprepared, unsupervised, and psychiatrically ill individuals taking hallucinogens, especially LSD (Frosch, 1969; Ungerleider et al., 1968). LSD was nearly always of uncertain quality and dose, and combinations of LSD and other drugs and alcohol were usual (Frosch et al., 1965).
These adverse consequences may be classified temporally as acute, subacute, and chronic (Strassman, 1984).

Acute
Acute adverse effects include: a) brief panic reactions to effects of the drug, which generally responded to verbal reassurance and protection of the patient, and only in severe instances, to medication (Taylor et al., 1970); and b) psychotic reactions, disorganized states that lasted longer than 24 hours and required more intensive management and often hospitalization. These psychotic reactions usually were superimposed on preexisting psychotic disorders in polydrug-abusing patients (Blumenfield and Glickman, 1967; Hekimian and Gershon, 1968; Hensala et al., 1967; Vardy and Kay, 1983). They typically responded to treatments appropriate to the non-drug-induced syndromes they resembled (Strassman, 1984).
Toxicology laboratories now can measure sub-nanogram/milliliter concentrations of LSD in body fluids (Nelson and Foltz, 1992), aiding diagnosis of acute adverse reactions.

Subacute
Subacute effects requiring clinical intervention are flashbacks, which refer to unbidden re-experiencing of certain aspects of hallucinogen-induced effects, often visual, but partaking of all psychic functions (Wesson and Smith, 1976). They occur after an intervening period of normalcy after a drug experience (Horowitz, 1969). Not all flashbacks are felt to be adverse, and many members of the psychedelic subculture find brief "free trips" pleasurable (Wesson and Smith, 1976). The incidence is reported to vary between 15% and 77% of individuals who have had at least one LSD experience (Strassman, 1984).
In our DMT studies with experienced hallucinogen users, we have seen an incidence of 5% to 10% in volunteers with at least one high-dose DMT session. These sessions, it should be noted, are almost uniformly regarded as "higher than I have ever been," and thus may be considered traumatic. Meditation, smoking marijuana, and falling to or waking from sleep are the most common precipitants. Several volunteers willfully attempt to re-experience aspects of the DMT state by these means.
The etiology of flashbacks is not known, but organic, psychological, and social hypotheses have been proposed (Alarcon et al., 1982). Their presence in post-traumatic stress disorder and elicitation by lactate infusion (Rainey et al., 1987) suggest a complex interaction of anxiety and stress with memory processes (McGee, 1984). Flashbacks are usually self-limited, if psychoactive drugs, especially hallucinogens and marijuana, are avoided. Persistent or particularly disturbing symptoms (Abraham, 1983) require a neurological evaluation.

Chronic
Chronic adverse effects may be divided into functional and organic. Functional syndromes rarely may be quite debilitating and treatment resistant, resembling an ego-syntonic, negative symptom-laden schizophrenic disorder (Glass and Bowers, 1970).
More difficult to diagnosis confidently as directly related to LSD use are changes in lifestyle and interpersonal behaviors associated with hallucinogen use (Blacker et al., 1968). The confluence of drugs and preexisting personality styles is suggested in McGlothlin and Arnold's (1971) 10-year follow-up of psychotherapy patients and normal volunteers who participated in sanctioned LSD studies. This study suggested a catalytic effect of LSD use in individuals predisposed to unconventional aesthetic and philosophic ideas (McGlothlin and Arnold, 1971).
LSD-induced organic central deficits have been difficult to document with certainty, because of no premorbid data and an inability to control for other substances of abuse (Acord and Barker, 1973). Statistically, but not clinically, significant decrements were reported in several studies. Lower Halsteads' Category and Reitan's Trail Making A test scores were reported in hallucinogen users compared with control subjects; however, both of these tests were within normal ranges in drug users (Culver and King, 1974; McGlothlin et al., 1969). Nonspecific EEG changes also were described (Blacker et al., 1968).
Chronic visual disturbances, posthallucinogen perceptual disorder, akin to chronic flashbacks, may partake of functional and organic bases. The validity of this diagnosis is uncertain because of lack of premorbid data and inability to control for other drugs of abuse. Its responsiveness to benzodiazepines (Abraham, 1983) support an anxiety/functional rather than organic disorder (McGee, 1984).

Mutagenicity / Teratogenicity
Initial reports of chromosomal (Cohen et al., 1967) and reproductive (Jacobson and Berlin, 1972) disorders in LSD users were not replicated in later studies (Dishotsky et al., 1971; Muneer, 1978). Until more controlled data are forthcoming, however, woman who are pregnant or not using reliable contraception are not suitable candidates for hallucinogen research protocols.

Conclusions and Recommendations
Hallucinogens are powerful drugs, with the potential to elicit or exacerbate psychiatric symptoms. Particularly aversive or overwhelming acute effects may traumatize or sensitize the individual, setting up the potential for flashbacks akin to those seen in post-traumatic stress disorder. The use of experienced hallucinogen users may reduce the traumatic nature of high-dose hallucinogen sessions, and is recommended for psychopharmacological research. Additionally, truly informed consent is possible only in experienced users. Studies comparing responses in normal subjects with those in psychiatric patients (see below) should use the lowest doses that will generate requisite data.
Psychotherapy protocols require a careful assessment of risk to benefit ratios balancing morbidity or mortality of an untreatable psychiatric condition with the likelihood of psychological sequelae of hallucinogen exposure. The risk associated with psychotherapy research protocols may be lessened by using the lowest possible dose of drug. If high-dose administration is necessary, it may be prudent to gradually build up to this dose over several sessions.

Current Research
In the United States, we have been administering DMT since late 1990 (Strassman, 1991) in psychopharmacologic studies utilizing experienced hallucinogen users (Strassman and Qualls, 1994; Strassman et al., 1994). The University of Miami has begun phase I studies of ibogaine in preparation for substance abuse treatment research. Similar phase I studies have begun at UCLA with MDMA, also in anticipation of therapeutic applications. Psychopharmacological studies using subanesthetic, psychotomimetic doses of ketamine in normal volunteers and patients with schizophrenia are ongoing at Yale University (Krystal et al., 1994). A substance abuse treatment amendment to the University of Maryland's inactive LSD protocol has been approved, and may begin within a year.
In Europe, group and individual psychodynamic psychotherapy with LSD or MDMA has been taking place in Switzerland since 1985, but no research data have been generated. The University of Zurich is studying the effects of psilocybin and ketamine on positron emission tomography and neuropsychological responses in normal volunteers (Vollenweider, 1994). In Germany, several sites are studying mescaline and MDE (the N-ethyl derivative of MDMA) effects in normal volunteers, studies in which multiple neurobiological variables are characterized (Hermle et al., 1992, 1993).

Areas for Future Research
As described previously, a wide range of temporal characteristics are available with the hallucinogens, and may be exploited for research with different goals. For example, psychotherapy protocols might be best served using short-acting drugs whose effects last between 1 and 2 hours, while neuroendocrine challenge studies would benefit from using ultra-short-acting drugs and keeping interactions with the environment to a minimum. Protocols requiring multiple within-individual assessments could use long-and ultra-long-acting drugs.

Measurement Variables
Recent DMT studies demonstrate the superiority of subjective (HRS) responses to biological ones with respect to subtle dose effects (Strassman et al., 1994). Thus, despite better characterization of mechanisms of action for neuroendocrine, cardiovascular, and other autonomic variables, sensitivity for effects of experimental manipulations is relatively low. This emphasizes the importance of introspection and subjective data in characterizing the effects of hallucinogens, especially using a within-subjects design.

Psychopharmacology
Human hallucinogen psychopharmacology requires further study, for both clinical and heuristic purposes. Research should assess the role of non-5-HT neurotransmitters, particularly dopamine. Risperidone, with potent 5-HT2 and D2 antagonism, is more potent than ritanserin, a pure 5-HT2A,( agent, in antagonizing animal responses to LSD (Meert et al., 1989). The importance of combined 5-HT/DA antagonism corresponds to efficacy in schizophrenia treatment with "atypical" antipsychotic medications (Meltzer, 1989), and suggests that antagonists to hallucinogens' behavioral effects in humans may be efficacious in schizophrenia.
Pretreatment blockade studies, based upon relevant animal and human data, will suggest interruption strategies for acute adverse reactions in the emergency setting. Blockade strategies (Kosten and Kosten, 1991) also could be utilized to prevent subjective effects in those prone to chronic abuse of hallucinogens in a manner similar to naltrexone.
Although most classical hallucinogens' qualitative psychopharmacological properties are believed identical (Isbell, 1959), little data exist for within-subject studies using multiple drugs. Many congeners of classical compounds have been administered safely to humans (Isbell et al., 1959b). Assessment of salient similarities and differences will suggest structure-activity relationships for design of drugs with desirable functional profiles for clinical research purposes (Nichols, 1987).
Responses to hallucinogens in psychiatric populations with presumed abnormalities in neurotransmitter systems relevant to hallucinogen action may be tested, if appropriate safeguards are in place. Such studies would generate unique human data relating disturbed subjective experience in psychiatric patients to pharmacological manipulations, generating both therapeutically and mechanistically valuable data.
Studies exploiting recently developed hallucinogen-induced animal models of information-processing defects in schizophrenia (Braff and Geyer, 1990) could be applied to normal volunteers' responses to these drugs, further comparing the two syndromes. In addition, the HRS could be applied to more carefully characterized schizophrenic patients at various stages of the disorder, allowing novel comparisons between functional and drug-induced psychoses.
Advances in in vivo brain-imaging techniques may better characterize hallucinogen effects and mechanisms of action. These include topographic pharmacoelectroencephalography, positron emission tomography (assessing metabolic effects of psychoactive doses, and distribution of low doses of labeled compounds), and magnetic resonance imaging (spectroscopy and functional imaging).

Psychotherapy
Economic constraints create increasing pressure for cost-effective medical psychotherapy (Krupnick and Pincus, 1992). Sophisticated psychotherapy protocols with proven efficacy (Frank et al., 1990) provide a strong foundation upon which hallucinogen-assisted psychotherapy research may be re-examined. Courses of therapy utilizing adjunctive, high-dose, hallucinogen-assisted sessions should be considered in a model combining the psychedelic and psycholytic models. This would be a logical extension of earlier work that suggested robust short-term improvement, but less impressive maintenance of therapeutic effects, in high-dose models.
The growing numbers of terminally ill cancer and acquired immune deficiency syndrome patients who require palliative, quality-of-life treatment suggest additional areas for future psychotherapy research that would build upon older, uncontrolled studies indicating beneficial responses. The reported elements of increased pain control, improved family relationships, and greater acceptance of illness and impending death, if verified by controlled studies, would provide additional clinical support for these patients. The use of "flooding" to treat post-traumatic stress disorder in both combat veterans (Grigsby, 1987) and others (Saigh, 1989) may also provide a unique interfacing of hallucinogenic drug effects with an established treatment modality for a particularly pernicious and common disorder. Hallucinogen-enhanced imagery and associations, and associated affective responses to these, could be used to enhance the efficacy of this treatment.

Set and Setting
Although complex and potentially controversial, set and setting issues require further study. Set refers to the personality, state, and expectations of the subject, and setting to the environment in which the session takes place. Setting partakes of the physical surroundings, e.g., inpatient, high-technology research unit or comfortable outpatient consultation suite; nuances of the investigator/therapist presentation, including clothing, appearance, odor, and other physical characteristics; being belted to the bed (Smart et al., 1966) or able to move about freely; and eyes open or blindfolded (Denber, 1958). In addition, it involves the "set" of the research team members, including the nature of countertransference and empathy (Day, 1957), type and amount of training in psychotherapy and working with regressed/psychotic individuals, and the theoretical model and expectations of the research, psychotomimetic, psychedelic, or otherwise.
Finally, research team members' experience with hallucinogens may affect the nature of the results of research/treatment protocols. Swiss and German health authorities require that the principal investigators first take study drugs at doses to be used in their protocols, both for safety issues and to provide more adequate informed consent.3 In the United States, self-experimentation by research teams initially was encouraged (Cerletti and Rothlin, 1955; Johnson, 1969; Szara, 1957). However, in response to highly publicized cases of self-experimentation and extraresearch drug taking with volunteers (Leary, 1968), this practice was discontinued. Future research must carefully account for these setting variables in assessing outcome measures, and the European practice of "going first" should be considered.

Training Issues
The small number of protocols using hallucinogens allows for very close contact between investigators and regulatory agencies overseeing this work. However, renewed examination of these compounds may generate a large number of requests to use them in clinical studies. State of the art methodologies are no guarantee against disasters resulting from imprudent administration of hallucinogens to humans.
Transference and countertransference issues are rarely discussed in psychopharmacology research, and increasingly less so in psychotherapy research. However, the regressed, suggestible, and unusual behavior of subjects under the influence of hallucinogens is easily observable. Interpersonal exchanges that would be readily overlooked in a normal state of awareness may assume extreme and confusing meaning. The clinical investigator not only may become the object of infantile wishes and fears, but may, in the subject's mind, actually look, smell, feel, and sound identical to highly emotionally charged people in his or her life. In addition, the clinical researcher may have multiple, conflicting, and more-or-less conscious motivations for administering incapacitating drugs to humans. These may include narcissistic, grandiose or sadistic, and voyeuristic impulses. Callous, offhand, or teasing remarks made for these and other, less malignant, but similarly unexamined, motivations can dramatically alter the course of a volunteer's hallucinogenic drug experience, from a psychedelic to psychotomimetic. Sexual relations between clinician and subject, during or after a hallucinogenic drug session, the most disastrous acting-out of both parties' drug-altered sensibilities, do occur.
Regulatory agencies determine professional qualifications and adequacy of facilities for conducting this research. However, I believe that specialized training, and perhaps certification, is necessary for clinical investigators performing human hallucinogen research. Such training/certification and ongoing periodic supervision would reduce the likelihood of subtle or flagrant misuse of these compounds by unknowing or unscrupulous clinical investigators. Specific proposals regarding the nature of this training and supervision is beyond the scope of this article. This suggestion is meant to stimulate further debate and discussion at institutional and governmental levels.

Conclusion
The renewal of human hallucinogen research is encouraging. However, it must be tempered with an appreciation that the controversial nature of these drugs caused a suspension of nearly a generation's worth of research in the field (Dahlberg et al., 1968). Ongoing studies are taking a painstaking, systematic approach, and are avoiding claims that cannot be substantiated by data. Careful attention to selection, screening, preparation, supervision, and follow-up of subjects undergoing hallucinogenic drug sessions is absolutely necessary. In addition, the training, characteristics, and research setting of clinical investigators desiring to work with these compounds must be addressed directly.
These precautions will provide a safety net to minimize many of the mistakes and false leads that plagued the first round of human studies. If appropriate circumspection is practiced, the re-examination of the role of hallucinogens in clinical research and treatment will be substantial.

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Ibogaine in the treatment of chemical dependence disorders: clinical perspectives

2009-08-11T07:56:00.000-07:00

Ibogaine in the treatment of chemical dependence disorders: clinical perspectives
H. S. Lotsof

The primary purpose of this paper is to provide general information to the clinician who will be using the Lotsof Proceduresm (Goutarel, 1993) developed by NDA International, Inc. in which Ibogaine is administered to treat chemical dependence disorders. This is a preliminary report. The patient base upon which my conclusions have been made totals thirty-five treatment episodes. All clinical observations conducted after 1963 have been made on patients treated outside of the United States.

Ibogaine is not a substitute for narcotics or stimulants, is not addicting and is given in a single administration modality (SAM). It is a chemical dependence interrupter. Retreatment may occasionally be needed until the people being treated with Ibogaine are able to extinguish certain conditioned responses related to drugs they abuse. Early data suggests that for many patients, a period of approximately two years of intermittent treatments may be required to attain the goal of long-term abstinence from narcotics and stimulants. The majority of patients treated with Ibogaine remain free from chemical dependence for a period of three to six months after a single dose. Approximately ten percent of patients remain free of chemical dependence for two or more years from a single Ibogaine treatment. An equal percentage return to drug use within two weeks after treatment. Multiple administrations of Ibogaine over a period of time are generally more effective in extending periods of abstinence. It is noteworthy that twenty-nine of the thirty-five patients successfully treated with Ibogaine had numerous unsuccessful experiences with other treatment modalities.

A Brief History
Ibogaine is a naturally occurring alkaloid found in Tabernanthe iboga and other plant species of Central West Africa. It was first reported to be effective in interrupting opiate narcotic dependence disorders in U.S. patent 4,499,096 (Lotsof, 1985), cocaine dependence disorders, U.S. patent 4,587,243 (Lotsof, 1986) and poly-drug dependence disorders, U.S. patent 5,152,994 (Lotsof, 1992). The initial studies demonstrating Ibogaine's effects on cocaine and heroin dependence were conducted in a series of focus group experiments by H. S. Lotsof in 1962 and 1963. Additional data on the clinical aspects of Ibogaine in the treatment of chemical dependence were reported by Kaplan (1993), Sisko (1993), Sanchez-Ramos & Mash (1994), and Sheppard (1994).
Prior to Ibogaine's evaluation for the interruption of various chemical dependencies, the use of Ibogaine was reported in psychotherapy by Naranjo (1969, 1973) and at the First International Ibogaine Conference held in Paris (Zeff, 1987). The use of Ibogaine-containing plants has been reported for cen-turies in West Africa in both religious practice and in traditional medicine (Fernandez, 1982; Gollnhofer & Sillans 1983, 1985). An overview of the history of Ibogaine research and use was published by Goutarel et al. (1993).

Claims of efficacy in treating dependence to opiates, cocaine, and alcohol in human subjects were supported in preclinical studies by researchers in the United States, the Netherlands and Canada. Dzoljic et al. (1988) were the first researchers to publish Ibogaine's ability to attenuate narcotic withdrawal. Stanley D. Glick et al. (1992) at Albany Medical College published original research and a review of the field concerning the attenuation of narcotic withdrawal. Maisonneuve et al. (1991) determined the pharmacological interactions between Ibogaine and morphine, and Glick et al. (1992) reported Ibogaine's ability to reduce or interrupt morphine self-administration in the rat. Woods et al. (1990) found that Ibogaine did not act as an opiate, and Aceto et al. (1991) established that Ibogaine did not precipitate withdrawal signs or cause dependence.

Cappendijk and Dzoljic (1993) published Ibogaine's effect in reducing cocaine self-administration in the rat. Broderick et al. (1992) first published Ibogaine's ability to reverse cocaine-induced dopamine increases and later reported on Ibogaine's reduction of cocaine-induced motor activity and other effects (1994). Broderick et al.'s research supported the findings of Sershen et al. (1992), that Ibogaine reduced cocaine-induced motor stimulation in the mouse. Sershen (1993) also demonstrated that Ibogaine reduced the consumption of cocaine in mice. Glick (1992) and Cappendijk (1993) discovered in the animal model that multiple administrations of Ibogaine over time were more effective than a single dose in interrupting or attenuating the self-administration of morphine and cocaine, supporting Lotsof's findings in human subjects (1985).

Popik et al. (1994) determined Ibogaine to be a competitive inhibitor of MK-801 binding to the NMDA receptor complex. MK-801 has been shown to attenuate tolerance to opiates (Trujillo & Akil 1991) and alcohol (Khanna et al. 1993). MK-801 has also shown to blockade reverse tolerance of stimulants (Karler et al. 1989). Ibogaine's effects on dopamine and the dopamine system (dopamine is a substance hypothesized to be responsible for reinforcing pleasurable effects of drugs of abuse) were found by Maisonneuve et al. (1991), Broderick et al. (1992) and Sershen et al. (1992). Ibogaine binding to the kappa opiate receptor was reported by Deecher et al. (1992). Thus we begin to see a broad spectrum of mechanisms by which Ibogaine may moderate use of substances as diverse as opiate narcotics, stimulants and alcohol.

Clinical Practice
The effects of Ibogaine treatment are viewed in three categories: acute, intermediate and long-term. The acute and intermediate effects have sometimes been referred to as the effects and aftereffects. The two major effects of Ibogaine are the ability to interrupt narcotic and stimulant withdrawal, and the attenuation or elimination of the craving to continue to seek and use opiates, stimulants and alcohol (Lotsof 1985, 1986, 1989). Knowledge concerning the use of Ibogaine in treating alcohol dependence is limited to: 1) a single alcohol-only dependent patient, 2) the atten-uation and, in some cases, cessation of alcohol use in persons treated for poly-drug dependence disorders. Ibogaine's ability to treat nicotine dependence (Lotsof, 1991) has been observed in poly-drug dependent subjects treated primarily for opiate and/or cocaine use. There are some general considerations in reviewing the use of Ibogaine. The primary obligations of the treatment team are four-fold: 1) to earn the trust of the patient, 2) to maintain the comfort of the patient, 3) to assist the patient in interrupting their chemical dependence and 4) to supply the psychosocial support network needed by the majority of patients to enable them to develop a sense of personal accomplishment and the ability to function as productive members of society. This is a process the Dutch treatment community refers to as normalization. In the Lotsof Proceduressm, for which a manual is now being prepared, the sense of conflict seen in most treatment modalities between the doctor and patient over the immediate cessation of drug use does not exist. The patients have been allowed, if narcotic-dependent, to continue their use of narcotics until a certain time prior to treatment with Ibogaine. There is no conflict over opiate use before treatment, as our position has been that Ibogaine will either work to interrupt chemical dependence or it will not. Patients dependent on stimulants are not maintained on stimulants and this has not created a problem for the patients or the medical staff. Prior to our conducting Ibogaine treatments in hospitals, addicted patients were allowed to use their personal supply of narcotics until the evening before treatment. However, during hospital-administered Ibogaine sessions, the narcotic-dependent patient is maintained on medications prescribed by the principal investigator during the three to five day intake process preceding their treatment with Ibogaine. Even under these circumstances, patient distrust of the medical establishment and extreme fear of going into withdrawal has resulted in the smuggling of narcotics into hospital environments. In order to protect the patient from possible overdose due to narcotics, stimulants or other drugs, a thorough physical examination is performed on all patients upon their admission to hospital environments. The examination and a search of the patient's possessions prior to treatment with Ibogaine serve two important functions. The first, is to limit the possibility of accidental overdose from hidden drugs. The second is to provide a complete understanding of the patient's physical health, since many of the people seeking treatment for chemical dependence have masked various and often numerous medical problems for years or even decades by self-medicating with illicit drugs.

Acute Effects Regimen
The acute effects of Ibogaine are dramatic. The initial reaction is usually noted within forty-five minutes after the oral administration. Full effects are generally evident within two to two and a half hours. The earliest subjective indication by patients of Ibogaine's effects is the report of a pervasive oscillating sound. The patient tends to lie down and, if asked to stand or walk, shows signs of ataxia.
The protocol for the Lotsof Procedures(sm) stipulates that the patient remain in bed with as little movement as possible from the time of Ibogaine administration. This is because nausea associated with Ibogaine use has proven to be motion-related and/or, in later stages (those longer than four hours after administration), possibly to be a psychosomatic reaction to previously repressed traumatic experiences. In addition to keeping the patient as still as possible, we use a non- phenothiazine anti-nauseant, since phenothiazines may interfere with the psychoactive properties of Ibogaine. If the patient vomits in less than two and a half hours after the administration of Ibogaine, an examination of the regurgitated material should be made to determine how much Ibogaine may have already been absorbed by the patient. A rectal infusion of Ibogaine to supplement the lost portion of the dose may be provided if it is not possible for this dose to be administered orally. The rectal administration should occur only if the patient has previously consented to this mode of dosing.

Visualization
One of Ibogaine's principal effects during its first phase of action is to produce a state which emulates dreaming, except that the subject is fully awake and has the ability to respond to the treatment staff's questions. In most cases, people under the influence of a therapeutic dose of Ibogaine do not wish to speak. They prefer instead to pay close attention to the visual presentation of memories or phenomena that they are experiencing. These phenomena have been noted to have both Freudian and Jungian connotations.
The presentation of visual material is rapid. Some patients have described it as a movie run at high speed. Others describe it as a slide show, each slide containing a motion picture of a specific event or circumstance in the viewer's life. In either case, the presentation of visual material is so compressed and fast moving that distracting the patient for even a moment may interfere with the process of abreaction. Therefore, during the primary phase of Ibogaine treatment, the intrusion of the medical staff should be kept to a minimum.

Autonomic Responses
During the first through the fifth hour there is a moderate rise in blood pressure of ten to fifteen percent and, in some cases, an associated decline in the pulse rate. The most significant autonomic changes occur between one and a half and two and a half hours after administration of therapeutic doses of Ibogaine. In many cases pulse rates are elevated due to pre-administration anxiety.
On two occasions, persons with transient hypertension were treated. In one of those instances the patient's blood pressure dropped to normal levels during the primary and secondary stages of treatment. The second hypertensive exhibited little change at a 23mg/kg therapeutic dose, but showed significant changes on two occasions when provided with only a 1.6mg/kg test dose. The two 1.6mg/kg doses were supplied due to our concern over the patient's hypertension. He had been previously treated with an 18 mg/kg dose by Dutch Addict Self-Help (DASH) with no apparent negative results. This alleviated some of our concern for the patient's safety. Variation in individual patient reactions should be anticipated.

Female Patient Safety
One 24-year-old female patient treated with Ibogaine for chemical dependence died from undiagnosed causes in the Netherlands. Although her autopsy did not determine the cause of death, it reported Ibogaine levels of 0.75 mg/liter in blood. This level has not been seen to be toxic in animal research or in our prior human experience. Subsequent to this death and to the previously reported death of a Swiss woman who received Ibogaine during a psychotherapy session in Europe (totally unrelated to NDA's research program), the FDA excluded women from the present clinical trials taking place at the University of Miami. However, the FDA decision is contrary to the gender guidelines of the National Institutes of Health. The guidelines with regard to women call for the inclusion of women at the earliest stages of clinical trials, as this would provide the greatest determination of drug safety for women. Thirty percent of NDA International's patients have been women who have shown no negative effects from taking Ibogaine either during or after treatment. However, considering all of the circumstances, the Procedure should be administered only in a hospital or clinic with the patient under continuous staff observation and electronic monitoring.
An ongoing international research program is developing evidence to determine a hypothesis for the cause of death of the woman in the Netherlands. We are additionally seeking Swiss government cooperation concerning the death of the Swiss woman. The results of this research may facilitate either an exclusion criteria or an antidote allowing Ibogaine safely to treat chemical dependence in women.

Cognitive Evaluation
During the second phase of Ibogaine's action in the Lotsof Procedures, the patient experiences the intellectual evaluation of his or her previous life experiences and decisions. This occurs after the visualization phase, which generally ends abruptly in three to five hours. However, individual reactions and variations are the norm and not the exception within the parameters of the Procedure.
When various decisions were made by the patient in the past, those decisions appeared to be the only options available at the time. However, due to Ibogaine's ability to catalyse the reevaluation of one's life, actions and behavior, it is possible for patients to understand that alternatives to their original decisions were available. This knowledge appears to allow the patient to modify their current behavior and cease their drug dependence.

Behavioral Immobility
During the periods of visualization, and extending into the stage of cognitive evaluation, patients will demonstrate a state of behavioral immobility (Depoortere, 1987). Brain wave patterns associated with dreaming and sleep, but distinct from those states, are represented by rhythmic slow activity of 4-6 Hz. These EEG patterns are associated with a state characterized by a lack of movement. Some early observers of the Lotsof Proceduressm (Kaplan, personal communication, 1990) initially believed that the condition represented paralysis, but when patients were asked to stand and move around, the patients were able to do so, albeit with difficulty.

Attenuation of Narcotic Withdrawl
One of the major acute effects experienced with Ibogaine treatment is the attenuation or elimination of narcotic withdrawal in opiate- dependent patients. This is extremely important to the narcotic-dependent patients who live in fear of going into withdrawal.
The treatment team's experience in the field is of the utmost importance in dealing with this aspect of the Procedure. Withdrawal symptoms are a combination of physical and, in many cases, psychosomatic manifestations that are anxiety-driven. Therefore, it is imperative for the medical and paramedical staff to have experience in identifying and distinguishing between these varieties of symptoms. Provided below are examples of psychosomatic withdrawal manifestations demonstrated by two of the patients treated outside the United States.

Example One

On one occasion I was called into the room by a colleague about twenty hours after Ibogaine had been administered to a twenty-five year old male heroin-dependent patient. The patient had been using approximately 1/4 gram of heroin a day, but had increased his daily intake to two grams while in the Netherlands.

I was informed that the patient was complaining of muscle spasms. I asked the patient if this was true, and he responded in the affirmative. I asked if I might see these spasms. The patient agreed, showing me the calf of his leg. He was exhibiting what appeared to be involuntary movements. I checked his pupils and observed that they were not dilated, nor was he exhibiting any other form or manifestation of withdrawal. When I turned to my colleague for discussion I noticed the patient's spasms had ceased. Upon reexamination of his calf, the spasms returned. I turned away once again, but continued to watch him and the spasms ceased again. I informed the patient that I believed the spasms to be psychosomatic in origin. I placed a pillow under the patient's calf to give it support and covered the patient with a blanket. The spasms did not occur again.

Example Two

On another occasion I received a call from a person involved with Dutch Addict Self-Help (DASH) groups who had been observing a number of treatments. She informed me that a Yugoslavian woman in her mid to late twenties had been complaining of narcotic withdrawal during Ibogaine treatment. However, the DASH observer did not believe this to be the case, as there were no observable signs of withdrawal.

When I arrived, the patient was sitting on a couch. I checked her pupils and observed they were not dilated, and asked her if she was in withdrawal. The patient said she was. "How are you in withdrawal? What are its manifestations?" I asked.
"I'm sick," she said.
I asked her if her eyes were tearing.
"Yes," she said, but her eyes were not tearing.
"Is your nose running?"
"Yes," she said, but her nose was dry.
"Do you have goose bumps?" I asked.
"Yes," she said, but I pointed out to her that she did not have goose bumps, and finally I said, "Do you have diarrhea?"
"Yes," she said, but I had no way to determine the validity of her statement.

The patient requested that I provide her with funds to return home. I told her I did not think it wise for her to leave at this time, but would give her carfare in the morning. The following day the DASH observer told me that the patient had left about four hours after I did, informing the observer as she left that she had not been sick, but had only said she was. This example should further demonstrate the im-portance of hospital administered treatments with a full medical staff of psychiatrists, neurologists, internists, therapists, nurses, peer counselors and patient advocates capable of evaluating and responding to any aspect of the patient's condition at all times.

The complaint of experiencing narcotic withdrawal after leaving the treatment environment has been reported in three cases. We have provided additional treatments six months to a year after the initial treatment to patients who were re-addicted and stated they had experienced some form of withdrawal within a week of their first Ibogaine treatment. Our working group decided to keep patients making such complaints under observation for periods equal to the number of post treatment days during which the patients stated they previously experienced withdrawal symptoms.

Our findings have been that, under the above conditions of monitoring, the reported withdrawal signs are usually symptoms of anxiety or anxiety related conditions that the patients characterized as withdrawal. These symptoms included nausea, diarrhea or increases in blood pressure in one hypertensive patient.

There have been two incidents which did not appear anxiety related, in which diarrhea occurred five to seven days after treatment in patients who had previously used one gram of heroin a day. These episodes were easily controlled with a single administration of an appropriate medication and did not occur again.

Aftereffects : Interruption of Craving
The acute interruption of craving to seek and use drugs of abuse is unique to the Lotsof Proceduressm as a treatment modality for chemical dependence disorders. This effect is generally not noticed by the patient until the principal actions of Ibogaine (visualization, cognitive evaluation, behavioral immobility and significant residual stimulation) are no longer evident and the patient has had the opportunity to sleep. The initial recognition of lack of craving is usually noticed forty-eight to seventy- two hours after Ibogaine administration. In a minority of treatments, recovery and the absence of craving may be evident to the person being treated in as little as twenty-four hours. The medical staff, on the other hand, usually notes the absence of craving in the patient in forty-five minutes to one and a half hours after Ibogaine administration. Our experience gained in recent years through the treatment of twenty persons outside the United States has shown that the majority of patients may need a series of treatments before the conditioned responses (craving) to a long history of chemical dependence can be extinguished. However, for three of these patients, a single treatment interrupted chemical dependence for a minimum of two years. The advantage of Ibogaine is that it allows patients time periods free of craving during which the psychiatrist, social worker, therapist, paraclinician and the patient often bond into a cohesive working group to ac-complish a state of long-term non-dependence by the patient to the drug(s) of abuse for which the patient is under treatment.

Psychosocial Support
All aspects of treatment for chemical dependence disorders common to other treatment modalities are common to the use of Ibogaine. The patient's characteristics in terms of psychopathology and behavior, societal accomplishments, as well as the skills of the treatment team are significant to treatment outcome.
In rare cases, when the patient already has the occupational, educational, and professional skills needed to succeed in society, the task may be somewhat easier. In cases where the patient does not have those societal skills, or lacks medical care for disorders other than chemical dependence, care and training must be provided through psychosocial support structures.

Trauma suffered by the patient during childhood appears to play an important part in the drive for love and the fear of abandonment that are common to many of the patients we have treated (Bastiaans, 1991). All psychosocial support paradigms should be available for the patient after the completion of an Ibogaine treatment. Their use should be contingent upon the evaluation of the patient's needs and progress. One of the primary differences that social workers, counselors or therapists offering psychosocial support notice in post-Ibogaine treated patients as compared to untreated subjects, is the rapidity with which the support can and must be provided to aid the patient in accomplishing goals and making decisions. Ibogaine presents a symptom-free window of opportunity, of which the patient and therapist must take advantage. One patient put it this way: Ibogaine and 12-Step (groups) both help you to get in touch with your soul. Ibogaine is like rocket fuel for that process. (Village Beat, 1990) This means moving quickly and dramatically to assist the patient to establish goals while the patient has the ability and desire to do so.

Ibogaine generally produces a receptive psychological state in the patient. This produces a relationship between the patient and the therapist which is mutually rewarding and beneficial, but requires the person providing psychosocial support to work both harder and faster than is the norm for other treatment modalities. Prior to the use of Ibogaine in the treatment of chemical dependence, it may have taken the therapist three to twenty-four months (Judd, personal communication, 1993) using traditional methods to assist the patient in reaching a state of well-being free of drug craving (Kaplan et al., 1993). This advantage that Ibogaine treatment provides enables the psychosocial support staff to assist patients in making decisions which facilitate their normalization and integration into society as self-fulfilled and productive human beings. Many of the accepted parameters of distance between the therapist and the patient are not effective in Ibogaine treatment. Patients require closer and more intensive guidance, and are generally more open to it. They require faster intervention to learn societal skills and to overcome and objectively understand various traumas experienced during their lives. Therefore, Ibogaine is not a treatment modality for clinicians whose pre- ference is to simply administer a pill or tablet and then distance themselves from their patients.

Reduction of the Need for Sleep
In all cases, Ibogaine temporally reduces the patient's need for sleep to as few as three or four hours a night. This effect may last a month or more, gradually returning to normal. Two theories have been put forth concerning the cause of this effect. One theory suggests the reduction in the need for sleep is due to the long-lasting bioavailability of Ibogaine or one of its metabolites. This is in keeping with the parmacokinetic studies conducted at the University of Miami (Mash, 1995). The second theory suggests the cause is due to the decrease in the psychological requirements for sleep associated with the necessity to dream. Evidence supporting this theory is that Ibogaine promotes an intense emulation of dreaming that lasts for many hours during its acute stage of activity. The reduction in the need for sleep is viewed by the majority of patients as a discomfort, since they have used drugs and sleep as an escape mechanism. These patients may require some mild form of sedation during the first days after treatment with Ibogaine. Normal precautions should be taken in providing sedatives to persons with a history of chemical dependence. In a minority of cases, patients have used this newly available time to advantage in their busy work schedules.

Long-Term Effects
Long-term effects are those which may be noticed from one to twenty-four months after treatment, and in some cases even longer. The following three examples illustrate this point.
Example One

A heroin-dependent couple was treated. The woman of 26 was a relatively new addict of three months while her 27-year-old husband had a history of over ten years of heroin use. At the time of their treatment, a protocol of treating one patient at a time was followed. These were early treatments and the medical and paramedical support staff were familiarizing themselves with what might be expected during such treatments.

Portions of the treatments were observed by Dr. Carlo Contoreggi, Deputy Medical Director of the Addiction Research Center of the National Institute on Drug Abuse in Baltimore and Dr. Lester Grinspoon of the Harvard School of Medicine.

The husband was treated first, and his wife was completely cooperative and helpful during his treatment. The following day, when the wife was administered her dose of Ibogaine, her husband demanded that he be allowed to leave his room and remain in bed with her. He informed the medical and paramedical staff present that unless he got his way he would create a disturbance to interfere with his wife's treatment. Rather than deal with a belligerent and angry patient, we decided it would be less harmful to let him have his way. He continuously disturbed his wife during her treatment. This resulted in a policy of treating couples simultaneously in separate rooms.

He recovered before his wife, as she had been administered Ibogaine twenty-four hours after his treatment. He complained that he was getting bedsore, was no longer able to stay in bed and asked for permission to go for a bicycle ride. Upon his leaving, his wife broke down and cried in the arms of a female paraclinician, stating she did not know if she could remain with her husband, but she was afraid he would die if she left him.

This was a concept he continuously stressed to her during their treatment.

After treatment, he followed a pattern of controlling his wife's contacts with other persons, including the treatment team, which was denied access to either of them. We later learned that they both returned to heroin use. However, three months later, the wife determined that her husband was incapable of loving himself or her and this was not the life she wanted. She stopped using heroin, enrolled in nursing school, filed divorce proceedings against her husband, and is now specializing in psychiatric nursing.

While initially she did not recognize that her decision to stop heroin use was due to her Ibogaine treatment, as the months went by, she realized that her determination to change her life was catalyzed by her experience with Ibogaine.

Example Two

A cocaine/cocaine-base dependent patient was treated with the Lotsof Procedure and experienced an acute interruption of his drug use. During his Ibogaine treatment, he had a strong impression that if he continued drug use God would punish him. He remained drug-free for about thirty days, after which he increased his drug use over the next months. He was then retreated. The dose he received proved to be inadequate due to his vomiting of the oral dose, and to a bowel movement immediately after the rectal administration of Ibogaine, which he requested to compensate for the loss of his oral dose. His drug use continued, but far below his original pretreatment levels.

About six months after his retreatment, the first Ibogaine therapy group sponsored by the International Coalition for Addict Self-Help, directed by psychotherapist Barbara Judd, CSW, was established in New York. The patient attended these sessions until fifteen months after his original treatment, when he recognized that he had to move away from his drug-infested neighborhood. Thereupon he moved to Florida.

In Florida, he has remained drug-free, even though he has access to cocaine. He is employed in the construction industry by a business with strict non-drug use guidelines that is owned and run by former drug users.

Example Three

One of the most important concepts learned by persons treated with Ibogaine is that addiction can be reversed. Persons dependent on drugs such as opiates or cocaine are not able to recognize that chemical dependence is a reversible phenomenon.

This third example is of the only chemically-dependent person from the 1962-1963 study to receive a series of Ibogaine treatments at therapeutic levels. The individual remained free of addiction for approximately three and a half years as a result of his series of treatments.

During that period he moved to California, married, and worked in pharmaceutical sales. He later lost his job and, when offered a ride back to New York, accepted it and returned to a life of minor drug dealing and use that resulted in his arrest and imprisonment.

After his release, he worked for a while as a machinist, then slowly fell back into heroin use and addiction in 1969. Luckily, this was a period when methadone programs were expanding, and he was able to enter one of the better programs run by Beth Israel Hospital. At that time, the programs were well-staffed with doctors, nurses and adequate counselors, and the patient reached a point in his life when he recognized that the life of a heroin addict was not what he wanted. It was not just the heroin, but the scene itself, wherein a human life was without value, where sometimes a human being would be murdered for two cents worth of an innocuous powder in a glassine envelope. The patient was ready to quit heroin, but was a slave to the craving to use opiates for the anxiolytic relief they provided.

Over a period of more than two years, the patient stabilized himself on methadone. He tried heroin once, two weeks after starting methadone, was satisfied with the level of blockage that methadone offered, and never used heroin again.

During the next few years the methadone programs changed. Many of the competent counselors were unable to continue in their positions due to the stress and sense of frustration in their work, a condition common in the treatment community. The Federal government placed more and more restrictions on methadone patients' freedom of movement and, though methadone is anticipated to maintain the methadone client for a period of twenty-four hours, in many cases it does not. For this patient, withdrawal signs were setting in at eighteen hours and not twenty-four. The patient began a slow detoxification process from 100mg of methadone per day that took approximately eighteen months.

The final stage of detoxification was followed by the patient's entry into University-level training, for which he had obtained a scholarship to a prominent university. At the time of the detoxification, the philosophy among methadone patients was that you could not get off methadone. However, having previously had the Ibogaine experience, the patient stated that he knew addiction was reversible. That knowledge allowed him to successfully leave addiction behind.

Current Treatments : A Self Report
The following report is from the type of patient we had been seeking for years: a medical doctor who needed to be treated with Ibogaine. The subject was chemically dependent on 600mg of Demerol a day, and had attempted to stop his drug use a number of times, without any lasting success. Our particular interest in this subject was the hope that, as a medical doctor, he might provide us with some professional insight into the results of his treatment. He kept notes and prepared a report on the four different doses he received. His report is presented below in its entirety.
This subject proved to be more sensitive to Ibogaine than any other individual in our studies conducted outside the United States, and had a full-blown experience from a 10mg/kg dose. The patient participated in a research protocol which called for an intermediate dose of 10mg/kg of Ibogaine. This dose was administered as part of a pharmacokinetic study, and was not expected to have a therapeutic effect, but it did. As part of the protocol, he was also administered a known therapeutic dose of 20mg/kg.

1st day - 100 mg (test dose #1)

I've taken my Ibogaine dose and went to bed, and stayed laying down. I felt nothing, until the medical staff arrived to do the 1 hour tests. I was surprised because in my mental measurements, I thought I had taken Ibogaine about 20 minutes earlier. When I stood up, I felt a little drowsiness, and it was difficult to walk in a straight line. I was feeling photophobia and every little noise seemed to be much louder than in reality. The sounds were very disturbing to me.

During the two hour testing, symptoms were worse. It was very difficult to walk in a straight line, and the room seemed to beat, like a heart. I felt very tired, and the only thing I wanted was to rest in bed. Each head movement seemed to make things worse.

When I stood up for the 3 hour test I felt that the symptoms were disappearing. I was very hungry and ate. After eating, I was a little nauseated. For the following hours I felt nothing, except for sensation that my mind images were richer in details than before, like a 3-D movie. I ate with no nausea, slept very well, and awakened in very good condition.

2nd day - 25 mg (test dose #2)

After this dose of Ibogaine I felt nothing different from my normal state.

3rd Day - 10 mg/kg (experimental dose)

For the first two hours I felt a little different, like I had smoked marijuana. I was very calm and relaxed and all the tension of the beginning of the procedure was gone. The room seemed to be a little different and the colors around me sharper than normal. The lights and sounds were disturbing to me, like the first time. Suddenly, with my eyes closed I began to see images that appeared in screens, exactly like TV or cinema screens. These screens were appearing in small sizes and then they would get bigger as I focused my attention on them. Sometimes they appeared small and would then begin to grow, like I was walking in their direction, and sometimes they were going from left to right, in a continuous way. The images on the screens were moving in slow motion and were very sharp and well defined. I saw trees moving with the wind, a man with bells in his hands, various landscapes with mountains and the sunset. At this time I was a little nauseated, and when the doctors asked me to stand up for some tests, I vomited. From all of the hundreds of images I saw this day, I recognized only two: the first, an image of myself as a child, static like a photo. This image began to approach me and get bigger, but something in the room happened and I opened my eyes, losing the image. The second image I recognized was one of some horses dancing in a circus. It was a TV show that I had seen two days before. The time seemed to go very quickly, because after about four hours (in my mind), they told me I had taken Ibogaine nine hours earlier! It was very difficult for me to speak in English or in Spanish. I was only able to speak in my native language. At this time the images started to appear at a slower rate and for another two hours I saw only screens with no images on them. About 10-11 hours after the beginning of the experiment they disappeared. I ate very well and stayed awake all night long, falling asleep only about 7 AM, almost 24 hours after the medication had been administered. During the night I had some insights about my life and about the things I realized I was doing wrong. I stayed all the following day very tired, sleepy, but very happy and relaxed, in a way I never was before.

5th day - 20 mg/kg (therapeutic dose)

The first 3 hours were similar to the last time; photophobia and a bad sensation with little noises. After that the images began to appear, in a slower rate than the other time. There were less images, but I was recognizing all of them as part of my childhood. I saw myself playing in my father's farm, riding a motorcycle, playing with a cousin, feeding a fish and other things. I saw some recent images, like one of my father, laughing in the living room of my house. This happened about a year ago. I understood that I had a happy childhood, and there was no one to blame for my addiction, only myself. I felt their love coming from my parents and relatives. I was feeling the same time distortion that I felt the other day, and after many hours I suddenly had an insight. It was that my mind and the universe were the same thing, and that all the people in the universe and all things in the universe are the only one. I saw many mistakes I was doing in my life, so many attitudes I could not have, and this helped me to decide very strongly that I will never use Demerol again. Now I can see very clearly that I don't need Demerol to live my life. And I feel better if I don't use it. During the first 8 hours of taking the Ibogaine I vomited 4 or 5 times, always when I tried to move. I was able to sleep about 4 AM, and to eat only about 9 AM the following day. I awakened feeling weak, tired and drowsy. As the hours were going, I slept a lot and began to feel better and in the morning of the following day I was normal."

Differences in day-by-day life after the experience
"I returned to my normal life with absolutely no cravings, with better appetite than before, and highly self-confident. Now I can see differences in some aspects of my personality, things are changed. For example, I used to avoid driving at night, because it reminded me of a car accident I had years ago. Now I can drive anytime, day or night, without anxiety. I'm sure that this is caused by Ibogaine, because now I'm not the same very anxious person I was. I'm not as shy as I used to be, too. It's easier now to contradict people when I think they are wrong, and to make them know what I want and what I think. I used to accept all that other people said only to avoid a discussion, even when I was sure that my point of view was the correct one.
These are the main happenings in my Ibogaine experience and the main differences I can perceive in these few days."

Some Months Later
"The most important thing I learned with all that happened is that I can never underestimate the power of the addictive personality I have inside. I can never say I'm cured because if I do this, I will forget to protect myself from drug using thoughts. I must know I have a chronic disease that will be quiet in its place until I decide to give it a chance to grow. This decision, and that's the point, is a conscious decision. If I give in, the disease will be out of control in a few days. But, if I could be strong to take real and honest control of my Demerol using thoughts, I will be free forever.
A few days ago, because of professional needs, I had to keep two Demerol doses with me, in my house, all night long. To protect myself, I gave them to my wife. But, it was amazing to see how I was not anxious to use them but, to give them to the patients that needed them. I clearly felt that Demerol was a strange thing in my environment. I wasn't curious about the place my wife had put them, I wasn't feeling any craving. I was only looking forward to the moment I could give them to the patient and say: I've done it. And I did it, because of all of you from NDA. I don't want to be boring, but I have no words to say how grateful we, my family and I, are. I will remember you for a lifetime."

Needless to say, this patient provided particular advantages in terms of his treatment outcome. He had a career, was highly motivated, and did not require the significant psychosocial support needed by so many others who do not have his background.

Summary
We have only been able to track a significant minority of patients for follow-up observations, about twenty-five percent. In many cases we have maintained direct contact with the patients for only two months after treatment. In a single case, for five years. The difficulty concerning patient contact has been one of geographic distances, both national and international, as our patients have come from diverse cities and countries. This factor, as well as the normal problems in tracking a chemically depen-dent population, must be taken into consideration when evaluating the findings of this paper.
General conclusions based on study observations are that a single administrationof Ibogaine is an interrupter for chemical dependence disorders. A series of treatments given over a period of time will produce more significant results. It may allow some of the persons treated to free themselves completely, (or for a period of years) from dependence to, or the use of, opiates and stimulants, including cocaine and nicotine. Data on alcohol dependence treatment in human subjects is minimal.

A single treatment of Ibogaine has the ability to significantly attenuate opiate with-drawal in all patients. In ninety percent of cases treated, a single treatment can interrupt an individual's craving to continue drug use for periods of time ranging from as short as two days to as long as two and a half years. Concurrently, Ibogaine has demonstrated the ability to precipitate the release of repressed memories and to foster a process of abreaction. I believe these are important aspects of Ibogaine's ability to interrupt chemical dependence.

In order to obtain the greatest benefit for those treated with Ibogaine, a psychosocial support structure should be in place. Providers of the Procedure should be knowledgeable in the field of chemical dependence treatment, and patients should be shown kindness and respect. In many cases, such an approach will be the first attentions of this kind the patient may have experienced in decades.

Patients are deserving of kindness and respect, and such care is an important part of the healing process. Ultimately, physicians and support staff should be specifically trained in the Lotsof Proceduressm to fully understand the physical and psychological transformation of the patient, the advantages of the Procedure, and the providers' responsibilities in administering Ibogaine to treat chemical dependence disorders. Eventually, the understanding of Ibogaine's actions may yield important data about memory, learning, dreams and sleep, as well as chemical dependence, tolerance and abuse.

Acknowledgements
The author acknowledges the editorial assistance of Norma E. Alexander; Rick Doblin; William J. Gladstone; David Goldstein; Barbara E. Judd, CSW; Daniel Luciano MD; Natalie Chantel Luke; Piotr Popik, MD; Bruce H. Sakow; Bob Sisko; Sylvia Thyssen; Boaz Wachtel and Rommell Washington.
The author thanks: N. Adriaans; N. Alexander; Z. Amit, Ph.D; J. Bastiaans, MD; P.A. Broderick, PhD; C. Contoreggi, MD; M.R. Dzoljic, MD; E. Della Sera, MD; G. Frenken; W.J. Gladstone; S.D. Glick, MD; O. Gollnhofer, PhD; R. Goutarel, MD (deceased); C. Grudzinskas, PhD; B.E. Judd, CSW; J.S. Kahan, Esq; C.D. Kaplan, PhD; D. Luciano, MD; D.C. Mash, PhD; G.J. Prud'Homme, Esq; L. Rolla, PhD; B.H. Sakow; J. Sanchez-Ramos, MD; B. Sisko; H. Sershen, PhD; Frank Vocci, PhD, B. Wachtel; R. Washington; Curtis Wright, MD and all of the volunteer patients for their courage, their science and the cooperation they have provided.

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Dilemmas and Controversies of Traditional Psychiatry

2009-08-11T07:53:00.000-07:00

Dilemmas and Controversies of Traditional Psychiatry
Stanislav Grof
Chapter 5 of Beyond the Brain: Birth, Death and Transcendence in Psychotherapy
©1985 State University of New York Press

The Medical Model in Psychiatry: Pros and Cons
As a result of its complex historical development, psychiatry became established as a branch of medicine. Mainstream conceptual thinking in psychiatry, the approach to individuals with emotional disorders and behavior problems, the strategy of research, basic education and training, and forensic measures—all are dominated by the medical model. This situation is a consequence of two important sets of circumstances: medicine has been successful in establishing etiology and finding effective therapy for a specific, relatively small group of mental abnormalities, and it has also demonstrated its ability to control symptomatically many of those disorders for which specific etiology could not be found.
The Cartesian-Newtonian world view that had a powerful impact on the development of various fields has played a crucial role in the evolution of neuropsychiatry and psychology. The renaissance of scientific interest in mental disorders culminated in a series of revolutionary discoveries in the nineteenth century that firmly defined psychiatry as a medical discipline. Rapid advances and remarkable results in anatomy, pathology, pathophysiology, chemistry, and bacteriology resulted in tendencies to find organic causes for all mental disturbances in infections, metabolic disorders, or degenerative processes in the brain.
The beginnings of this "organic orientation" were stimulated when the discovery of the etiology of several mental abnormalities led to the development of successful methods of therapy. Thus, the recognition that general paresis—a condition associated, among others, with delusions of grandeur and disturbances of intellect and memory—was the result of tertiary syphilis of the brain caused by the protozoon Spirochaeta pallida was followed by successful therapy using chemicals and fever. Similarly, once it became clear that the mental disorder accompanying pellagra was due to a vitamin B deficiency (lack of nicotinic acid or its amid), the problem could be corrected by an adequate supply of the missing vitamin. Some other types of mental dysfunction were found to be linked to brain tumors, degenerative changes in the brain, encephalitis and meningitis, various forms of malnutrition, and pernicious anemia.
Medicine has been equally successful in the symptomatic control of many emotional and behavior disorders the etiology of which it has not been able to find. Here belong the dramatic interventions using pentamethylenetetrazol (Cardiazol) shocks, electroshock therapy, insulin shock treatment, and psychosurgery. Modern psychopharmacology has been particularly effective in this regard with its rich armamentarium of specifically acting drugs—hypnotics, sedatives, myorelaxants, analgesics, psychostimulants, tranquilizers, antidepressants, and lithium salts.
These apparent triumphs of medical research and therapy served to define psychiatry as a specialized branch of medicine and committed it to the medical model. With the privilege of hindsight, this was a premature conclusion; it led to a development that was not without problems. The successes in unraveling the causes of mental disorders, however astonishing, were really isolated and limited to a small fraction of the problems that psychiatry deals with. In spite of its initial successes, the medical approach to psychiatry has failed to find specific organic etiology for problems vexing the absolute majority of its clients—depressions, psychoneuroses, and psychosomatic disorders. Moreover, it has had very limited and problematic success in unraveling the medical causes underlying the so-called endogenous psychoses, particularly schizophrenia and manic-depressive psychosis. The failure of the medical approach and the systematic clinical study of emotional disorders gave rise to an alternative movement—the psychological approach to psychiatry, which led to the development of dynamic schools of psychotherapy.
In general, psychological research provided better explanatory models for the majority of emotional disorders than the medical approach; it developed significant alternatives to biological treatment and in many ways brought psychiatry close to the social sciences and philosophy. However, this did not influence the status of psychiatry as a medical discipline. In a way, the position of medicine became self-perpetuating, because many of the symptom-relieving drugs discovered by medical research have distinct side effects and require a physician to prescribe and administer them. The symbiotic liaison between medicine and the rich pharmaceutical industry, vitally interested in selling its products and offering support to medical endeavors, then sealed the vicious circle. The hegemony of the medical model was further reinforced by the nature and structure of psychiatric training and the legal aspects of mental health policies.
Most psychiatrists are physicians with postgraduate training in psychiatry—and a very inadequate background in psychology. In most instances, individuals who suffer from emotional disorders are treated in medical facilities with the psychiatrist legally responsible for the therapeutic procedures. In this situation, the clinical psychologist frequently has the function of ancillary personnel, subordinate to the psychiatrist, a role not dissimilar to that of the biochemist or laboratory technician. Traditional assignments of clinical psychologists are assessment of intelligence, personality, and organicity, assistance with differential diagnosis, evaluation of treatment, and vocational guidance. These tasks cover many of the activities of those psychologists who are not involved in research or psychotherapy. The problem to what extent psychologists are qualified and entitled to conduct therapy with psychiatric patients has been subject to much controversy.
The hegemony of the medical model in psychiatry has resulted in a mechanical transplantation of medical concepts and methods of proven usefulness into the field of emotional disorders. The application of medical thinking to the majority of psychiatric problems and to the treatment of emotional disorders, particularly various forms of neuroses, has been widely criticized in recent years. There are strong indications that this strategy has created at least as many problems as it solved.
Disorders for which no specific etiology has been found are loosely referred to as "mental diseases."[1] Individuals who suffer from such disorders receive socially stigmatizing labels and are routinely called "patients." They are treated in medical facilities where the per diem expenses for hospitalization amount to several hundred dollars. Much of this cost reflects enormous overhead directly related to the medical model, such as costs for examinations and services that are of questionable value in the effective treatment of the disorder in question. Much research money is dedicated to refining medically oriented research that will eventually discover the etiology of "mental diseases" and thus confirm the medical nature of psychiatry.
There has been increasing dissatisfaction with the application of the medical model in psychiatry. Probably the best known and most eloquent representative of this movement is Thomas Szasz In a series of books, including his Myth of Mental Illness (1961); Szasz has adduced strong evidence that most cases of so-called mental illness should be regarded as expressions and reflections of the individual's struggles with the problems of living. They represent social, ethical, and legal problems, rather than "diseases" in the medical sense. The doctor-patient relationship as defined by the medical model also reinforces the passive and dependent role of the client. It implies that the solution of the problem depends critically on the resources of the person in the role of scientific authority, rather than on the inner resources of the client.
The consequences of the medical model for the theory and practice of psychiatry are far reaching. As a result of the mechanical application of medical thinking, all disorders that a psychiatrist deals with are seen in principle as diseases for which the etiology will eventually be found in the form of an anatomical, physiological or biochemical abnormality. That such causes have not yet been discovered is not seen as a reason to exclude the problem from the context of the medical model. Instead, it serves as an incentive for more determined and refined research along medical lines. Thus, the hopes of organically-minded psychiatrists were recently rekindled by the successes of molecular biology.
Another important consequence of the medical model is a great emphasis on establishing the correct diagnosis of an individual patient and creating an accurate diagnostic or classificatory system. This approach is of critical importance in medicine, where proper diagnosis reflects a specific etiology and has clear, distinct, and agreed-upon consequences for therapy and for prognostication. It is essential to diagnose properly the type of an infectious disease, because each of them requires quite different management and the infectious agents involved respond differently to specific antibiotic treatments. Similarly, the type of tumor determines the nature of the therapeutic intervention, approximate prognosis, or danger of metastases. It is critical to diagnose properly the type of anemia, because one kind will respond to medication with iron, another requires cobalt treatment, and so on.
A good deal of wasted effort has been poured into refining and standardizing psychiatric diagnosis, simply because the concept of diagnosis appropriate for medicine is not applicable to most psychiatric disorders. The lack of agreement can be illustrated clearly by comparing the systems of psychiatric classification used in different countries, for example in the United States, Great Britain, France, and Australia. Used indiscriminately in psychiatry, the medical concept of diagnosis is vexed by the problems of unreliability, lack of validity, and questionable value and usefulness. A diagnosis depends critically on the school to which the psychiatrist adheres, on his or her individual preferences, on the amount of data available for evaluation, and on many other factors.
Some psychiatrists arrive at a diagnosis only on the basis of the presenting complex of symptoms, others on the basis of psychodynamic speculations, still others on a combination of both. The psychiatrist's subjective evaluation of the psychological relevance of an existing physical disorder—such as thyroid problems, viral disease, or diabetes—or of certain biographical events in the past or present life of the patient can have a significant influence on the diagnosis. There is also considerable disagreement concerning the interpretation of certain diagnostic terms; for example, there are great differences between the American and European schools about the diagnosis of schizophrenia.
Another factor that can influence the psychiatric diagnosis is the nature of the interaction between the psychiatrist and the patient. While the diagnosis of appendicitis or a hypophyseal tumor will not be appreciably affected by the personality of the doctor, a psychiatric diagnosis could be influenced by the behavior of the patient toward the psychiatrist who establishes the diagnosis. Thus, specific transference-counter-transference dynamics, or even the interpersonal ineptness of a psychiatrist, can become significant factors. It is a well-known clinical fact that the experience and behavior of a patient changes during interaction with different persons and can also be influenced significantly by circumstances and situational factors. Certain aspects of current psychiatric routines tend to reinforce or even provoke various behavioral maladjustments
Because of the lack of objective criteria, which are so essential for the medical approach to physical diseases, there is a tendency among psychiatrists to rely on clinical experience and judgment as self-validating processes. In addition, classificatory systems and concerns are frequently products of medical sociology, reflecting specific pressures on physicians in the task imposed on them. A psychiatric diagnostic label is sufficiently flexible to be affected by the purpose for which it is given—whether for an employer, an insurance company, or forensic purposes. Even without such special considerations, different psychiatrists or psychiatric teams will frequently disagree about the diagnosis of a particular patient.
A considerable lack of clarity can be found even regarding such a seemingly important question as differential diagnosis between neurosis and psychosis. This issue is usually approached with great seriousness, although it is not even clearly established whether there is a single dimension of psychopathology. If psychosis and neurosis are orthogonal and independent, then the patient can suffer from both. If they are on the same continuum and the difference between them is only quantitative, then a psychotic individual would have to pass through a neurotic stage on the way to psychosis and return to it again during recovery.
Even if psychiatric diagnosis could be made both reliable and valid, there is the question of its practical relevance and usefulness. It is quite clear that with a few exceptions the search for accurate diagnosis is ultimately futile because it has no agreed-upon relevance for etiology, therapy, and prognosis. Establishing the diagnosis consumes much time and energy on the part of the psychiatrist, and particularly the psychologist, who must sometimes spend hours of testing to make the final decision.
Ultimately, the therapeutic choice will reflect the psychiatrist's orientation rather than a clinical diagnosis. Organically-minded psychiatrists will routinely use biological treatment with neurotics, and a psychologically-oriented psychiatrist may rely on psychotherapy even with psychotic patients. During psychotherapeutic work, the therapist will be responding to events during sessions rather than following a preconceived psychotherapeutic plan determined by the diagnosis. Similarly, specific pharmacological procedures do not show a generally agreed-upon relation between diagnosis and choice of the psychopharmacon. Frequently the choice is determined by the therapist's subjective preferences, the clinical response of the patient, the incidence of side effects, and similar concerns.
Another important legacy of the medical model is the interpretation of the function of the psychopathological symptoms. In medicine, there is generally a linear relationship between the intensity of symptoms and the seriousness of the disease. Alleviation of symptoms is thus seen as a sign of improvement of the underlying conditions. Therapy in physical medicine is causal whenever possible, and symptomatic therapy is used only for incurable diseases or in addition to causal therapy.
Applying this principle to psychiatry causes considerable confusion. Although it is common to consider the alleviation of symptoms as an improvement, dynamic psychiatry has introduced a distinction between causal and symptomatic treatment. It is thus clear that symptomatic treatment does not solve the underlying problem but, in a way, masks it. Observations from psychoanalysis show that intensification of symptoms is frequently an indication of significant work on the underlying problem. The new experiential approaches view the intensification of symptoms as a major therapeutic tool and use powerful techniques to activate them. Observations from work of this kind strongly suggest that symptoms represent an incomplete effort of the organism to get rid of an old problem—and that this effort should be encouraged and supported.[2]
From this point of view, much of the symptomatic treatment in contemporary psychiatry is essentially antitherapeutic, since it interferes with the spontaneous healing activity of the organism. It should thus be used not as a method of choice but as a compromise when the patient explicitly refuses a more appropriate alternative or if such an alternative is not possible or available for financial or other reasons.
In conclusion, the hegemony of the medical model in psychiatry should be viewed as a situation created by specific historical circumstances and maintained at present by a powerful combination of philosophical, political, economical, administrative, and legal factors. Rather than reflecting the scientific knowledge about the nature of emotional disorders and their optimal treatment, it is at best a mixed blessing.
In the future, patients with psychiatric disorders having a clear organic basis may be treated in medical units especially equipped to handle behavior problems. Those in whom repeated physical checkups detect no medical problems could then use the service of special facilities where the emphasis would be psychological sociological, philosophical, and spiritual, rather than medical. Powerful and effective techniques of healing and personality transformation addressing both the psychological and physical aspects of human beings have already been developed by humanistic and transpersonal therapists.

Disagreements about Theory and Therapeutic Measures
Conflicting theories and alternative interpretations of data can be found in most scientific disciplines. Even the so-called exact sciences have their share of disagreements, as exemplified by the differences of opinion on how to interpret the mathematical formalism of quantum theory. However, there are very few scientific fields where the lack of unanimity is so great and the body of agreed-upon knowledge so limited as in psychiatry and psychology. There is a broad spectrum of competing theories of personality, offering a number of mutually exclusive explanations about how the psyche functions, why and how psychopathology develops, and what constitutes a truly scientific approach to therapy.
The degree of disagreement about the most fundamental assumptions is so phenomenal that it is not surprising that psychology and psychiatry are frequently denied the status of science. Thus, psychiatrists and psychologists with impeccable academic training, superior intelligence, and great talent for scientific observation frequently formulate and defend concepts that are theoretically absolutely incompatible and offer exactly opposite practical measures.
Thus, there are schools of psychopathology that have a purely organic emphasis. They consider the Newtonian-Cartesian model of the universe to be an accurate description of reality and believe that an organism that is structurally and functionally normal should correctly reflect the surrounding material world and function adequately within it. According to this view, every departure from this ideal must have some basis in the anatomical, physiological, or biochemical abnormality of the central nervous system or some other part of the body that can influence its functioning.
Scientists who share this view are involved in a determined search for hereditary factors, cellular pathology, hormonal imbalance, biochemical deviations, and other physical causes. They do not consider an explanation of an emotional disorder to be truly scientific unless it can be meaningfully related to, and derived from, specific material causes. The extreme of this approach is the German organic school of thought with its credo that "for every deranged thought there is a deranged brain cell," and that one-to-one correlates will ultimately be found between various aspects of psychopathology and brain anatomy.
Another extreme example at the same end of the spectrum is behaviorism, whose proponents like to claim that it is the only truly scientific approach to psychology. It sees the organism as a complex biological machine the functioning of which, including the higher mental functions, can be explained from complex reflex activity based on the stimulus-response principle. As indicated by its name, behaviorism emphasizes the study of behavior and in its extreme form refuses to take into consideration introspective data of any kind, and even the notion of consciousness.
Although it definitely has its place in psychology as a fruitful approach to a certain kind of laboratory experimentation, behaviorism cannot be considered a serious candidate for a mandatory explanatory system of the human psyche. An attempt to formulate a psychological theory without mentioning consciousness is a strange endeavor at a time when many physicists believe that consciousness may have to be included explicitly in future theories of matter. While organic schools look for medical causes for mental abnormalities, behaviorism tends to see them as assemblies of faulty habits that can be traced back to conditioning.
The middle band of the spectrum of the theories explaining psychopathology is occupied by the speculations of depth psychology. Besides being in fundamental conceptual conflict with the organic schools and behaviorism, they also have serious disagreements with each other. Some of the theoretical arguments within this group have already been described in connection with the renegades of the psychoanalytic movement. In many instances, the disagreements within the group of depth psychologies are quite serious and fundamental.
On the opposite end of the spectrum, we find approaches that disagree with the organic, behaviorist, or psychological interpretations of psychopathology. As a matter of fact, they refuse to talk about pathology altogether. So, for phenomenology or daseinsanalysis, most of the states that psychiatry deals with represent philosophical problems, since they reflect only variations of existence, different forms of being in the world.
Many psychiatrists refuse these days to subscribe to the narrow and linear approaches described above and instead talk about multiple etiology. They see emotional disorders as end results of a complex multidimensional interaction of factors, some of which might be biological, while others are of a psychological, sociological, or philosophical nature. Psychedelic research certainly supports this understanding of psychiatric problems. Although psychedelic states are induced by a clearly defined chemical stimulus, this surely does not mean that the study of biochemical and pharmacological interactions in the human body following the ingestion can provide a complete and comprehensive explanation of the entire spectrum of psychedelic phenomena. The drug can be seen only as a trigger and catalyst of the psychedelic state that releases certain intrinsic potential of the psyche. The psychological, philosophical, and spiritual dimensions of the experience cannot be reduced to anatomy, physiology, biochemistry, or behavior study; they must be explored by means that are appropriate for such phenomena.
The situation in psychiatric therapy is as unsatisfactory as the one just outlined in regard to the theory of psychopathological problems. It is not surprising, since the two are closely related. Thus, organically-minded psychiatrists frequently advocate extreme biological measures, not only for the treatment of severe disorders such as schizophrenia and manic-depressive psychosis, but for neurosis and psychosomatic diseases as well. Until the early 1950s, most of the common psychiatric biological treatments were of a radical nature—Cardiazol shocks, electroshock therapy, insulin shock treatment, and lobotomy.[3]
Even the modern psychopharmacopeia that has all but replaced these drastic measures, although far more subtle, is not without problems. It is generally understood that in psychiatry drugs do not solve the problem, but control the symptoms. In many instances, the period of active treatment is followed by an indefinite period during which the patient is obliged to take maintenance dosages. Many of the major tranquilizers are used quite routinely and usually for a long period of time. This can lead to such problems as irreversible neurological or retinal damage, and even true addiction.
The psychological schools favor psychotherapy, not only for neuroses, but also for many psychotic states. As mentioned earlier, there are ultimately no agreed-upon diagnostic criteria, except for well-established organic causations of particular disorders (encephalitis, tumor, arteriosclerosis), which would clearly assign the patient to organic therapy or psychotherapy. In addition, there is considerable disagreement as to the rules of combining biological therapy and psychotherapy. Although psychopharmacological treatment may occasionally be necessary for psychotic patients who receive psychotherapy and is generally compatible with its superficial, supportive forms, many psychotherapists feel that it is incompatible with a systematic depth-psychological approach. While the uncovering strategy aims to get to the roots of the problem and uses the symptoms for this purpose, symptomatic therapy masks the symptoms and obscures the problem.
The situation is now further complicated by the increasing popularity of the new experiential approaches. These not only use symptoms specifically as the entry point for therapy and self-exploration, but see them as an expression of the self-healing effort of the organism and try to develop powerful techniques that accentuate them. While one segment of the psychiatric profession focuses all its efforts on developing more and more effective ways of controlling symptoms, another segment is trying equally hard to design more effective methods of exteriorizing them. While many psychiatrists understand that symptomatic treatment is a compromise when a more effective treatment is not known or feasible, others insist that a failure to administer tranquilizers represents a serious neglect.
In view of the lack of unanimity regarding psychiatric therapy—with the exception of those situations that, strictly speaking, belong to the domain of neurology or some other branch of medicine, such as general paresis, brain tumors, or arteriosclerosis—one can suggest new therapeutic concepts and strategies without violating any principles considered absolute and mandatory by the entire psychiatric profession.

Criteria of Mental Health and Therapeutic Results
Since the majority of clinical problems psychiatrists deal with are not diseases in the true sense of the word, application of the medical model in psychiatry runs into considerable difficulty. Although psychiatrists have tried very hard for over a century to develop a "comprehensive" diagnostic system, they have largely failed in their effort. The reason for this is that they lack the disease-specific pathogenesis on which all good diagnostic systems are based.[4] Thomas Scheff (1974) has described this situation succinctly: "For major mental illness classifications, none of the components of the medical model has been demonstrated: cause, lesion, uniform and invariate symptoms, course, and treatment of choice." There are so many points of view, so many schools, and so many national differences that very few diagnostic concepts mean one and the same thing to all psychiatrists.
However, this has not discouraged psychiatrists from producing more and more extensive and detailed official nomenclatures Mental health professionals continue to use the established terms despite overwhelming evidence that large numbers of patients do not have the symptoms to fit the diagnostic categories used to describe them. In general, psychiatric health care is based on unreliable and unsubstantiated diagnostic criteria and guidelines for treatment. To determine who is "mentally ill" and who is "mentally healthy," and what the nature of this "disease" is, is a far more difficult and complicated problem than it seems, and the process through which such decisions are made is considerably less rational than traditional psychiatry would like us to believe.
Considering the large number of people with serious symptoms and problems and the lack of agreed-upon diagnostic criteria, the critical issue seems to be why and how some of them are labeled as mentally ill and receive psychiatric treatment. Research shows that this depends more on various social characteristics than on the nature of the primary deviance (Light 1980). Thus, a factor of great importance is the degree to which the symptoms are manifest. It makes a great difference whether they are noticeable to everybody involved or relatively invisible. Another significant variable is the cultural context in which symptoms occur; concepts of what is normal and acceptable vary widely by social class, ethnic group, religious community, geographical region, and historical period. Also, measures of status, such as age, race, income, and education tend to correlate with diagnosis. The preconception of the psychiatrist is a critical factor; Rosenhan's remarkable study (1973) shows that, once a person has been designated as mentally ill—even if actually normal—the professional staff tends to interpret ordinary daily behavior as pathological.
The psychiatric diagnosis is sufficiently vague and flexible to be adjusted to a variety of circumstances. It can be applied and defended with relative ease when the psychiatrist needs to justify involuntary commitment or prove in court that a client was not legally responsible. This situation is in sharp contrast with the strict criteria applied by the psychiatrist for the prosecution, or by a military psychiatrist whose psychiatric diagnosis would justify discharge from military service. Similarly flexible can be psychiatric diagnostic reasoning in malpractice and insurance suits; the professional argumentation might vary considerably depending on which side the psychiatrist stands.
Because of the lack of precise and objective criteria, psychiatry is always deeply influenced by the social, cultural, and political structure of the community in which it is practiced. In the nineteenth century, masturbation was considered pathological, and many professionals wrote cautionary books, papers, and pamphlets about its deleterious effects. Modern psychiatrists consider it harmless and endorse it as a safety valve for excessive sexual tension. During the Stalinist era, psychiatrists in Russia declared neuroses and sexual deviations to be products of class conflicts and the deteriorated morals of bourgeois society. They claimed that problems of this kind had practically disappeared with the change in their social order. Patients exhibiting such symptoms were seen as partisans of the old order and "enemies of the people." Conversely, in more recent years it has become common in Soviet psychiatry to view political dissidence as a sign of insanity requiring psychiatric hospitalization and treatment. In the United States, homosexuality was defined as mental illness, until 1973 when the American Psychiatric Association decided by vote that it was not. The members of the hippie movement in the sixties were seen by traditional professionals as emotionally unstable, mentally ill, and possibly brain-damaged by drug use, while the New Age psychiatrists and psychologists considered them to be the emotionally liberated avant-garde of humanity. We have already discussed the cultural differences in concepts of normalcy and mental health. Many of the phenomena that Western psychiatry considers symptomatic of mental disease seem to represent variations of the collective unconscious, which have been considered perfectly normal and acceptable by some cultures and at some times in human history.
Psychiatric classification and emphasis on presenting symptoms, although problematic, is somewhat justifiable in the context of the current therapeutic practices. Verbal orientation in psychotherapy offers little opportunity for dramatic changes in the clinical condition, and suppressive medication actively interferes with further development of the clinical picture, tending to freeze the process in a stationary condition. However, the relativity of such an approach becomes obvious when therapy involves psychedelics or some powerful experiential nondrug techniques. This results in such a flux of symptoms that on occasion the client can move within a matter of hours into an entirely different diagnostic category. It becomes obvious that what psychiatry describes as distinct diagnostic categories are stages of a transformative process in which the client has become arrested.
The situation is scarcely more encouraging when we turn from the problem of psychiatric diagnosis to psychiatric treatment and evaluation of the results. Different psychiatrists have their own therapeutic styles, which they use on a wide range of problems, although there is no good evidence that one technique is more effective than another. Critics of psychotherapy have found it easy to argue that there is no convincing evidence that patients treated by professionals improve more than those who are not treated at all or who are supported by nonprofessionals (Eysenck and Rachman 1965). When improvement occurs in the course of psychotherapy, it is difficult to demonstrate that it was directly related either to the process of therapy or to the theoretical beliefs of the therapist.
The evidence for the efficacy of psychopharmacological agents and their ability to control symptoms is somewhat more encouraging. However, the critical issue here is to determine whether symptomatic relief means true improvement or whether administration of pharmacological agents merely masks the underlying problems and prevents their resolution. There seems to be increasing evidence that in many instances tranquilizing medication actually interferes with the healing and transformative process, and that it should be administered only if it is the patient's choice or if the circumstances do not allow pursuit of the uncovering process.
Since the criteria of mental health are unclear, psychiatric labels are problematic, and since there is no agreement as to what constitutes effective treatment, one should not expect much clarity in assessing therapeutic results. In everyday clinical practice, the measure of the patient's condition is the nature and intensity of the presenting symptoms. Intensification of symptoms is referred to as a worsening of the clinical condition, and alleviation of symptoms is called improvement. This approach conflicts with dynamic psychiatry, where the emphasis is on resolution of conflicts and improvement of interpersonal adjustment. In dynamic psychiatry, the activation of symptoms frequently precedes or accompanies major therapeutic progress. The therapeutic philosophy based primarily on evaluation of symptoms is also in sharp conflict with the view presented in this book, according to which an intensity of symptoms indicates the activity of the healing process, and symptoms represent an opportunity as much as they are a problem.
Whereas some psychiatrists rely exclusively on the changes in symptoms when they assess therapeutic results, others include in their criteria the quality of interpersonal relationships and social adjustment. Moreover, it is not uncommon to use such obviously culture-bound criteria as professional and residential adjustment. An increase in income or moving into a more prestigious residential area can thus become important measures of mental health. The absurdity of such criteria becomes immediately obvious when one considers the emotional stability and mental health of some individuals who might rank very high by such standards, say, Howard Hughes or Elvis Presley. It shows the degree of conceptual confusion when criteria of this kind can enter clinical considerations. It would be easy to demonstrate that an increase of ambition, competitiveness, and a need to impress reflect an increase of pathology rather than improvement. In the present state of the world, voluntary simplicity might well be an expression of basic sanity.
Since the theoretical system presented in this book puts much emphasis on the spiritual dimension in human life, it seems appropriate to mention spirituality at this point. In traditional psychiatry, spiritual inclinations and interests have clear pathological connotations. Although not clearly spelled out, it is somehow implicit in the current psychiatric system of thought that mental health is associated with atheism, materialism, and the world view of mechanistic science. Thus, spiritual experiences, religious beliefs, and involvement in spiritual practices would generally support a psychopathological diagnosis.
I can illustrate this with a personal experience from the time when I arrived in the United States and began lecturing about my European LSD research. In 1967, I gave a presentation at the Psychiatric Department of Harvard University, describing the results achieved in a group of patients with severe psychiatric problems treated by LSD psychotherapy. During the discussion, one of the psychiatrists offered his interpretation of what I considered therapeutic successes. According to his opinion, the patients' neurotic symptoms were actually replaced by psychotic phenomena. I had said that many of them showed major improvement after undergoing powerful death-rebirth experiences and states of cosmic unity. As a result, they became spiritual and showed a deep interest in ancient and Oriental philosophies. Some became open to the idea of reincarnation; others became involved in meditation, yoga, and other forms of spiritual practices. These manifestations were, according to him, clear indications of a psychotic process. Such a conclusion would be more difficult today than it was in the late sixties, in light of the current widespread interest in spiritual practice. However, this remains a good example of the general orientation of current psychiatric thinking.
The situation in Western psychiatry concerning the definition of mental health and disease, clinical diagnosis, general strategy of treatment, and evaluation of therapeutic results is rather confusing and leaves much to be desired. Sanity and healthy mental functioning are defined by the absence of psychopathology and there is no positive description of a normal human being. Such concepts as the active enjoyment of existence, the capacity to love, altruism, reverence for life, creativity, and self-actualization hardly ever enter psychiatric considerations. The currently available psychiatric techniques can hardly achieve even the therapeutic goal defined by Freud: "to change the excessive suffering of the neurotic into the normal misery of everyday life." More ambitious results are inconceivable without introducing spirituality and the transpersonal perspective into the practice of psychiatry, psychology, and psychotherapy.

Psychiatry and Religion: Role of Spirituality in Human Life
The attitude of traditional psychiatry and psychology toward religion and mysticism is determined by the mechanistic and materialistic orientation of Western science. In a universe where matter is primary and life and consciousness its accidental products, there can be no genuine recognition of the spiritual dimension of existence. A truly enlightened scientific attitude means acceptance of one's own insignificance as an inhabitant of one of the countless celestial bodies in a universe that has millions of galaxies. It also requires the recognition that we are nothing but highly developed animals and biological machines composed of cells, tissues, and organs. And finally, a scientific understanding of one's existence includes acceptance of the view that consciousness is a physiological function of the brain and that the psyche is governed by unconscious forces of an instinctual nature.
It is frequently emphasized that three major revolutions in the history of science have shown human beings their proper place in the universe. The first was the Copernican revolution, which destroyed the belief that the earth was the center of the universe and humanity had a special place within it. The second was the Darwinian revolution, bringing to an end the concept that humans occupied a unique and privileged place among animals. Finally, the Freudian revolution reduced the psyche to a derivative of base instincts.
Psychiatry and psychology governed by a mechanistic world view are incapable of making any distinction between the narrow-minded and superficial religious beliefs characterizing mainstream interpretations of many religions and the depth of genuine mystical traditions or the great spiritual philosophies, such as the various schools of yoga, Kashmir Shaivism, Vajrayana, Zen, Taoism, Kabbalah, Gnosticism, or Sufism. Western science is blind to the fact that these traditions are the result of centuries of research into the human mind that combines systematic observation, experiment, and the construction of theories in a manner resembling the scientific method.
Western psychology and psychiatry thus tend to discard globally any form of spirituality, no matter how sophisticated and wellfounded, as unscientific. In the context of mechanistic science, spirituality is equated with primitive superstition, lack of education, or clinical psychopathology. When a religious belief is shared by a large group within which it is perpetuated by cultural programming, it is more or less tolerated by psychiatrists. Under these circumstances, the usual clinical criteria are not applied, and sharing such a belief is seen as not necessarily indicative of psychopathology.
When deep spiritual convictions are found in non-Western cultures with inadequate educational systems, this is usually attributed to ignorance, childlike gullibility, and superstition. In our own society, such an interpretation of spirituality obviously will not do, particularly when it occurs among well-educated and highly intelligent individuals. Consequently, psychiatry resorts to the findings of psychoanalysis, suggesting that the origins of religion are found in unresolved conflicts from infancy and childhood: the concept of deities reflects the infantile image of parental figures, the attitudes of believers toward them are signs of immaturity and childlike dependency, and ritual activities indicate a struggle with threatening psychosexual impulses, comparable to that of an obsessive compulsive neurotic.
Direct spiritual experiences, such as feelings of cosmic unity a sense of divine energy streaming through the body, death-rebirth sequences, visions of light of supernatural beauty, past incarnation memories, or encounters with archetypal personages, are then seen as gross psychotic distortions of objective reality indicative of a serious pathological process or mental disease. Until the publication of Maslow's research, there was no recognition in academic psychology that any of these phenomena could be interpreted in any other way. The theories of Jung and Assagioli pointing in the same direction were too remote from mainstream academic psychology to make a serious impact.
In principle, Western mechanistic science tends to see spiritual experiences of any kind as pathological phenomena. Mainstream psychoanalysis, following Freud's example, interprets the unifying and oceanic states of mystics as regression to primary narcissism and infantile helplessness (Freud 1961) and sees religion as a collective obsessive-compulsive neurosis (Freud 1924). Franz Alexander (1931), a very well-known psychoanalyst, wrote a special paper describing the states achieved by Buddhist meditation as self-induced catatonia. The great shamans of various aboriginal traditions have been described as schizophrenic or epileptic, and various psychiatric labels have been put on all major saints, prophets, and religious teachers. While many scientific studies describe the similarities between mysticism and mental disease, there is very little genuine appreciation of mysticism or awareness of the differences between the mystical world view and psychosis. A recent report of the Group for the Advancement of Psychiatry described mysticism as an intermediate phenomenon between normalcy and psychosis (1976). In other sources, these differences tend to be discussed in terms of ambulant versus florid psychosis, or with emphasis on the cultural context that allowed integration of a particular psychosis into the social and historical fabric. These psychiatric criteria are applied routinely and without distinction even to great religious teachers of the scope of Buddha, Jesus, Mohammed, Sri Ramana Maharishi, or Ramakrishna.
This results in a peculiar situation in our culture. In many communities considerable psychological, social, and even political pressure persists, forcing people into regular attendance at church. The Bible can be found in the drawers of many motels and hotels, and lip service is paid to God and religion in the speeches of many prominent politicians and other public figures. Yet, if a member of a typical congregation were to have a profound religious experience, its minister would very likely send him or her to a psychiatrist for medical treatment.

Notes
1. The term disease, or nosological unit (from the Greek nosos, "disease"), has a very specific meaning in medicine. It implies a disorder that has a specific cause, or etiology, from which one should be able to derive its pathogenesis, or the development of symptoms. An understanding of the disorder in these terms should lead one to specific therapeutic strategies and measures, and to prognostic conclusions. (back)
2. The principle of the intensification of symptoms is essential for psychedelic therapy, holonomic integration, and Gestalt practice. The same emphasis also governs the practice of homeopathic medicine and can be found in Victor Frankl's technique of paradoxical intention . (back)
3. Lobotomy is a psychosurgical procedure that in its crudest form involves severing the connections between the frontal lobe and the rest of the brain. This technique, for which the Portuguese surgeon Egas Moniz received the 1949 Nobel prize, was initially used widely in schizophrenics and severe obsessive-compulsive neurotics. Later, it was abandoned and replaced by more subtle microsurgical in terventions. The significance of irrational motifs for psychiatry can be illustrated by the fact that some of the psychiatrists who did not hesitate to recommend this operation for their patients later resisted the use of LSD on the premise that it might cause brain damage not detectable by present methods. (back)
4. A detailed discussion of the problems related to psychiatric diagnosis, definition of normalcy, classification, assessment of therapeutic results, and related issues is not possible here. The interested reader will find more relevant information in the works of Donald Light (1980), Thomas Scheff (1974), R. L. Spitzer and P. T. Wilson (1975), Thomas Szasz (1961), and others. (back)

References
Alexander, F. 1931. "Buddhist Training as Artificial Catatonia." Psychoanalyt. Rev., 18: 129.

Freud, S. 1924. "Obsessive Acts and Religious Practices." Collected Papers vol. 6, Institute of Psychoanalysis. London: The Hogarth Press and the Institute of Psychoanalysis, 1952.

— 1961. Civilization and its Discontents. Standard Edition, vol. 21. London: The Hogarth Press

Group for the Advancement of Psychiatry, Committee on Psychiatry and Religion. 1976. "Mysticism: Spiritual Quest or Psychic Disorder?" Washington, D.C.

Light, D. 1980. Becoming Psychiatrists. New York: W.W. Noroton &Co.

Rosenhan, D. 1973. "On Being Sane in Insane Places." Science 179: 250.

Scheff, T.J. 1974. "The Labeling Theory of Mental Illness." Amer. Sociol. Rev. 39: 444

Mescaline, LSD, Psilocybin and Personality Change

2009-08-11T07:49:00.000-07:00

Mescaline, LSD, Psilocybin and Personality Change
Sanford M. Unger, Ph.D.*
from: Psychiatry: Journal for the Study of Interpersonal Processes
Vol. 26, No. 2, May, 1963. © The William Alanson White Psychiatric Foundation

. . . our normal waking consciousness . . . is but one special type of consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different.... No account of the universe in its totality can be final which leaves these . . . disregarded. How to regard them is the question—for they are so discontinuous with ordinary consciousness.—William James. (1)

In recent years, how to regard the "forms of consciousness entirely different" induced by mescaline, LSD-25, and psilocybin has posed a seemingly perplexing issue. For articulate self-experimenters from Mitchell to Huxley, mescaline has provided many-splendored visual experiences, or a life-enlarging sojourn in "the Antipodes of the mind" (2). For Stockings, it may be recalled, mescaline produced controlled schizophrenia (3)—a thesis which earned the Bronze Medal of the Royal Medico-Psychological Association and apparently inaugurated, in conjunction with the advent of LSD-25, a period of concerted chemical activity in the exploration and experimental induction of "model psychoses" (4). In counterpoint, this same so-called "psychotomimetic" LSD has increasingly found use as a purposeful intervention or "adjuvant" in psychotherapy (5). The recently arrived "magic mushroom," psilocybin, has been similarly equivocal—"psychotogenic" for some, "mysticomimetic" for others (6). The present paper will review the literature on drug experience—paying particular attention to the effects of extradrug variables, for the realization of the extent of their potential influence has only recently crystallized, and promises to reduce some of the abundant disorder in this area.
The phenomenon of drug-associated rapid personality or behavior change will be discussed in some detail. For example, a number of different alcoholic treatment facilities, especially in Canada, have reported, for many of their patients, complete abstinence after a single LSD session (7). More generally, neurotic ailments over the full range have been described as practically evaporating (8). Given this picture, and the present state and practice of the therapeutic art, it is not surprising to find at least one psychiatrist envisioning ". . . mass therapy: institutions in which every patient with a neurosis could get LSD treatment and work out his problems largely by himself" (9). James would have been much attracted by the "spectacular and almost unbelievable results" (10) reported on the modern drug scene; and, in fact, their resemblance to the "instantaneous transformations" attendant on "mystical" religious conversions —which he discussed so eloquently—may well be more than superficial and seems worthy of attention.

The Equivalent Action of Mescaline, LSD-25, and Psilocybin
Since the evidence and testimony accumulated over the years on the separate drugs will be treated interchangeably, this raises a preliminary point of some importance. Although the conclusion was delayed by both dissimilarities in their chemical structure and differing modes of introduction to the scientific community, it is now rather commonly adjudged that the subjective effects of mescaline, LSD-25, and psilocybin are similar, equivalent, or indistinguishable. Both Isbell and Abramson have administered LSD and psilocybin in the same study; Wolbach and his co-workers have administered all three. All have found that their subjects were unable to distinguish between the drugs (11).
The reported equivalence in subjective reactions seems quite consistent—or at least not inconsistent—with present pharmacodynamic knowledge. Studies of radioactively tagged mescaline and LSD indicate that the compounds largely disappear from the brain in relatively short order—in fact, at about the same time that the first "mental phenomena" make their appearance (12). Hence, it has been tentatively suggested that the characteristic effects, which persist for a relatively long period, are to be attributed not to the action of the drug itself but to some as yet unidentified aspect of the chain of events triggered by drug administration. Isbell, observing the "remarkably similar" reactions to LSD and psilocybin, hypothesized "some common biochemical or physiological mechanism" to be responsible for the effects—that is, that the various compounds share a final common path (13). The most direct support for this inference of biological identity in ultimate mechanism of action has come from cross-tolerance studies wherein subjects rendered tolerant to one drug—that is, nonreactive after repeated administrations —have then been challenged by a different drug. Present indications are that cross-tolerance among the drugs does in fact develop (14).
This is not intended to suggest that a drug experience is invariable among subjects—quite the contrary has been the case. In fact, experiences even for the same subject differ from one session to the next (15). But when relevant extradrug variables are controlled, the within-drug variance is apparently coextensive with between-drug variance, and is attributable to ubiquitous personality differences; in other words, while a range of reactions is reported to all of the drugs, there is no reaction distinctively associated with any particular drug. Extradrug variables, which have been uncontrolled and largely unrecognized until recently, are apparently responsible for much of the variance erroneously attributed to specific drug action.

Invariant Drug Reactions
By common consent, the drug experience is paranormal—that is, beyond or outside the range of the normal, the everyday. Exclamations of "indescribable" recurrently appear in the literature. However, whenever descriptions are essayed, there is relative unanimity about certain features. These, it may be said, are attributable to the drug administration, per se, independent of the personality of the subject, the setting, or the experimenter's or subject's expectations. A sampling from the literature of subjective reports and testimony may communicate, or at least transmit the flavor of, these invariant reactions.
First, and perhaps most easily conveyed, is the characteristic of the drug experience called by Ellis a "saturnalia" or "orgy" of vision (16). Subsequent authors have been only slightly more restrained:

The predominance of visual experiences in the picture is striking— not only on account of the persistent hallucinations and illusions, but by the impressiveness of seen real objects, their shape and color.... (17)

There is a great intensification of light; this intensification is experienced both when the eyes are closed and when they are open.... With this intensification of light there goes a tremendous intensification of color, and this holds good of the outer world as well as of the inner world (18).

When I closed my eyes . . . I experienced fantastic images of an extraordinary plasticity. These were associated with an intense kaleidoscopic play of colors (19).

Changes in the perception of visual form occur in virtually everyone.... Consistently reported [are] the plasticity which the forms of the visual world assume . . . the emphasis upon play of light and color, as though light were alive (20).

A second invariant set of drug reactions, more difficult to characterize or communicate, has been called, variously, depersonalization, dissociation, levitation, derealization, abnormal detachment, body image distortion or alteration, and the like:

There is an awareness of an abnormal distance between the self and what happens in its consciousness; on the other hand, the experience of an abnormal fusion of subject and object (21).

My ideas of space were strange beyond description. I could see myself from head to foot as well as the sofa on which I was lying. About me was nothingness, absolutely empty space. I was floating on a solitary island in the ether. No part of my body was subject to the laws of gravitation (22).

What happens in the LSD experience? . . . the universe is overtly structured in terms of an identification between the perceiver and the thing perceived. You hear the music way off down in a cavern, and suddenly it is you who is way down in the cavern. Are you now the music, or is the music now at the mouth of the cavern? Did you change places with it? And so on? (23)

Some degree of depersonalization probably occurs during every LSD experience . . . the detachment of the conscious self, a sort of detached ego. This self is in touch with reality and is in touch with the self experiencing the psychic phenomena (24).

Regardless of whatever else a drug experience may be reported to include, alterations in visual experience and in experience of self, as detailed above, may be predicted with considerable confidence (25).
In connection with the so-called dissociation phenomenon— and in view of the connotations of the "psychotomimetic" and "intoxicant" labels—it may be well to emphasize that drug experiences, at least for most nonpsychotic subjects, do not seem to approximate delirium:

The mescal drinker remains calm and collected amid the sensory turmoil around him; his judgment is as clear as in the normal state.... (26)

It is difficult to classify the state of consciousness during the intoxication which allows such self-observation and, at times, seems to foster detachment and self-scrutiny (27).

. . . in a state of clear consciousness [the subject] . . . is able to describe in detail the manifold mental changes daring drug intoxication (28).

The nondelirious condition of normal volunteers, at least with low to moderate drug dosage, has been objectively attested by their ability to perform psychological tests. The most exhaustive series of investigations along this line has been carried out for LSD by Abramson and his associates (29). Generally, although not consistently, subjects show slight decrements in performance—at least some of which may well be attributable to an altered state of attention-motivation-affect. However, the test setting itself seems to contaminate the drug experience; Savage, among others, has noted "a less profound effect when subjects are kept busy doing psychological tests...." (30)
Another and final set of seemingly invariant reactions concerns the retrospective impressiveness of the drug experience. The succession of testimonials to this effect is a striking and salient feature of the history of research with these compounds:

In some individuals, the "ivresse divine" is rather an "ivresse diabolique." But in either case . . . one looks "beyond the horizon" of the normal world and this "beyond" is often so impressive or even shocking that its after-effects linger for years in one's memory (31).

The experience of the intoxication, as Beringer also observed, makes a particularly deep impression.... The personality is touched to its core and is led into provinces of psychic life otherwise unexplored; light is shed on boundaries otherwise dark and unrevealed and in this some aid may be given to Existenzerhellung (illumination of existence) (32).

. . . most subjects find the experience valuable, some find it frightening, and many say that it is uniquely lovely.... For myself, my experiences with these substances have been the most strange, most awesome, and among the most beautiful things in a varied and fortunate life (33).

To be shaken out of the ruts of ordinary perception . . . this is an experience of inestimable value to everyone and especially to the intellectual . . . the man who comes back through the Door in the Wall will never be quite the same as the man who went out (34).

. . . the whole experience is (and is as) a profound piece of knowledge. It is an indelible experience; it is forever known. I have known myself in a way I doubt would have ever occurred except as it did (35).

The "Psychotomimetic" Label
After the above renditions, a querulous reader may be concerned about the appellation "psychotomimetic drugs." So are many contemporary researchers and therapists, too numerous to mention. Holliday has provided a trenchant analysis of "how the semantics in the field of psychopharmacology became so confused and generally misleading" (36); here, only a few points will be noted.
Early mescaline investigators clearly tempered their comparisons between the mescal-induced state and the hallucinations and dissociations of endogenous psychosis. As far back as 1930, it was found that when chronic schizophrenics suffering from persistent hallucinations were given mescal, they distinguished the mescal phenomena, remarked on their appearance, and usually blamed them on the same persecutors who had molested them before (37). Kluver, though he foresaw and extensively discussed the "model" values of mescal, persisted in calling it "the divine plant" (38). It was apparently difficult to consider a sacramental substance—"the comfort, healer, and guide of us poor Indians . . . the great teacher" (39)—as unequivocally psychotomimetic.
With LSD, a laboratory-born drug having no history to contend with, the situation changed. The adventurous Hofmann, on that fateful day in 1943, started his self-experiment with 250 micrograms of LSD, thinking, as he put it, that such a small amount would probably be harmless. His response to this quite large dose—in terms of present-day experimental standards— was as follows:

I noted with dismay that my environment was undergoing progressive change. Everything seemed strange and I had the greatest difficulty in expressing myself. My visual fields wavered and everything appeared deformed as in a faulty mirror. I was overcome by a fear that I was going crazy, the worst part of it being that I was clearly aware of my condition. The mind and power of observation were apparently unimpaired (40).

Hofmann went on to list, as his most marked symptoms, visual disturbances, motor restlessness alternating with paralysis, and a suffocating sensation, and added: "Occasionally I felt as if I were outside my body. My 'ego' seemed suspended in space. .. ." (41)
Stoll, who in 1947 reported experimental confirmation of Hofmann's experience, is widely reputed to have warned informally of a case of suicide as the aftermath of an experimental trial. The most common accounts thereafter had a psychotic female subject committing suicide two weeks after the administration; or, in another version, a subject committing suicide after the drug had been administered without her knowledge. At any rate, this story, though itself never appearing in print, is referred to in one form or another in nearly all of the early work with LSD; it apparently influenced experimenter attitudes for a number of years.
For many and varied reasons, too involved to trace here, the initial formulation of the "model psychosis" properties of LSD engendered enormous investigative enthusiasm. In this climate, latent reservations on the score of psychotomimesis tended to go unvoiced. In the more recent, postenthusiasm era, however, reservations have been more or less vigorously expressed—for example:

There are considerable differences between LSD-induced and schizophrenic symptoms. The characteristic autism and dissociation of schizophrenia are absent with LSD. Perceptual disturbances due to LSD differ from those due to schizophrenia and, as a rule, are not true hallucinations. Finally, disturbances of consciousness following LSD do not resemble those occurring in schizophrenia (42).

Many alternatives to the "psychotomimetic" characterization of "hallucinogenic" agents have recently been proposed. In 1957, Osmond offered, among others, "psychelytic" (mind-releasing) and "psychedelic" (mind-manifesting) (43). Other investigators have proposed consciousness-expanding, transcendental, emotionalgenic, mysticomimetic, and so forth. It becomes ever more apparent, though, that old labels never die (44).

Variable Drug Reactions and Extradrug Variables
It may probably be stated as a pharmacopoeias commonplace that the effects of a drug administration of any kind are likely to be compounded by factors other than specific pharmacologic action. Often this is attributed to "personality," to individual differences (45). However, though there have been as yet very few controlled investigations in the case of the drugs considered here, it has become abundantly clear from the systematic variability reported in subject and patient reactions—in both the affective and ideational dimensions of drug experience—that factors other than "personality" are also at issue.
Affective reactions attendant on a drug administration have varied, according to reports, all the way from hyperphoric ecstasy to unutterable terror—though not with all investigators. The opinion leader Hoch, through a decade of observations, consistently maintained:

LSD and mescaline disorganize the psychic integration of the individual.... (46)

. . . mescaline and LSD are essentially anxiety-producing drugs. . . . (47)

The following interchange was recorded at the 1959 conference on the use of LSD in psychotherapy held under the auspices of the Josiah Macy, Jr. Foundation:

Hoch: Actually, in my experience, no patient asks for it [LSD] again.
Katzenelbogen: I can say the same.
Denber: I have used mescaline in the office . . . and the experience was such that patients said, "Once is enough." The same thing happened in the hospital. I asked the patients there if, voluntarily, they would like to take this again. Over 200 times the answer has been "No" (48).

Subsequently, Malitz also stated:

None of our normal volunteers wanted to take it [LSD] again (49).

In contrast, DeShon and his co-workers reported the results of the first LSD study done with normal subjects in this country as follows:

... anxiety was infrequent, transient, and never marked.... All subjects were willing to repeat the test (50).

The experience of other investigators has been similar:

During the past four years we have administered the drug [LSD] hundreds of times to nonpsychotics in doses up to 225 micrograms. . . . Those who have participated in these groups are nearly always definitely benefited by their experiences. Almost invariably they wish to return and to participate in new experiments (51).

. . . few patients discontinue treatment, in fact, enthusiasm and eagerness to continue are among the features of LSD patients (52) .

The rapidly expanding use of LSD in psychotherapeutic contexts has provided highly revealing clues to the patterning of extradrug variability. Busch and Johnson were the first to report administering LSD to neurotic patients whose therapy had "stalled" and whose prognosis was "dim." The result was "a reliving of repressed traumatic episodes of childhood," with "profound" influence on the course of therapy (53). Sandison and his colleagues also found that LSD "produces an upsurge of unconscious material into consciousness" (54), and that "repressed memories are relived with remarkable clarity" (55)—with therapeutically beneficial consequences.
Since these early reports, whenever psychoanalytically oriented therapists have employed LSD, practically without exception the patient relives childhood memories. The interesting point is that this phenomenon has practically never been noted in the experimental literature!
Jungian therapists, on the other hand, have repeatedly found that their patients have "transcendental" experiences—a state beyond conflict—often with rapid and dramatic therapeutic results. As a matter of fact, in an amusing and somewhat bemused account, Hartman has described his LSD-using group comprised of two Freudians and two Jungians, in which the patients of the former report childhood memories, while those of the latter have "transcendental" experiences. In addition, for Jungian patients, the transcendental state is associated with "spectacular" therapeutic results, while for Freudians, should such a state "accidentally" occur, no such spectacular consequence is observed (56).
While not from a therapeutic setting, the reports which have emanated from Harvard are noteworthy on the score of ideational content. Under psilocybin, Harvard subjects do not relive their childhood experiences, but grapple with age-old paradoxes:

. . . the problem of the one and the many, unity and variety, determinism and freedom; mechanism and vitalism; good and evil; time and eternity; the plenum and the void; moral absolutism and moral relativism; monotheism and polytheism and atheism. These are the basic problems of human existence.... We need not wonder that the Indians called the mushroom sacred and gave it a name which means "the flesh of the god" (57).

Without multiplying or belaboring divergences further, it should be apparent that affective reactions and ideational content may be systematically variable dimensions of drug experience; in addition, the possible therapeutic uses or consequences, however these are conceived, seem clearly variable. Once these "facts" are arrayed, in Baconian fashion, they nearly speak for themselves. At the Josiah Macy conference, the emerging consensus was perhaps best expressed by Savage:

This meeting is most valuable because it allows us to see all at once results ranging from the nihilistic conclusions of some to the evangelical ones of others. Because the results are so much influenced by the personality, aims, and expectations of the therapist, and by the setting, only such a meeting as this could provide us with such a variety of personalities and settings. It seems clear, first of all, that where there is no therapeutic intent, there is no therapeutic result. . . . I think we can also say that where the atmosphere is fear-ridden and skeptical, the results are generally not good.... This is all of tremendous significance, for few drugs are so dependent on the milieu and require such careful attention to it as LSD does (58).

The same conclusion has come from experimental quarters as well—for example:

[The effect] of hallucinogens is not limited to any single agent since, in addition to psilocybin, we have seen it with LSD-25 and mescaline. The environmental setting in which the drug is administered . . . affects the emerging behavior pattern. This factor may account for variations in results with different investigators. Our hospital setting, with the subject, a paid volunteer, receiving an unknown agent, in an experimental framework surrounded by unfamiliar doctors and nurses, differs markedly from the mystical setting which Wasson observed.... Only one of our subjects reported what might be described as a transcendental experience.... The differences in expectation and setting between these two grossly divergent groups may account in part for the disparity in their responses (59).

More specifically, anxiety in the therapist or experimenter about administering the drug, about "inducing psychosis," seems likely to render the experience anxiety-ridden for the subject. Abramson has flatly declared: "The response of the subject . . . will depend markedly upon the attitude of the therapist.... In particular, if the therapist is not anxious about the use of the drug, anxiety in the patient will be much decreased" (60). Hyde has reported that "impersonal, hostile, and investigative attitudes" arouse hostile and paranoid responses (61). Sandison has observed that the occurrence of anxiety seems largely to depend on "what the patient is told beforehand [as well as] rumors and myths current among patients and staff, or even in the press, about hallucinogenic drugs" (62). Huxley had intimated this before it became clarified in the psychiatric literature:

. . . the reasonably healthy person knows in advance that, so far as he is concerned, mescaline is completely innocuous.... Fortified by this knowledge, he embarks upon the experience without fear—it: other words, without any disposition to convert an unprecedented strange and other than human experience into something appalling, something actually diabolical (63).

That the positive or negative character of the experience can be systematically directed, overriding even personality factors, seems now to have been fairly conclusively demonstrated. With "adequate" preparation—that is, with the specific intent of rendering drug experiences "positive"—approximately 90 percent of the subjects or patients, in each of the two most recent studies, reported at least a "pleasant" or "rewarding" session, and nearly as many called it "an experience of great beauty" or something equally superlative (64).
In content, as in affect, subjects apparently respond to the implicit or explicit suggestion or expectation of the therapist or experimenter. The Harvard subjects were prepared for their metaphysical binges, it may be noted, with such assigned readings as the "Idols of the Cave" parable in Plato's Republic and passages from The Tibetan Book of the Dead. The preparation of psychotherapy patients hardly needs specification.
Finally, what may be said about therapeutic implications?— given the fact that the compounds under discussion may induce a powerful paranormal experience whose affective and ideational content can be guided. Only perhaps that the extent to which the experience can serve as a useful adjunct to traditional interview therapies, or vice versa, or even as a "compleat therapie" would seem to depend on the particular practitioner of the art—his conceptions of therapeutic gains and consequences, his philosophy and enthusiasm, and his orientation toward "placebo" or "faith" cures (65). Schmiege has summarized the current state of affairs as follows:

Those using LSD in multiple doses as an adjunct to psychotherapy feel that it is so useful because of its ability to do the following: (I) It helps the patient to remember and abreact both recent and childhood traumatic experiences. (2) It increases the transference reaction while enabling the patient to discuss it more easily. (3) It activates the patient's unconscious so as to bring forth fantasies and emotional phenomena which may be handled by the therapist as dreams. (4) It intensifies the patient's affectivity so that excessive intellectualization is less likely to occur. (5) It allows the patient to better see his customary defenses and sometimes allows him to alter them. Because of these effects, therapists feel that psychotherapy progresses at a faster rate. Of course this poses the age old problem of what is the essence of psychotherapy.

There are many reports of patients receiving meaningful insight about themselves in an LSD experience without the intervention, participation or even presence of a therapist.... Those who administer lysergic acid in a single dose have as their goal, in the words of Sherwood, et al., an overwhelming reaction "in which an individual comes to experience himself in a totally new way and finds that the age old question 'Who am I?' does have a significant answer." Frequently, this is accompanied by a transcendental feeling of being united with the world.... Some spectacular, and almost unbelievable, results have been achieved by using one dose of the drug (66) .

Rapid Personality Change
An increasing number of subjects, patients, experimenters, and psychiatrists—spontaneously or with priming—have declared their drug experiences to be transcendental, mystical, cosmic, visionary, revelatory, and the like. There seems to be difficulty in finding the right name for the experience, even among the professional so-called "mystics":

There is no really satisfactory name for this type of experience. To call it mystical is to confuse it with visions of another world, or of god and angels. To call it spiritual or metaphysical is to suggest that it is not also extremely concrete and physical, while the term "cosmic consciousness" itself has the unpoetic flavor of occultist jargon. But from all historical times and cultures we have reports of this same unmistakable sensation emerging, as a rule, quite suddenly and unexpectedly and from no clearly understood cause (67).

Whatever this type of experience is called, however, a growing body of "expert" testimony apparently confirms the possibility of its induction by drugs. Watts, the dean of current Western Zen scholars, has recently described "cosmic consciousness," courtesy of LSD, in exquisite detail (68). Seminary students and professors in the Boston area are said to have definitely concluded that their contact with psilocybin was "mystico-religious" (as to whether or not it was "Christian," however, they are still in doubt) (69). Huxley has been most outspoken about the capacity of the drugs to induce "traditional" mystical-visionary states:

For an aspiring mystic to revert, in the present state of knowledge, to prolonged fasting and violent self-flagellation would be as senseless as it would be for an aspiring cook to behave like Charles Lamb's Chinaman, who burned down the house in order to roast a pig. Knowing as he does (or at least as he can know, if he so desires) what are the chemical conditions of transcendental experience, the aspiring mystic should turn for technical help to the specialists.... (70)

Nearly invariably, whenever dramatic personality change has been noted following the use of these drugs, it has been associated with this kind of experience—that is, one called transcendental or visionary—with the particular name the experience is given seemingly most dependent upon whether the investigator focuses on affect or content. These experiments in drug-induced behavior change will shortly be reviewed in detail.

Examples Not Associated with Drugs
Since accounts of behavior transformations attendant on paranormal experience are not without precedent, it may be helpful to set the stage for present developments by citing some examples not connected with drugs. James reported on the phenomenon in its most familiar and perhaps prototypic context:

In this lecture we have to finish the subject of conversion, considering it first through striking instantaneous instances of which St. Paul's is the most eminent, and in which, often amid tremendous emotional excitement or perturbation of the senses, a complete division is established in the twinkling of an eye between the old life and the new.

After adducing numerous examples, James continued:

I might multiply cases almost indefinitely, but these will suffice to show you how real, definite, and memorable an event a sudden conversion may be to him who has the experience. Throughout the height of it he undoubtedly seems to himself a passive spectator or undergoer of an astounding process performed upon him from above. There is too much evidence of this for any doubt of it to be possible. Theology, combining this fact with the doctrine of election and grace, has concluded that the spirit of God is with us at these dramatic moments in a peculiarly miraculous way, unlike what happens at any other juncture of our lives. At that moment, it believes, an absolutely new nature is breathed into us, and we become partakers of the very substance of the Deity (71).

One may also recall to mind the "vision-seeking" American Indians whom Ruth Benedict immortalized. Adapting Nietzsche's designation "Dionysian" to characterize their cultural pattern, she portrayed its fundamental contrast with the "Apollonian" Zuni-Pueblo way of life. The Dionysian "seeks to attain in his most valued moments escape from the boundaries imposed on him by his five senses, to break through into another order of experience." He values "all means by which human beings may break through the usual sensory routine" (72).
Widespread among the western Indians (except in the Pueblos) was what Benedict called the "Dionysian dogma and practice" of the vision-quest—sought by fasting, by torture, and by drugs. The point of interest, of course, is that when the vision came, it could apparently trigger large-scale behavior alterations which had the stamp and reinforcement of social approval.

. . . on the western plains men sought these visions with hideous tortures. They cut strips from the skin of their arms; they struck off fingers; they swung themselves from tall poles by straps inserted under the muscles of their shoulders. They went without food and water for extreme periods. They sought in every way to achieve an order of experience set apart from daily living.

On the western plains they believed that when the vision came, it determined their life and the success they might expect. If no vision came, they were doomed to failure.... If the experience was of curing, one had curing powers; if of warfare, one had warrior's powers. If one encountered Double Woman, one was a transvestite, and took woman's occupations and habits. If one was blessed by the mythical Water-Serpent, one had supernatural power for evil, and sacrificed the lives of one's wife and children in payment for becoming a sorcerer (73).

The final example which will be noted here of rapid personality change not induced by drugs has emerged quite recently from Maslow's studies of "self-actualization." Maslow reports that the occurrence of a dramatic "peak experience"— defined or alternatively described as a "cognition of being," or as "mystic" or "oceanic"—is a major event in the life histories of his "self-actualizing" subjects. Maslow avers "unanimous agreement" among his subjects as to the "therapeutic" after-effects of such peak experiences—for example, that they were so profound as to remove neurotic symptoms forever; or were followed by greater creativity, spontaneity, or expressiveness; or produced a more or less permanently changed, more healthy world-view or view of self, and so on (74).

Drug-Associated Personality Change: A "New Concept" in Psychotherapy
It is an intriguing historical accident that, on the one hand, anthropological studies of the Native American Church (Peyotism) consistently record the peyote-associated reformation of alcoholic and generally reprobate characters (75), and, on the other hand, LSD has been increasingly utilized in the treatment of the white man's "fire-water" ills. LSD was first systematically administered to non-Indian alcoholics in order to explore a putative similarity between the so-called model psychosis and delirium tremens. Two independent undertakings along this line, one in the U.S. and one in Canada, resulted in highly unexpected and sudden "cures" (76).
Investigators in Saskatchewan pursued this serendipitous result aggressively. The outcome, with lately-evolved refinements in technique, has been an explicitly formulated "new concept" in psychotherapy (77). The following narrative, pieced together from Hoffer's statements at the Macy LSD conference, describes the conditions under which the rapid change phenomenon seems first to have occurred in sizeable numbers:

. . . we have what we call the "businessman's special," for very busy people, the weekend treatment.... They come in because the police or Alcoholics Anonymous or others bring them in. They come in on day one. They know they are going to take a treatment, but they know nothing about what it is. We take a psychiatric history to establish a diagnosis. That is on day one. On day two, they have the LSD. On day three, they are discharged.
Our objective [in using 200-400 gamma doses] is to give each patient a particular LSD experience.
The results are that 50 per cent of these people are changed [that is, they stop drinking or are much improved].... As a general rule . . . those who have not had the transcendental experience are not changed; they continue to drink. However, the large proportion of those who have had it are changed (78).

The only other investigators to report a "weekend treatment" are Ball and Armstrong (79). They describe a small series of "sex perverts," at least two of whom had had, over a number of years, "a variety of forms of psychotherapy, including psychoanalysis . . . [resulting in] no improvement whatever." The large-dose LSD experience, however, is said to have had "remarkable, long-lasting remedial effects" (80).
MacLean and his co-workers in British Columbia, Canada have reported on a series which included 61 alcoholics and 33 neurotics (personality trait disturbance and anxiety reaction neurosis) (81). Each patient was carefully and intensively prepared for the 400-1500 gamma, "psychedelic LSD-day"—which was jointly conducted by a psychiatrist, a psychologist, a psychiatric nurse, and a music therapist. Their follow-up data (median follow-up was for 9 months) were interpreted to yield a "much improved" or "improved" rating for over 90 percent of the neurotics and 60 percent of the alcoholics, with just under 50 percent of the alcoholics found at follow-up to have remained "totally dry" (82). The results of this single LSD session with the alcoholic cases seem most impressive, in view of the picture provided:

These were considered to be difficult cases; 59 had experienced typical delirium tremens; 36 had tried Alcoholics Anonymous and were considered to have failed in that program. The average period of uncontrolled drinking was 14.36 years. The average number of admissions to hospital for alcoholism during the preceding 3 years was 8.07 (83).

Since Hoffer's account, procedures in Saskatchewan have apparently been modified to incorporate considerable "psychotherapy"—as an adjunct to, and preparation for, the LSD experience. In a recent report, Jensen has described a greatly expanded treatment method and its results:

The treatment program includes three weekly A.A. meetings. The patients are strongly encouraged, but not forced, to attend. There are also 2 hours of group psychotherapy, in the course of which those who are not already familiar with the A.A. program are indoctrinated mainly by the other patients' discussion.... Because of the fairly short time available, the group therapy is superficial in nature and primarily educational.
Toward the end of hospitalization (which averaged 2 months), the patients were given an LSD experience. They routinely received 200 gamma of the drug.... (84)
Of 58 patients who experienced the full program, including LSD, and were followed up for 6 to 18 months, 34 had remained totally abstinent since discharge or had been abstinent following a short experimental bout immediately after discharge; 7 were considered improved, i.e., were drinking definitely less than before; 13 were unimproved; and 4 broke contact.
Of 35 patients who received group therapy without LSD, 4 were abstinent, 4 were improved, 9 were unimproved and 18 were lost to follow-up.
Of 45 controls, consisting of patients admitted to the hospital during the same period who received individual treatment by other psychiatrists, 7 were abstinent, 3 improved, 12 unimproved, and 23 lost to follow-up (85).

Among the reservations that might be expressed about Jensen's study, two are outstanding. First, there is some ambiguity about the assignment of patients to the different treatment conditions—it does not seem to have been entirely random. Second, Jensen's assumption that patients who broke or refused follow-up contact with the hospital staff are safely categorized, for statistical purposes, as "treatment failures" would seem somewhat overweening. At any rate, on his count, the difference in percentages of patients "abstinent or improved" between the "full program-LSD" group (41 out of 58, or 71 percent) and the "individual psychotherapy" group (10 out of 45, or 22 percent) was highly statistically significant.
The present "official policy" of the Saskatchewan Department of Public Health may be of interest. A recently issued document, which reviews the results of four such follow-up studies as Jensen's, concludes with the directive that the single, large-dose LSD treatment of alcoholism is to be considered "no longer as experimental," but rather, "to be used where indicated" (86).
There seem to have been only two efforts in the U.S. to explicitly and systematically follow the Canadian model. In quite different contexts, both are reported as at least "doing well." Leary and his co-workers at Harvard, over the last two years, have conducted a research and treatment program at Massachusetts Correctional Institution, Concord, "designed to test the effects of consciousness-expanding drugs on prisoner rehabilitation" (87). This undertaking, which emphasizes the crucial importance of drug-induced "far-reaching insight experiences" —prepared for, supported, and reinforced by group therapy sessions—has resulted in a recidivism rate considerably reduced from actuarial expectation. The number of post-treatment cases on which this evaluation is based, however, is only 26. The program is ongoing (88).
In a much more familiar setting, a group of workers on the West Coast has been treating the full range of garden-variety neuroses. The patients are intensively prepared over a two- to three-week period for a large-dosage, "transcendental" drug session. The stated intent is to induce a "single overwhelming experience . . . so profound and impressive that . . . the months and years that follow become a continuing growth process" (89). Thus far, in over 100 treated cases, at least "marked improvement" in the condition for which treatment was sought has been reported in about 80 percent—after one so-called overwhelming experience (90).
It is a commonplace that new psychiatric treatments seem to effect remarkable cures—at least for a short time and in the hands of their originators. In raising the spectre of the powerful placebo effect (91), it need hardly be pointed out that the results reviewed above should be regarded with healthy skepticism. On the other hand, they are more than merely trifling.

Explanatory Concepts
In addressing a recent international assemblage at Copenhagen, Leary asserted:

The visionary experience is the key to behavior change. [In its wake] change in behavior can occur with dramatic spontaneity . . . (92).

Van Dusen, who bids fair to become the psychologist-philosopher of the "new concept" movement, puts the issue as follows:

There is a central human experience which alters all other experiences . . . not just an experience among others, but . . . rather the very heart of human experience. It is the center that gives understanding to the whole.... It has been called satori in Japanese Zen, moksha in Hinduism, religious enlightenment or cosmic consciousness in the West.... Once found life is altered because the very root of human identity has been deepened . . . the still experimental drug d-lysergic acid diethylamide (LSD) appears to facilitate the discovery of this apparently ancient and universal experience (93).

Although reminded on all sides of the incommunicableness of "the transport," as James called it, of its ineffability, one may, before following him in the descent toward "medico-materialistic" explanation, inquire further of its nature. James proffered the traditional demurrer ". . . it is probably difficult to realize [its] intensity unless one has been through the experience one's self . . ." (94). He then proceeded, with seeming aplomb, to describe it:

The central [characteristic] is the loss of all worry, the sense that all is ultimately well with one, the peace, the harmony, the willingness to be....
The second feature is the sense of perceiving truths not known before . . . insight into depths of truth unplumbed by the discursive intellect.... The mysteries of life become lucid ... illuminations, revelations, full of significance and importance, all inarticulate though they remain....
A third peculiarity . . . is the objective change which the world often appears to undergo. "An appearance of newness beautifies every object" . . . clean and beautiful newness within and without . . . (95).

In James' view, "melting emotions and tumultuous affections" were the constant handmaiden of "crises of change" (96). Also Benedict, in the context of the vision-quest, remarked on ". . . very strong affect, either ultimate despair or release from all inadequacy and insecurity" (97). Chwelos and his co-workers, describing the transcendental drug experience as "mainly in the sphere of emotions or feeling" (98), exemplify this by quoting an alcoholic patient:

I was swept by every conceivable variety of pleasant emotion from my own feeling of well-being through feelings of sublimity and grandeur to a sensation of ecstasy (99).

Finally now, turning from the poetry of phenomenal experience to medico-materialism, how did James approach the matter of explanation?

If you open the chapter on Association, of any treatise on psychology, you will find that a man's ideas, aims, and objects form diverse internal groups and systems, relatively independent of one another.... When one group is present and engrosses the interest, all the ideas connected with other groups may be excluded from the mental field.... Our ordinary alterations of character as we pass from one of our aims to another, are not commonly called transformations . . . but whenever one aim grows so stable as to expel definitively its previous rivals from the individual's life we tend to speak of the phenomenon and perhaps to wonder at it, as a "transformation."
Whether such language be rigorously exact is for the present of no importance. It is exact enough, to recognize from your own experience the fact which I seek to designate by it.
Now if you ask of psychology just how the excitement shifts in a man's mental system, and why aims that were peripheral become at a certain moment central, psychology has to reply that although she can give a general description of what happens, she is unable in a given case to account accurately for all the single forces at work.
In the end we fall back on the hackneyed symbolism of mechanical equilibrium. A mind is a system of ideas, each with the excitement it arouses, and with tendencies impulsive and inhibitive, which mutually check or reinforce one another.... A new perception, a sudden emotional shock . . . will make the whole fabric fall together, and then the center of gravity sinks into an attitude more stable, for the new ideas that reach the center in the rearrangement seem now to be locked there, and the new structure remains permanent (100).

More modern discussions of rapid personality change seem, in large part, to be variations on the theme of "melting emotions and tumultuous affections." There have been two relatively recent efforts to deal with rapid change associated primarily with conversion. Wallace, who attempted an heroic amalgam of Selye's "stress" theory and cultural anthropology, summed this up as follows:

. . . the physiologic events of the general adaptation syndrome [in situations of massive emotion] establish a physicochemical milieu in which certain brains can perform a function of which they are normally incapable: a wholesale resynthesis that transforms intellectual insight into appropriate motivation, reduces conflict by partial or total abandonment of certain values and acceptance of others, and displaces old values to new, more suitable objects (101).

Sargant has linked along an axis of abnormal "anger, fear, or exaltation" such "abrupt total reorientations" in personality as attend religious and political conversion experiences—as well as violent abreactions in therapy, spontaneous or narcosynthetic. His explanatory scheme derives directly from Pavlov—in the final analysis, sudden alterations in behavior are attributed to "paradoxical" and "ultraparadoxical" brain processes, and the like, induced by extreme emotion (102).
To return to LSD-related developments, Ditman and his coworkers have reviewed a whole range of considerations and theories which might "rationalize" the sudden change phenomenon—including a highly libidinized psychoanalytic formulation (103).
It remains to raise just one final query. Rapid personality change, translated into language more congenial to behavioral psychology, could be taken to describe a situation in which formerly dominant or high-probability responses, overt or mediational, were suddenly greatly reduced in frequency of occurrence; and, vice versa, uncommon responses, or those formerly low in a hierarchy, appear with greatly elevated frequency. The only experimental results which even approximate this order of events seem to be those which have arisen with the aid of direct intracranial electrical stimulation. With response-contingent reinforcement of this kind—that is, with electrical "trains" delivered to the hypothalamic, so-called pleasure or reward centers—the repertoires of many rats and monkeys have been dramatically altered in a very few moments: Utterly new behaviors have been shaped, old responses eliminated (104). The degree to which such "artificially induced" learning has been sustained has been a function, as with all behavior, of the ebb and flow of environmental contingencies. Thus, to point the issue: Do transcendental experiences at the human level, however they are interpreted, tread in this area of superreinforcement—with a potential for radically altering the probability of occurrence of "heuristic" mediating processes (for example, positive rather than negative self-concepts) which might channel behavior, at least temporarily, in new directions, toward a "new beginning"?

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With Ruth Benedict's "Apollonian" Zuni, the tendency of the modern West is to regard paranormal experiences, indiscriminately and often with little idea of their nature, as "pathological"—to be distrusted, feared, avoided. The Zuni Indian, said Benedict, "finds means to outlaw them from his conscious life. . . . He keeps the middle of the road, stays within the known map, does not meddle with disruptive psychological states" (105). It would seem unfortunate were this Zeitgeist to unduly prejudice the exploration of therapeutic potential in the drugs here discussed.
In conclusion, let it be noted that the public health implications of drug-associated rapid personality change, should this phenomenon prove not to be a will-of-the-wisp, are apparently great. Intensive investigation would seem a reasonable order of the day. The procedures and time involved are manifestly economical—in truth, there seems little to be lost.

REFERENCES
1. The Varieties of Religious Experience New York: Modern Library, 1902; pp. 378-379.
2. S. Weir Mitchell, "The Effects of Anhelonium Lewinii (the Mescal Button)," Brit. Med. J. (1896) 2:1625-1629. Aldous Huxley, "Mescaline and the Other World," pp. 46-50, in Proceedings of the Round Table on Lysergic acid Diethylamide and Mescaline in Experimental Psychiatry, edited by Louis Cholden. New York: Grune & Stratton, 1956; see p. 47.
3. G. Tayleur Stockings, "Clinical Study of the Mescaline Psychosis with Special Reference to the Mechanisms of the Genesis of Schizophrenia and Other Psychotic States," J. Mental Science (1940) 86:29-47.
4. For example, see Max Rinkel, Editor, Chemical Concepts of Psychosis. New York: McDowell, Obolensky, 1958.
5. For example, see Harold A. Abramson, Editor, The Use of LSD in Psychotherapy: Transactions of a Conference. New York: Josiah Macy, Jr., Foundation Publications, 1960.
6. Max Rinkel, C. W. Atwell, Alberto DiMascio, and J. R. Brown, "Experimental Psychiatry, V: Psilocybin, a New Psychotogenic Drug," New England J. Med. (1960) 262:293-299. Stephen Szara, "Psychotomimetic or Mysticomimetic?," paper presented at NIMH, Bethesda, Md., Nov. 14, 1961.
7. For examples, see: Nicholas Chwelos, Duncan Blewett, Colin Smith, and Abram Hoffer, "Use of LSD-25 in the Treatment of Alcoholism," Quart. J. Studies on Alcohol (1959) 20:577-590. J. Ross MacLean, D. C. MacDonald, Ultan P. Byrne, and A. M. Hubbard, "The Use of LSD-25 in the Treatment of Alcoholism and Other Psychiatric Problems," Quart. J. Studies on Alcohol (1961) 22:3445. P. O. O'Reilly and Genevieve Reich, "Lysergic Acid and the Alcoholic," Diseases Nervous System (1962) 23:331-34.
8. For examples, see: Charles Savage, James Terrill, and Donald D. Jackson, "LSD, Transcendence, and the New Beginning," J. Nervous and Mental Disease (1962) 135:425-439. John N. Sherwood, Myron J. Stolaroff, and Willis W. Harman, "The Psychedelic Experience—A New Concept in Psychotherapy," J. Neuropsychiatry
(1962) 3:370_375.
9. C. H. Van Rhijn, "Introductory Remarks: Participants," in footnote 5; p. 14.
10. Gustav R. Schmiege, "The Current Status of LSD as a Therapeutic Tool—A Summary of the Clinical Literature," paper presented to the Amer. Psychiatric Assn., Toronto, Canada, May 8, 1962 (in press, New Jersey Med. Soc. J., 1963).
11. Harris Isbell, "Comparison of the Reactions Induced by Psilocybin and LSD-25 in Man," Psychopharmacologia (1959) 1:29-38. Harold A. Abramson, "Lysergic Acid Diethylamide (LSD-25): XXX, The Questionnaire Technique with Notes on Its Use," J. Psychology (1960) 49:57-65. A. B. Wolbach, E. J. Miner, and Harris Isbell, "Comparison of Psilocin with Psilocybin, Mescaline and LSD-25," Psychopharmacologia (1962) 3:219-223.
12. For examples, see: Max Rinkel, "Pharmacodynamics of LSD and Mescaline," J. Nervous and Mental Disease (1957) 125:424-426. T. J. Haley and J. Rutschmann, "Brain Concentrations of LSD-25 (Delysid) after Intracerebral or Intravenous Administration in Conscious Animals," Experientia
(1957) 13:199-200.
13. See Isbell, in footnote 11: p. 37.
14. For examples, see: Antonio Balestrieri and Diego Fontanari, "Acquired and Crossed Tolerance to Mescaline, LSD-25, and BOL148," Arch. General Psychiatry (1959) 1:279-282. Harris Isbell, A. B. Wolbach, Abraham Wikler, and E. J. Miner, "Cross-Tolerance Between LSD and Psilocybin," Psychopharmacologia (1961) 2:147-151.
15. T. W. Richards and Ian P. Stephenson, "Consistency in the Psychologic Reaction to Mescaline," Southern Med. J. (1961) 54:13191320.
16. Havelock Ellis, "Mescal, a New Artificial Paradise," pp. 537-548, in Annual Reports Smithsonian Institution, 1897; p. 547.
17. W. Mayer-Gross, "Experimental Psychoses and Other Mental Abnormalities Produced by Drugs," Brit. Med. J. (1951) 57:317-321; p. 318.
18. See Huxley, in footnote 2; pp 47-48.
19. From Albert Hofmann's laboratory report, translated and quoted in H. Jackson DeShon, Max Rinkel, and Harry C. Solomon, "Mental Changes Experimentally Produced by LSD," Psychiatric Quart. (1952) 26:33-53; p. 34.
20. Frank Barron, "Unusual Realization and the Resolution of Paradox When Certain Structural Aspects of Consciousness Are Altered," paper read at the Amer. Psychological Assn., New York, September, 1961.
21. E. Guttman and W. S. Maclay, "Mescaline and Depersonalization: Therapeutic Experiments," J. Neurol. Psychopath. (1936) 16: 193-212; p. 194
22. Translated from a subject's account in K. Beringer, Der Mcskalinrausch; Berlin, Springer. 1927; and quoted in Robert S. DeRopp, Drugs and the Mind. New York: Grove, 1957; p. 51.
23. Gregory Bateson, "Group Interchange," in footnote 5; p. 188.
24. Ronald A. Sandison, A. M. Spencer, and J. D. A. Whitelaw, "The Therapeutic Value of Lysergic Acid Diethylamide in Mental Illness," J. Mental Science (1954) 100:491-507; p. 498.
25. Electrophysiological investigations have shown definite alterations in firing at a number of points in the visual system (also in auditory evoked potentials) and in the functioning of cortico-cortical (transcallosal) connections. However, in concluding an extensive review of electrophysiological results, Evarts warned: ". . . it does not appear that we have reached the point of being able to assign any particular psychological effect . . . to a demonstrated disturbance of the electrical activity of the nervous system." See Edward V. Evarts, "A Review of the Neurophysiological Effects of LSD and Other Psychotomimetic Agents," Annals N. Y. Acad. Science (1957) 66:479495; p. 489. Speculation on this issue may best be tempered by consulting Evarts' most thoughtful summation and evaluation.
26. See footnote 16; p. 547.
27. See footnote 17; p. 319.
28. Paul H. Hoch, "Experimental Psychiatry," Amer. J. Psychiatry (1955) 111:787-790; p. 787.
29. For example, see A. Levine, Harold A. Abramson, M. R. Kaufman, and S. Markham, "Lysergic Acid Diethylamide (LSD-25) : XVI The Effect of Intellectual Functioning as Measured by the Wechsler-Bellevue Intelligence Scale." J. Psychology (1955) 40:385-395.
30. Charles Savage, "The Resolution and Subsequent Remobilization of Resistance by LSD in Psychotherapy," J. Nervous and Mental Disease (1957) 125:434-436; p. 436.
31. Heinrich Kluver, Mescal: The Divine Plant and Its Psychological Effects. London: Kegan Paul, 1928; pp. 105-106.
32. See footnote 21; p. 195.
33. Humphry Osmond, "A Review of the Clinical Effects of Psychotomimetic Agents," Annals N. Y. Acad. Science (1957) 66:418-434; p. 419.
34. Aldous Huxley, The Doors of Perception. New York: Harper, 1954; pp. 73, 79.
35. Philip B. Smith, "A Sunday with Mescaline," Bull. Menninger Clinic (1959) 23:20-27; p. 27.
36. Audrey R. Holliday, "The Hallucinogens: A Consideration of Semantics and Methodology with Particular Reference to Psychological Studies," pp. 301-318, in A Pharmacologic Approach to the Study of the Mind, edited by R. Featherstone and A. Simon. Springfield, 111.: Thomas. 1959; p 301.
37. See footnote 17, p. 320, for a review of the findings of K. Zucker, Z. ges. Neurol. Psychiat. (1930) 127:108.
38. See footnote 31.
39. James S. Slotkin, Peyote Religion. Glencoe, III.: Free Press, 1956;; pp. 76-77.
40. Translated from Albert Hofmann's laboratory report, and quoted in "Discovery of D-lysergic Add Diethylamide—LSD ' Sandoz Excerpta (1955) 1:1-2: p. 1.
41. See footnote 40; p. 2. For the record, it may be noted not only that Hofmann recovered, and subsequently synthesized psilocybin, but that he has recently written of the use of "psychotomimetics" in psychotherapy: ". . . these substances are new drug aids which . . . enable the patient to attain self-awareness and gain insight into his disease." See Albert Hofmann, "Chemical, Pharmacological and Medical Aspects of Psychotomimetics," J. Exper. Med. Science (1961) 5:31—51 p. 48.
42. Translated from B. Manzini and A. Saraval, "L'intossicazione Sperimentale da LSD ed i Suoi Rapporti con la Schizofrenia, Riv. Sper. Freniat. (1960) 84:589; and quoted in Delysid (LSD-25), Annotated Bibliography, Addendum No. 3, mimeographed, Sandoz Pharmaceuticals, 1961; p. 307.
43. See footnote 33; p. 429.
44. In taking issue with the "psychotomimetic" label, it had best be emphasized that the present intent is hardly to transmit a cavalier attitude toward drug administrations; these are obviously potent agents. On the other hand, they are also apparently "safe" when used with reasonable precaution. For a survey of the outcome of 25,000 administrations, see Sidney Cohen, "LSD: Side Effects and Complications," J. Nervous and Mental Disease (1960) 130:30-40.
45. For example, see Joseph Zubin and Martin M. Katz, "Psychopharmacology and Personality," presented at the Colloquium on Personality Change, Univ. of Texas, Austin, Texas, March 9, 1962 (in press).
46. See footnote 28; p. 788.
47. Paul H. Hoch, "Remarks on LSD and Mescaline," J. Nervous and Mental Disease (1957) 125:442444; p. 442.
48. Paul H. Hoch, Solomon Katzenelbogen, and Herman C. B. Denber, "Group Interchange," in footnote 5; p. 58.
49. Sidney Malitz, "Group Interchange," in footnote 5; p. 215.
50. See footnote 19; p. 50.
51. Harold A. Abramson, "Some Observations on Normal Volunteers and Patients," pp. 51-54, in Proceedings of the Round Table on Lysergic Acid Diethylamide and Mescaline in Experimental Psychiatry, in footnote 2; see pp. 5253.
52. Ronald A. Sandison, "The Clinical Uses of LSD," pp. 27-34, in Proceedings of the Round Table on Lysergic Acid Diethylamide and Mescaline in Experimental Psychiatry, in footnote 2; see p. 33.
53. Anthony K. Busch and Walter C. Johnson, "LSD-25 as an Aid in Psychotherapy (Preliminary Report of a New Drug)," Diseases Nervous System (1950) 11:241-243; pp. 242-243.
54. Ronald A. Sandison, "Psychological Aspects of the LSD Treatment of the Neuroses," J. Mental Science (1954), 100:508-515; p. 514.
55. See footnote 24; p. 507.
56. Mortimer A. Hartman, "Group Interchange," in footnote 5; p. 115.
57. See footnote 20.
58. See Charles Savage, "Group Interchange," in footnote 5; pp. 193194.
59. Sidney Malitz, Harold Esecover, Bernard Wilkens, and Paul H. Hoch, "Some Observations on Psilocybin, a New Hallucinogen, in Volunteer Subjects," Comprehensive Psychiatry (1960) 1:8-17; p. 15.
60. See footnote 51; p. 52.
61. Robert W. Hyde, "Psychological and Social Determinants of Drug Action," pp. 297-312, in The Dynamics of Psychiatric Drug Therapy, edited by G. J. Sarwer-Foner. Springfield, III.: Thomas, 1960.
62. Ronald A. Sandison, 'Group Interchange," in footnote 5; p. 91. Any remaining skeptics on the score of expectation and attitude may want to take note of Cohen's caveat: "Invariably, those who take hallucinogenic agents to demonstrate that they have no value in psychiatric exploration have an unhappy time of it. In a small series of four psychoanalysts who took 100 gamma of LSD, all had dysphoric responses." See footnote 44; p. 32.
63. See footnote 34; p. 14.
64. Ralph Metzner, George Litwin, and Gunther Weil, "The Relation of Expectation and Setting to Experiences with Psilocybin: A Questionnaire Study," dittoed, Harvard Univ., 1963. Charles Savage, Willis Harman, James Fadiman, and Ethel Savage, "A Follow-up Note on the Psychedelic Experience," mimeographed, International Foundation for Advanced Study, 1963.
It may be noted that only slightly lower figures have been reported without explicit preparation of the subjects—though with an "atmosphere" that was enthusiastic and supportive. See Keith S. Ditman, Max Hyman, and John R. B. Whittlesey, "Nature and Frequency of Claims Following LSD," J. Nervous and Mental Disease (1962) 134:346352.
65. For example, see Jerome D. Frank, Persuasion and Healing: A Comparative Study of Psychotherapy. Baltimore, Johns Hopkins Press, 1961. More specifically, see Colin M. Smith, "Some Reflections on the Possible Therapeutic Effects of the Hallucinogens," Quart. J. Studies on Alcohol (1959) 20:292-301.
66. See footnote 10.
67. Alan W. Watts, This is IT. New York: Pantheon, 1960; p. 17.
68. Alan W. Watts, The Joyous Cosmology. New York: Pantheon, 1962.
69. Timothy Leary, "The Influence of Psilocybin on Subjective Experience," paper presented at NIMH, Bethesda, Md., May 29, 1962.
70. Aldous Huxley, Heaven and Hell. New York: Harper, 1956 p. 63.
71. See footnote l; pp. 213-222.
72. Ruth Benedict, Patterns of culture. New York: New American Library, 1934; pp. 72-73.
73. See footnote 72: pp. 74-75
74. Abraham H. Maslow, "Cognition of Being in the Peak Experience," J. Genetic Psychology (1959) 9S: 43-66.
75. See footnote 39.
76. Keith S. Ditman and John R. B. Whittlesey, "Comparison of the LSD-25 Experience and Delirium Tremens," Arch. General Psychiatry (1959) 1:47-57. Colin M. Smith, "A New Adjunct to the Treatment of Alcoholism: The Hallucinogenic Drugs," Quart. J. Studies on Alcohol (1958) 19:1931. By the way, the LSD experience and delirium tremens were found to be distinctly dissimilar in most respects.
77. See Sherwood and co-workers, in footnote 8.
78. Abram Hoffer, "Group Interchange," in footnote 5; pp. 59, 114-115.
79. J. R. Ball and Jean J. Armstrong, "The Use of L.S.D. 2S in the Treatment of the Sexual Perversions," Canadian Psychiatric Assn. J. (1961) 6:231-235. 80. See footnote 79; p. 234.
81. See MacLean and co-workers, in footnote 7.
82. A personal communication (1963) from J. Ross MacLean indicates sustained success in 270 additional postpublication cases of "psychedelic treatment."
83. See MacLean and co-workers, in footnote 7; p. 38.
84. The preparation of the subject and the conduct of the 12-hour session were patterned along the lines described by Blewett and Chwelos. See Duncan B. Blewett and Nicholas Chwelos, Handbook for the Therapeutic Use of Lysergic Acid Diethylamide-25, Individual and Group Procedures; to be published.
85. Sven E. Jensen, "A Treatment Program for Alcoholics in a Mental Hospital," Quart. J. Studies on Alcohol (1962) 23:315-320; pp. 317-319.
86. "Apparent Results of Referrals of Alcoholics for LSD Therapy," Report of the Bureau on Alcoholism, Saskatchewan Department of Public Health, Regina, Saskatchewan, Dec. 31, 1962; p. 5.
87. Timothy Leary, Ralph Metmer, Madison Presnell, Gunther Weil, Ralph Schwitzgebel, and Sara Kinne, "A Change Program for Adult Offenders Using Psilocybin," dittoed, Harvard Univ., 1962.
88. Timothy Leary, "Second Annual Report: Psilocybin Rehabilitation Project," dittoed, Freedom Center, Inc., 1963.
89. See Sherwood and co-workers, in footnote 8; p. 370.
90. See footnote 89 and Savage and co-workers in footnote 64.
91. See David Rosenthal and Jerome D. Frank, "Psychotherapy and the Placebo Effect," Psychol. Bull. (1956) 53:294-302.
92. Timothy Leary, "How to Change Behavior," pp. 50-68, in Clinical Psychology, XIV International Congress of Applied Psychology, Vol. 4, edited by Gerhard S. Neilsen; Copenhagen, Munksgaard, 1962; p. 58.
93. Wilson Van Dusen, "LSD and the Enlightenment of Zen," Psychologia (1961) 4:11-16; p. 11.
94. See footnote l; p. 242.
95. See footnote l; pp. 242-243.
96. See footnote l; p. 195.
97. See footnote 72; p. 78.
98. See Chwelos and co-workers, in footnote 7; p. 583.
99. See footnote 7; p. 584.
100. See footnote l; pp. 190-194.
101 Anthony F. C. Wallace, "Stress and Rapid Personality Changes," Internat. Record Med. (1956) 169: 761-774; p. 770.
102. William Sargant, Battle for the Mind: A Physiology of Conversion and Brain-washing. Garden City, N,Y.: Doubleday, 1957.
103. See Ditman and co-workers, in footnote 64.
104. For example, see Daniel E. Sheer, Editor, Electrical Stimulation of the Brain. Austin: Univ. of Texas Press, 1961.
105. See footnote 72; p. 72.
Grateful acknowledgment is made of the substantial contributions of Miss Judith C. Marshall and the assistance of Mrs. Linda B. J. P. Moncure in the preparation of this paper.
* B.A. Antioch College, '53; M.A., '55; Ph.D., '60 Cornell Univ. U.S. Army (Criminal Investigation Division) '5G'56; Grant Foundation Fellow in Human Development '57-'58; Senior Fellow, Cornell Graduate School '58-'59; Chairrnan, Psychology Curriculum, Shimer College '59-'60; Rsc. Psychologist, Lab. of Psychology, NIMH '60—.

Dream drug or Demon brew?

2009-08-11T07:42:00.000-07:00

Dream Drug or Demon Brew?
New Scientist vol 182 issue 2453 - 26 June 2004, page 42
By Lisa Melton

A mind-altering substance used in shamanistic rituals may hold clues todreaming and a natural way of alleviating depression but could also
trigger schizophrenic hallucinations.

Lisa Melton investigates

IN THE brightly lit chapel, the ceremony is due to begin. Dennis McKenna lines up with 500 others to sip the sacrament. It takes 45 minutes before it hits him. Then, eyes closed, he finds himself hovering above the Amazon basin, aware of the massive forests and the meandering rivers beneath. A giant vine winds up towards him and he hurtles down it, shrinking as he goesuntil the leaves themselves seem the size of trees. Shrinking further, he finds himself surrounded by a new forest made up of molecules engaged in photosynthesis. McKenna, an ethnobotanist from the University of Minnesota in Minneapolis, is high on ayahuasca.

Ayahuasca is not the latest party drug but a foul-tasting plant concoction Amazonian people have been downing for centuries. It is the stuff of legends, credited with sending people on the most incredible trips. Today this bitter tea, also known as hoasca, has become the sacramental ritual of two modern religions in Brazil; one of them, the Unio do Vegetal (UDV) church, has invited McKenna, an expert on psychoactive plants, and other research teams, to scrutinise this sacred brew. Their fascination with ayahuasca stems from a little-known mind-altering compound called dimethyltryptamine, or DMT, a substance the sacred tea contains by the bucketload. When it comes to psychedelic compounds, DMT is in a league of its own, as the only hallucinogen our body produces naturally.

Scientists have found DMT pretty much everywhere they've looked in animals, plants and fungi. But despite its ubiquity, DMT's role remains a mystery. Some believe it fuels vivid dreams, mystical revelations and religious exaltation, as well as playing a part in memory. The more sinister possibility is that over-producing DMT could tip a person over the edge into insanity, inducing the psychotic symptoms of schizophrenia. McKenna and his colleagues hope the tripping churchgoers could help them find the answers. DMT doesn't hang around long enough for people to study it easily. It acts rapidly and is broken down swiftly by the enzyme monoamine oxidase (MAO). Normally if you eat or drink it, DMT doesn't stand a chance of getting into the brain as MAO in the gut breaks it down.

Cocktail effect

Shamans, McKenna discovered, overcame this problem by carefully combining plants in the ayahuasca brew. One is the Psychotria viridis bush, which is packed with DMT. The other is the vine Banisteriopsis caapi, which contains harmine, one of the most effective MAO inhibitors. By inactivating MAO with the vine bark, DMT can be absorbed from the gut and crosses the blood-brain barrier to trigger a psychedelic response.

It turns out that harmine-like compounds are also ubiquitous in our bodies. This led some researchers to suggest that maybe our bodies regulate the levels of DMT in the same way as in the tea, sometimes boosting its activity by knocking out MAO so it can fulfil some sort of physiological role. Pharmacologist Jordi Riba from the University of Barcelona, Spain, has been trying to work out what that physiological role might be, using brain scans to study its effect on brain activity. His preliminary results are tantalising, showing areas lighting up that are related to memory. Riba
believes DMT may be involved in retrieving facts and experiences. "When you give people ayahuasca, they re-experience memories that are there already. It's like pressing a random access button to your stored memories," he says..

Jace Callaway from the University of Kuopio in Finland has another idea. He suggests that endogenous DMT and harmine-like substances may play a role in generating dream imagery. "We experience psychedelic states on a regular basis while dreaming," he says. But while its natural role is still uncertain, a more unnatural role is coming to the fore. The effects produced by psychedelic drugs are strikingly similar to the symptoms of psychosis. In the 1950s, these similarities led to the suggestion that psychoactive compounds like DMT were the cause of schizophrenia.

According to the theory, an enzymatic disturbance in the body could lead to overproduction of hallucinogenic compounds. And if MAO activity is low, as suspected in people with schizophrenia, the compounds would linger and the hallucinations they trigger seep into everyday existence. But researchers had always failed to detect consistent differences in DMT levels between patients and controls. "I spent my youth collecting and analysing gallons of urine from people with schizophrenia," recalls Robin Murray from the Institute of Psychiatry in London. "The endogenous DMT hypothesis of schizophrenia was never disproved but was just overtaken by the dopamine theory, which was more immediately plausible."

But the theory is enjoying something of a comeback. Alicia Pomilio, an organic chemist, and Jorge Ciprian-Ollivier, a psychiatrist, at the
University of Buenos Aires in Argentina realised that the church congregation members could help them to look for the signature of DMT in the
urine using gas chromatography and mass spectrometry. Once they knew what to look for, they were able to detect traces in the urine of patients with active schizophrenia but not in controls. It is not clear whether people with schizophrenia are producing too much DMT, or too little MAO the result would be the same. But the discovery is exciting in that it paves the way to finding new drugs to treat schizophrenia.

But if DMT might be the cause of one medical problem, it could be the cure for others. McKenna has found that DMT exerts its effect by attaching mainly to one particular type of serotonin uptake site called 5-HT2A, as do other psychedelic drugs such as LSD, psilocybin and mescaline. Serotonin is a mood-altering neurotransmitter, also known to influence sleep, appetite, aggression and love. The newest class of antidepressant drugs, including Prozac, are thought to work by blocking the uptake of serotonin into nerve cells. Callaway's recent studies suggest that ayahuasca might have some of the effects of antidepressant drugs nature's very own Prozac.

He measured serotonin levels in rats after giving them ayahuasca and says the levels of the neurotransmitter "go through the roof". After
drinking hoasca tea users report a feel-good effect that can last for days. Callaway found that hoasca drinkers had a greater than normal density of serotonin uptake sites on their blood platelets, where they are easier to measure than in the brain. People seem to respond, he says, by creating more receptors. When they are not getting a buzz from the tea, the additional receptors hunger for more serotonin, pushing the body to produce more.

But does the brain bump up its number of serotonin uptake sites too?

Using a brain imaging technique that labels serotonin receptors, Callaway has now tested one person, and found signs of a similar upregulation in a serotonin-rich region of the brain. Of course, this observation needs following up, but it's an encouraging sign. "It's a true tonic effect," says Callaway. The sacred tea "apparently does what antidepressants fail to do. It could lead to long-term plastic changes in the brain without having to pop a pill every day."

Charles Grob, a psychiatrist at the University of California, Los Angeles, School of Medicine, reckons that this sustained effect on mood makes
ayahuasca a good candidate for treating addictions as well as alleviating depression. People with serious alcohol problems and mood disorders
were transformed by the church. All religions boast life-changing stories, but Grob believes the tea itself is important. There is already one centre in Peru testing ayahuasca in clinical trials for drug abuse.

But the researchers are proceeding cautiously. Many people have been taking the hallucinogen within the supportive setting of the UDV for 30 years with seemingly no adverse side effects. But it is not always so. "If the tea is not properly prepared, or in the hands of an individual without the appropriate support, the consequences can be negative," says Grob. Even in the highly controlled lab setting it can trigger twitching, vomiting and diarrhoea. Useful if you are an Amazonian hunter wanting to rid your gut of parasites, perhaps, but not exactly convenient if you're not.

Psychedelic medicine: Mind bending, health giving

2009-08-11T07:35:00.000-07:00

Psychedelic medicine: Mind bending, health giving
Johm Horgan, New Scientist 2005

JOHN HALPERN clearly remembers what made him change his mind about psychedelic drugs. It was the early 1990s and the young medical student at a hospital in Brooklyn, New York, was getting frustrated that he could not do more to help the alcoholics and addicts in his care. He sounded off to an older psychiatrist, who mentioned that LSD and related drugs had once been considered promising treatments for addiction. "I was so fascinated that I did all this research," Halpern recalls. "I was reading all these papers from the 60s and going, whoa, wait a minute! How come nobody's talking about this?"

More than a decade later, Halpern is now an associate director of substance abuse research at Harvard University's McLean Hospital and is at the forefront of a revival of research into psychedelic medicine. He recently received approval from the US Food and Drug Administration (FDA) to give late-stage cancer patients the psychedelic drug MDMA, also known as ecstasy. He is also laying the groundwork for testing LSD as a treatment for dreaded super-migraines known as cluster headaches.

And Halpern is not alone. Clinical trials of psychedelic drugs are planned or under way at numerous centres around the world for conditions ranging from anxiety to alcoholism. It may not be long before doctors are legally prescribing hallucinogens for the first time in decades. "There are medicines here that have been overlooked, that are fundamentally valuable," says Halpern.

These developments are a remarkable turnaround. Scientists first became interested in psychedelic drugs - also called hallucinogens because of their profound effect on perception - after Albert Hofmann, a chemist working for the Swiss pharmaceutical firm Sandoz, accidentally swallowed LSD in 1943. Hofmann's description of his experience, which he found both enchanting and terrifying, spurred scientific interest in LSD as well as naturally occurring compounds with similar effects: mescaline, the active ingredient of the peyote cactus; psilocybin, found in magic mushrooms; and DMT, from the Amazonian shamans' brew ayahuasca.

At first, many scientists called these drugs "psychotomimetics" because their effects appeared to mimic the symptoms of schizophrenia and other mental illnesses. However, many users rhapsodised about the life-changing insights they achieved during their experiences, so much so that in 1957, British psychiatrist Humphry Osmond proposed that the compounds be renamed "psychedelic", from the Greek for "mind-revealing". The term caught on, and psychiatrists started experimenting with the drugs as treatments for mental illness. By the mid-1960s, more than 1000 peer-reviewed papers had been published describing the treatment of more than 40,000 patients for schizophrenia, depression, alcoholism and other disorders.

A prominent member of this movement was Harvard psychologist Timothy Leary, who among other things tested whether psilocybin and LSD could be used to treat alcoholism and rehabilitate convicts. Although his studies were initially well received, Leary eventually lost his reputation - and his job - after he began touting psychedelics as a hotline to spiritual enlightenment. Leary's antics helped trigger a backlash, and by the late 1960s psychedelics had been outlawed in the US, Canada and Europe. Unsurprisingly, clinical research ground to a halt, partly because obtaining the necessary permits became much more difficult, but also because few researchers were willing to risk their reputations studying demonised substances.

But to some brave souls, psychedelic medicine never lost its allure. One of them is Rick Doblin, who in 1986 founded the Multidisciplinary Association for Psychedelic Studies (MAPS) in Sarasota, Florida, and who earned a doctorate from Harvard's Kennedy School of Government after writing a dissertation on the federal regulation of psychedelics. For nearly 20 years MAPS has lobbied the FDA and other government agencies to allow research on psychedelics to resume. It has also persuaded scientists to pursue the work and raised funds to support them. A similar body, the Heffter Research Institute in Santa Fe, New Mexico, was founded in 1993 by scientists with an interest in hallucinogens.

In the past couple of years their efforts have begun to pay off. Doblin is optimistic that psychedelic research is back for good, and this time it will do things right. "This gives us the chance to show that we have learned our lessons," he says. Halpern, too, is anxious to lay to rest the ghost of Leary. "That man screwed it up for so many people," he says.

With this in mind, Halpern says the first task for him and others is to evaluate the safety of psychedelics. And they are up against an entrenched orthodoxy: a 1971 editorial in The Journal of the American Medical Association warned that repeated ingestion of psychedelics causes personality deterioration. "Only a few of those who experience more than 50 'trips' are spared," it warned.

I was reading all these papers from the 60s and going, whoa, wait a minute! How come nobody's talking about this?
So Halpern's first big foray into psychedelic research was aimed at risk-assessment. In the late 1990s he launched a study of members of the Native American Church, who are permitted by US law to consume peyote. Halpern examined 210 residents of a Navajo reservation in the south-west US, who fell into three categories: church members who had taken peyote at least 100 times but had had little exposure to other drugs or alcohol; non-church members who abstained from alcohol or drugs; and former alcoholics who had been sober for at least three months.

Halpern tested the subjects' IQ, memory, reading ability and other functions. His interim results showed that church members had no cognitive impairment compared with the abstainers, and scored significantly better than recovering alcoholics. Church members also reported no "flashbacks" - sudden recurrences of a psychedelic's effects long after the initial trip. Halpern believes this study, which he expects will be published soon, shows that contrary to the 1971 editorial, peyote at least can be taken repeatedly without adverse effects.

He is now conducting a similar assessment of MDMA. This drug is sometimes called an "empathogen" because it heightens feelings of compassion and reduces anxiety. Anecdotal reports suggest it has therapeutic potential, and some psychiatrists used it alongside psychotherapy before it was outlawed in 1985. However, anecdotal and scientific evidence have also linked MDMA with brain damage, though the research is controversial.

Ecstasy impact
Judging the true impact of MDMA is complicated by the fact that users often combine it with other drugs and alcohol. To get around this, Halpern recruited a group of American mid-westerners who admitted taking MDMA but said they shunned other substances. He separated them into "moderate" users, who had consumed MDMA 22 to 50 times, and "heavy" users, who had taken it more than 50 times.

Halpern recently reported in the journal Drug and Alcohol Dependence that, compared with controls, heavy users displayed "significant deficits" in mental processing speed and impulsivity. Moderate users, however, had no major problems. Halpern believes this shows that MDMA's benefits may outweigh its risks for certain patients. And apparently the FDA and the McLean Hospital agree, since both have approved Halpern's plan to test MDMA as an anti-anxiety drug for a dozen late-stage cancer patients. Halpern still needs permission from the Drug Enforcement Administration, but he expects to begin recruiting patients soon.

He is also interested in the potential benefits of the true hallucinogens. In 1996, he reviewed almost 100 substance abuse trials involving LSD, psilocybin, DMT and ibogaine, an extract of the African shrub Tabernanthe iboga. Halpern found tentative evidence that the drugs can reduce addicts' cravings during a post-trip "afterglow" lasting for a month or two. Exactly how this happens is something of a mystery. A popular theory is that the benefits stem from the drugs' psychological effects, which include profound insights and cathartic emotions, but Halpern suspects that there may be a biochemical explanation too.

For now, however, Halpern isn't planning to pursue addiction therapy. He is more interested in another medical use for LSD and psilocybin: treating a debilitating condition known as cluster headaches. These attacks appear to be caused by swelling of blood vessels in the brain and are worse than migraines. Sufferers say the pain exceeds that of passing a kidney stone or giving birth without anaesthetics. They affect about 3 in every 1000 people sporadically, and 1 in 10,000 chronically. "There's a tremendous potential need for this," says Halpern, who investigated the problem after being approached by a patient group.

Many patients get little or no relief from painkillers, but some claim that small doses of LSD or psilocybin can alleviate the headaches and even prevent them from occurring. Halpern was intrigued; LSD is chemically related to ergot, a naturally occurring compound that constricts blood vessels, and the derivatives ergotamine and methysergide are commonly prescribed for migraines.

Halpern and his Harvard colleague Andrew Sewell are now gathering evidence to persuade licensing officials - and themselves - that LSD and psilocybin merit a clinical trial. Sewell has gathered more than 60 testimonials from cluster headache sufferers who have treated themselves with LSD or psilocybin.

Another member of the vanguard in the psychedelic revival is Charles Grob, a psychiatrist at the Harbor-UCLA Medical Center in Los Angeles, California, and co-founder of the Heffter Institute. After years struggling to get permits, Grob says he is slowly moving forward with a study into using psilocybin to reduce distress in terminal cancer patients. He points out that studies done in the 1960s suggested that psychedelics can help patients come to terms with their impending death. So far Grob has treated three patients, but he hopes to enrol more subjects shortly.

Grob has also led several investigations like Halpern's peyote study, but looking at ayahuasca, the DMT-rich shamanic brew. Ayahuasca often causes nausea and diarrhoea, and its psychedelic effects can be terrifying, but Amazonian shamans nonetheless prize it for its visionary properties. Since 1987 it has been a legal sacrament for several churches in Brazil, the largest of which is União Do Vegetal. UDV combines elements of Christianity with nature worship, and claims 8000 members.

In 1996 a team led by Grob reported in the Journal of Nervous And Mental Disease that UDV members who regularly took ayahuasca were on average physiologically and psychologically healthier than a control group of non-worshippers. The UDV followers also had more receptors for the neurotransmitter serotonin, which has been linked to lower rates of depression and other disorders. Many of the UDV members told the scientists that ayahuasca had helped them overcome alcoholism, drug addiction and other self-destructive behaviours.

Addicts often end up filled with revulsion for their past lives and determined to change
More recently, Grob has found that adolescents who grew up participating in ayahuasca ceremonies showed no ill effects and were less likely to engage in crime and substance abuse than members of a control group. Of course, Grob acknowledges that they could be benefiting from the social effects of membership in a church as well as the effects of ayahuasca itself. Grob plans to publish these results this year.

Several other scientists are quietly pursuing psychedelic research. Since 2001, psychiatrist Francisco Moreno of the University of Arizona in Tucson has been testing psilocybin as a treatment for obsessive-compulsive disorder. Psychotherapy and antidepressants such as Prozac help many patients, but some have such severe symptoms and are so resistant to treatment that they turn to electroshock therapy and even brain surgery. As with the work on cluster headaches, Moreno's study was motivated by reports from people with OCD that psilocybin relieves their symptoms.

So far, Moreno has given both sub-psychedelic and psychedelic doses of pure psilocybin to nine treatment-resistant OCD subjects, in a total of 29 therapy sessions. His preliminary findings suggest firstly that it is safe to ingest psilocybin, which was a primary concern of the trial. Beyond that, Moreno calls his results "promising", but won't discuss them further, since he plans to submit a paper to a peer-reviewed journal this year.

By the mid-1960s, over 1000 papers had been published describing psychedelic therapy
Meanwhile in Charleston, South Carolina, physician Michael Mithoefer is carrying out a MAPS-sponsored clinical trial of MDMA as a treatment for post-traumatic stress disorder. PTSD affects up to 20 per cent of people who experience a traumatic event, and involves distressing symptoms such as nightmares and panic attacks. Conventional treatments typically consist of cognitive therapy and antidepressants, but many patients don't respond to these. In the past year Mithoefer has given "MDMA-assisted" psychotherapy to six treatment-resistant patients, all traumatised by violent crimes; he plans to treat 20 patients in all.

The longest-running psychedelic therapy programme started almost 20 years ago in Russia. Evgeny Krupitsky, a psychiatrist who heads a substance-abuse clinic in St Petersburg, has treated more than 300 alcoholics and about 200 heroin addicts with ketamine. Used primarily in veterinary medicine, ketamine is an anaesthetic that can trigger an extremely disorienting hallucinogenic episode lasting an hour or so. Krupitsky's subjects often emerge from their sessions filled with revulsion for their past lives and determined to change. The therapists encourage these feelings with tricks such as forcing the subjects to sniff a bottle of vodka at the peak of their session; the patients' disgust often persists long after the ketamine's effects have worn off.

In one of Krupitsky's studies, 73 out of 111 alcoholics stayed dry for at least a year after their session, compared with 24 per cent of those in a control group. Yet his programme, which was funded by MAPS and the Heffter Institute, was recently shut down because the Russian government tightened restrictions on ketamine. Although Krupitsky says he and his colleagues "are in the process of getting permission to continue", it may be several years before research resumes.

Although disappointed by this setback, Doblin is encouraged by developments elsewhere. He is lobbying officials in Spain and Israel to approve studies of MDMA for PTSD, and is raising funds for a substance-abuse trial of ibogaine outside the US together with the Heffter Institute. MAPS has also supported Frans Vollenweider, a psychiatrist at the University of Zurich in Switzerland, who has done basic research on the physiological effects of psilocybin and MDMA, and hopes to begin clinical research soon.

Doblin's primary goal is to see psychedelics legally recognised as medicines. But he also hopes that someday healthy people may take these substances for psychological or spiritual purposes, as members of the Native American Church and União Do Vegetal do, and as he did in his youth. After all, drugs such as Prozac and Viagra are already prescribed not just to heal the ill but also to enhance the lives of the healthy.

It is still an uphill struggle. Government funds for psychedelic studies are hard to come by, and drug companies have shown absolutely no interest in supporting the research. But there are signs that the wind is changing. Although psychedelics are still classified in the US as schedule-1 drugs, and so are banned for all non-research purposes, in November a US Federal Appeals Court in Colorado ruled that a branch of the UDV based in Santa Fe, New Mexico, could import ayahuasca for use in ceremonies. Among the research findings cited in the court decision were Grob's studies showing no ill effects from ayahuasca. The Department of Justice is appealing the decision, but if the Supreme Court denies the appeal, UDV members in the US will be able to ingest ayahuasca legally.

Maybe, just maybe, after more than 30 years in the wilderness, this powerful, misunderstood but potentially mind-healing class of drugs is ready to be rehabilitated.

http://www.newscientist.com/article/mg18524881.400-psychedelic-medicine-mind-bending-health-giving.html?full=true

New Uses for Psychedelic Drugs

2009-08-11T07:27:00.000-07:00

New Uses for Psychedelic Drugs

Psychedelic drugs have elicited new interest for potential therapeutic benefits, Walter A. Brown, MD, said in another presentation at the Congress.

Ketamine has psychedelic properties such as dissociation and perceptual alteration, but is also used legitimately as an anesthetic and analgesic. Work going back to 2000 suggests that it also is "a uniquely rapid acting and effective antidepressant," said Dr. Brown, Clinical Professor of Psychiatry at Brown University School of Medicine. In a small, double-blinded placebo-controlled study published that year, Berman and colleagues found that intravenous ketamine infusion significantly improved scores on the Hamilton Depression Rating Scale in 4 of 8 patients with major depressive disorder.[10] The effects lasted several days, much longer than any "psychedelic" or dissociative side effects, Dr. Brown said. He cited another study, presented by Sanjay Mathew, MD, and colleagues at the 2008 meeting of the New Clinical Drug Evaluation Unit of the National Institute of Mental Health, held last May, in which 20 treatment-resistant patients who were on either lamotrigine or a placebo were followed after receiving a 40-minute infusion of ketamine.[11] The dissociative symptoms lasted about 90 minutes, but 24 hours after the infusion, the patients' scores on the Montgomery-Asberg Depression Rating Scale (MADRS) had improved. Patients in both the lamotrigine and the placebo groups showed striking benefits in individual MADRS components, including concentration, sadness, suicidal and pessimistic thoughts, and sleep and appetite difficulties. Patients required infusions 3 times a week to maintain this effect, but they became tolerant of the dissociative symptoms over time.

Another agent, psilocybin, is a tryptamine alkaloid found in the "psychedelic" mushrooms. In a few small studies, psilocybin has emerged as a potential treatment for obsessive-compulsive disorder (in a modified, double-blind study in which patients received varying doses)[12] and cluster headaches (based on clinical interviews with headache sufferers describing the effects of their psilocybin use).[13] And in a study that truly evokes the spirit of the 1960s, psilocybin also was shown to enhance and prolong spiritual experiences and deepen their meaning for people open to such events.[14] Dr. Brown reported that a study is now under way under the direction of Charles Grob, MD, at Harbor-UCLA Medical Center to examine the drug's ability to relieve the pain and anguish of terminal cancer.

References

Lieberman JA, Stroup TS, McEvoy JP, et al, for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223. Abstract

Stroup TS, McEvoy JP, Swartz MS, et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull. 2003;29:15-31. Abstract

Tarsy D. Neuroleptic-induced extrapyramidal reactions: classification, description, and diagnosis. Clin Neuropharmacol. 1983;6 :S9-S26. Abstract

Kane JM. In: Bloom FE (Kupfer DJ, ed.). Psychopharmacology: The Fourth Generation of Progress. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995:1485-1495.

Woerner MG, Kane JM, Lieberman JA, et al. The prevalence of tardive dyskinesia. J Clin Psychopharmacol. 1991 ;11:34-42. Abstract

Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982 ;39:486-487.

Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005 ;80:33-43. Abstract

Kinon BJ, Jeste DV, Kollack-Walker S, et al. Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods. Prog Neuropsychopharmacol Biol Psychiatry. 2004 ;28:985-996. Abstract

Beasley CM, Dellva MA, Tamura RN, et al. Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol. Br J Psychiatry. 1999 ;174:23-30. Abstract

Berman RM, Cappiello A, Anand A, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000 ;47:351-354. Abstract

Mathew S, 48th Annual NCDEU Meeting, May 2008.

Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiatry. 2006;67:1735-1740. Abstract

Sewell RA, Halpern JH, Pope HG Jr. Response of cluster headache to psilocybin and LSD. Neurology. 2006;66:1920-1922. Abstract

Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology. 2006;187:268-283. Abstract

http://www.medscape.com/viewarticle/584548

Revisiting "Realms of the Human Unconscious"

2009-08-11T07:22:00.000-07:00

Revisiting "Realms of the Human Unconscious"
Stanislav Grof

In 1975, I presented the first edition of Realms of the Human Unconscious to my professional colleagues and to the general public with somewhat mixed feelings and not without hesitation, because I was fully aware of how unusual and surprising some of its sections might seem to a reader who has not had a firsthand experience with psychedelics or some other type of non-ordinary state of consciousness.

This volume is the second U.S. edition of the book, now re-titled LSD: Doorway to the Numinous. In it I summarize and condense, in a systematic and comprehensive way, observations and experiences gleaned during the first seventeen years of my research with LSD and other psychedelic substances; it represents the first of a series of books about LSD and psychedelics that I have written. Exploration of the potential of psychedelics for the study of schizophrenia, for didactic purposes, for a deeper understanding of art and religion, for personality diagnostics and the therapy of emotional disorders, and for transforming the experience of dying has been my major professional interest and has consumed most of the time I have spent in psychiatric research.

I know from my own personal development how difficult it was for me to seriously consider and eventually accept the implications of some of the quite extraordinary observations from LSD sessions. I had resisted the influx of the revolutionary new data that I was exposed to in my everyday clinical work and kept trying to explain them within the accepted theoretical frameworks, until my tendency to defend traditional ways of thinking was defeated and overwhelmed by an avalanche of indisputable clinical facts. Whenever I violated the boundaries of tradition, conventional thinking, and commonly shared assumptions, it was only because rather convincing evidence made the old concepts incomplete, unsatisfactory, implausible, or untenable.

I would like to emphasize in this context that I did not indulge in iconoclastic pleasure in opposing the existing concepts and theories. On the contrary, having been rather conservative by nature, I experienced a considerable amount of discomfort when the accepted systems proved inadequate. I had to suffer through a long period of rather unpleasant conceptual chaos, with a painful lack of any meaningful guidelines. This lasted until I developed a broader theoretical framework that seemed to introduce new order into the research data and made possible a simplifying integration and synthesis of the most important observations.

Looking for an appropriate form to communicate my findings, I rejected what seemed to be a tempting alternative, namely censoring or truncating some of the most unusual observations in order to avoid disapproval and harsh criticism of my colleagues. In addition to being personally and professionally dishonest, such an approach would have defeated the very purpose for which this book was written. It seemed important to share the data in their true form, including the challenge that they represent to our common sense and to scientific thinking. I therefore decided to take the risk of attacks, fierce criticism, and possible ridicule for the sake of integrity and accurate reporting.

In the early stage of my psychedelic research, I suggested that the potential significance of LSD and other psychedelics for psychiatry and psychology was comparable to the value the microscope has for biology and medicine or the telescope has for astronomy. My later experience with psychedelics only confirmed this initial impression. These substances seem to function as relatively unspecific amplifiers that increase the cathexis (energetic charge) associated with the deep unconscious contents of the psyche and make them available for conscious processing. This unique property of psychedelics makes it possible to study psychological undercurrents that govern our experiences and behaviors to a depth that cannot be matched by any other method or tool available in mainstream psychiatry and psychology. In addition, it offers unique opportunities for healing of emotional and psychosomatic disorders, for positive personality transformation, and for consciousness evolution.

Naturally, the tools of this power carry with them greater risks than more conservative and far less effective tools currently accepted and used by mainstream psychiatry, such as verbal psychotherapy, anti-depressants, or tranquillizing medication. Clinical research has shown that these greater risks can be minimized by responsible use and careful control of the set and setting. The safety of psychedelic therapy, when conducted in a clinical setting, was demonstrated by Sidney Cohen's study based on information drawn from more than 25,000 psychedelic sessions run by therapists in different parts of the world. According to Cohen, LSD therapy appeared to be much safer than many other procedures that had been at one time or another routinely used in psychiatric treatment, such as electroshock therapy, insulin coma therapy, and psychosurgery (Cohen 1960).

However, legislators responding to unsupervised mass use of psychedelics did not get their information from scientific publications, but from the stories of sensation-hunting journalists. The legal and administrative sanctions against psychedelics did not deter lay experimentation, but they all but terminated legitimate scientific research of these substances. For those of us who had the privilege to explore and experience the extraordinary potential of psychedelics, this was a tragic loss for psychiatry, psychology, and psychotherapy. We felt that these unfortunate developments wasted what was probably the single most important opportunity in the history of these disciplines. Had it been possible to avoid the unnecessary mass hysteria and continue responsible research of psychedelics, they could have undoubtedly radically transformed the theory and practice of psychiatry. This new knowledge could have become an integral part of a comprehensive new scientific paradigm of the twenty-first century.

Now, thirty-five years after I stopped conducting official research with psychedelics, I can make an attempt to evaluate what has been called the "golden era of psychopharmacology" -- to review the past history of psychedelic research and try to glimpse into its future. After having personally conducted over the last fifty years more than four thousand psychedelic sessions, I have developed great awe and respect for these compounds and their enormous potential, both positive and negative. They are powerful tools and, like any tool, they can be used skillfully, ineptly, or destructively. The result will be critically dependent on the set and setting.

The question whether LSD is a phenomenal medicine or a devil's drug makes as little sense as asking a similar question about a knife -- is it a dangerous instrument or a very useful tool? Naturally, we will get a very different report from a surgeon, who bases his or her judgment on successful operations performed with a knife, and from the police chief, who investigates murders committed with knives in back alleys of New York City. A housewife would see the knife primarily as a useful kitchen tool and an artist would employ it in carving wooden sculptures or woodcuts. It would make little sense to judge the usefulness and dangers of a knife by watching children who play with it without adequate maturity and skill. Similarly, the image of LSD will vary, depending upon whether we focus on the results of responsible clinical or spiritual use, or the deliberately destructive experiments of military circles or the secret police.

Until it is clearly understood that the results of the administration of psychedelics are critically influenced by the factors of set and setting, there is no hope for rational decisions in regard to psychedelic drug policies. I firmly believe that psychedelics can be used in such a way that the benefits far outweigh the risks. This has been amply proven by millennia of safe ritual and spiritual use of psychedelics by generations of shamans, individual healers, and entire native cultures. However, the Western industrial civilization has so far abused nearly all its discoveries and there is not much hope that psychedelics will make an exception, unless we rise as a group to a higher level of consciousness and emotional maturity.

Whether or not psychedelics will return into psychiatry and will again become part of the therapeutic armamentarium is a complex problem and its solution will probably be determined not only by the results of scientific research, but also by a variety of political, legal, economic, and mass-psychological factors. However, I believe that Western society is at present much better equipped to accept and assimilate psychedelics than it was in the 1950s. At the time when psychiatrists and psychologists started to experiment with LSD, psychotherapy was limited to verbal exchanges between therapist and clients. Intense emotions and active behavior were referred to as "acting-out" and were seen as violations of basic therapeutic rules.

Psychedelic sessions were on the other side of the spectrum, evoking dramatic emotions, psychomotor excitement, and vivid perceptual changes. They thus seemed to be more like states that psychiatrists saw as pathological and tried to suppress by all means, than conditions to which one would attribute therapeutic potential. This was reflected in the terms "hallucinogens," "delirogens," "psychotomimetics," and "experimental psychoses," used initially for psychedelics and the states induced by them. In any case, psychedelic sessions more closely resembled scenes from anthropological movies about healing rituals of "primitive" cultures and other aboriginal ceremonies, than those expected in a psychiatrist's or psychotherapist's office.

In addition, many of the experiences and observations from psychedelic sessions seemed to seriously challenge the image of the human psyche and of the universe developed by Newtonian-Cartesian science, considered to be accurate and definitive descriptions of "objective reality." Psychedelic subjects reported experiential identification with other people, animals, and various aspects of nature, during which they gained access to new information about areas of which they previously had no intellectual knowledge. The same was true about experiential excursions into the lives of their human and animal ancestors, as well as racial, collective, and karmic memories.

On occasion, this new information was drawn from experiences involving the reliving of biological birth and memories of prenatal life, encounters with archetypal beings, and visits to mythological realms of different cultures of the world. In out-of-body experiences, experimental subjects were able to witness and accurately describe remote events occurring in locations that were outside of the range of their senses. None of these happenings were considered possible in the context of traditional materialistic science, and yet, in psychedelic sessions, they were observed frequently. This naturally caused deep conceptual turmoil and confusion in the minds of conventionally trained experimenters. Under these circumstances, many professionals chose to shy away from this area to protect their respectable scientific world-view and professional reputation and to preserve their common sense and sanity.

The last three decades have brought many revolutionary changes that have profoundly influenced the climate in the world of psychotherapy. Humanistic and transpersonal psychologies have developed powerful experiential techniques that emphasize psychological regression, direct expression of intense emotions, and bodywork leading to release of physical energies. Among these new approaches to self-exploration are Gestalt practice, bioenergetics and other neo-Reichian methods, primal therapy, rebirthing, and holotropic breathwork. The inner experiences and outer manifestations, as well as therapeutic strategies used in these therapies bear a great similarity to those observed in psychedelic sessions. These non-drug therapeutic strategies involve not only a similar spectrum of experiences, but also comparable conceptual challenges. As a result, for therapists practicing along these lines, the introduction of psychedelics would represent the next logical step in their practice, rather than a dramatic change in it.

Moreover, the Newtonian-Cartesian thinking in science, which in the 1960s enjoyed great authority and popularity, has been progressively undermined by astonishing developments in a variety of disciplines. This has happened to such an extent that an increasing number of scientists feel an urgent need for an entirely different world-view, a new scientific paradigm. Salient examples of this development are philosophical implications of quantum-relativistic physics (Capra 1975, Goswami 1995, Wolf 1981), David Bohm's theory of holomovement (Bohm 1980), Karl Pribram's holographic theory of the brain (Pribram 1971), Ilya Prigogine's theory of dissipative structures (Prigogine 1980), Rupert Sheldrake's theory of morphogenetic fields (Sheldrake 1981), Gregory Bateson's brilliant synthesis of systems and information theory, cybernetics, anthropology, and psychology (Bateson 1979), and particularly Ervin Laszlo's concept of the PSI field (akashic field), his connectivity hypothesis, and his "integral theory of everything" (Laszlo 1993, 2003, 2004). It is very encouraging to see that all these new developments that are in irreconcilable conflict with traditional science seem to be compatible with the findings of psychedelic research and with transpersonal psychology. This list would not be complete without mentioning the remarkable efforts of Ken Wilber to create a comprehensive synthesis of a variety of scientific disciplines and perennial philosophy (Wilber 2000).

Even more encouraging than the changes in the general scientific climate is the fact that, in a few cases, researchers of the younger generation in the United States, Switzerland, and other countries have, in recent years, been able to obtain official permission to start programs of psychedelic therapy, involving LSD, psilocybin, dimethyltryptamine (DMT), methylene-dioxy-methamphetamine (MMDA), and ketamine. I hope that this is the beginning of a renaissance of interest in psychedelic research that will eventually return these extraordinary tools into the hands of responsible therapists.

References

Bateson, G. 1972. Steps to An Ecology of Mind. San Francisco: Chandler

Publications.

Bateson, G. 1979. Mind and Nature: A Necessary Unity. New York: E. P. Dutton.

Bohm, D. 1980. Wholeness and the Implicate Order. London: Routledge & Kegan Paul.

Capra, F. 1975. The Tao of Physics. Berkeley: Shambhala Publications.

Cohen, S. 1960. "Lysergic Acid Diethylamide: Side Effects and Complications."

Journal of Nervous and Mental Diseases 130: 30-40.

Glieck, J. 1987. Chaos: Making A New Science. New York: Viking Penguin.

Goswami, A. 1995. The Self-Aware Universe: How Consciousness Creates the Material

World. Los Angeles, CA: J. P. Tarcher.

Grof, S, 1980. LSD Psychotherapy. Pomona, CA: Hunter House.

Grof, S. 1985. Beyond the Brain: Birth, Death, and Transcendence in Psychotherapy.

Albany, NY: State University of New York (SUNY) Press.

Grof, S, 1987. The Adventure of Self-Discovery. Albany, NY: State University of New

York (SUNY) Press.

Grof, S. 1998. The Cosmic Game: Explorations of the Frontiers of Human

Consciousness. Albany, NY: State University of New York (SUNY) Press.

Grof, S. 2000. Psychology of the Future: Lessons from Modern Consciousness Research.

Albany, NY: State University of New York (SUNY) Press.

Grof, S. 2006. The Ultimate Journey: Consciousness and the Mystery of Death. Ben

Lomond, CA: MAPS Publications.

Laszlo, E. 1993. The Creative Cosmos. Edinburgh: Floris Books.

Laszlo, E. 2003. The Connectivity Hypothesis: Foundations of an Integral Science of

Quantum, Cosmos, Life, and Consciousness. Albany, NY: State University of

New York (SUNY) Press.

Laszlo, E. 2004. Science and the Akashic Field: An Integral Theory of Everything.

Rochester, VT: Inner Traditions.

Pribram, K. 1971. Languages of the Brain. Englewood Cliffs, N.J.: Prentice Hall.

Prigogine, I. 1980. From Being to Becoming: Time and Complexity in the Physical

Sciences. San Francisco, CA: W. H. Freeman.

Prigogine, I., and Stengers, I. 1984. Order out of Chaos: Man's Dialogue with Nature.

New York: Bantam Books.

Sheldrake, R. 1981. A New Science of Life: The Hypothesis of Formative Causation.

Los Angeles, CA: J. P. Tarcher.

Wilber, K. 2000. A Theory of Everything: An Integral Vision for Business, Politics,

Science and Spirituality. Berkeley: Shambhala Publications.

Wolf, F. A. 1981. Taking the Quantum Leap. San Francisco, CA: Harper & Row.

Spiritual Emergencies: Understanding and Treatment of Psychospiritual Crises

2009-08-11T07:17:00.000-07:00

Spiritual Emergencies: Understanding and Treatment of Psychospiritual Crises
Stanislav Grof

One of the most important implications of the research of holotropic states is the realization that many of the conditions, which are currently diagnosed as psychotic and indiscriminately treated by suppressive medication, are actually difficult stages of a radical personality transformation and of spiritual opening. If they are correctly understood and supported, these psychospiritual crises can result in emotional and psychosomatic healing, remarkable psychological transformation, and consciousness evolution (Grof and Grof 1989, 1990).

Episodes of this nature can be found in the life stories of shamans, founders of the great religions of the world, famous spiritual teachers, mystics, and saints. Mystical literature of the world describes these crises as important signposts of the spiritual path and confirms their healing and transformative potential. Mainstream psychiatrists do not differentiate psychospiritual crises, or even episodes of uncomplicated mystical experiences, from serious mental diseases, because of their narrow conceptual framework.

Academic psychiatry, being a subdiscipline of medicine, has a
strong preference for biological interpretations, and uses a model of the psyche limited to postnatal biography and the Freudian individual unconscious. These are serious obstacles in understanding the nature and content of mystical states and the ability to distinguish them from manifestations of mental disease.

The term "spiritual emergency" (psychospiritual crisis), which my wife Christina and I coined for these states alludes to their positive potential. In English, this term is a play on words reflecting the similarity between the word "emergency" (a suddenly appearing acute crisis) and "emergence" (surfacing or rising). It thus suggests both a problem and opportunity to rise to a higher level of psychological functioning and spiritual awareness. We often refer in this context to the Chinese pictogram for crisis that illustrates the basic idea of spiritual emergency. This ideogram is composed of two images, one of which means danger and the other opportunity.

Among the benefits that can result from psychospiritual crises that receive expert support and are allowed to run their natural course are improved psychosomatic health, increased zest for life, a more rewarding life strategy, and an expanded worldview that includes the spiritual dimension. Successful completion and integration of such episodes also involves a substantial reduction of aggression, increase of racial, political, and religious tolerance, ecological awareness, and deep changes in the hierarchy of values and existential priorities. It is not an exaggeration to say that successful completion and integration of psychospiritual crisis can move the individual to a higher level of consciousness evolution.

In recent decades, we have seen rapidly growing interest in spiritual matters that leads to extensive experimentation with ancient, aboriginal, and modern "technologies of the sacred," consciousness-expanding techniques that can mediate spiritual opening. Among them are various shamanic methods, Eastern meditative practices, use of psychedelic substances, effective experiential psychotherapies, and laboratory methods developed by experimental psychiatry. According to public polls, the number of Americans who have had spiritual experiences significantly increased in the second half of the twentieth century and continues to grow. It seems that this has been accompanied by a parallel increase of psychospiritual crises.

More and more people seem to realize that genuine spirituality based on profound personal experience is a vitally important dimension of life. In view of the escalating global crisis brought about by the materialistic orientation of Western technological civilization, it has become obvious that we are paying a great price for having rejected spirituality. We have banned from our life a force that nourishes, empowers, and gives meaning to human existence.

On the individual level, the toll for the loss of spirituality is an impoverished, alienated, and unfulfilling way of life and an increase of emotional and psychosomatic disorders. On the collective level, the absence of spiritual values leads to strategies of existence that threaten the survival of life on our planet, such as plundering of nonrenewable resources, polluting the natural environment, disturbing ecological balance, and using violence as a principal means of international problem-solving.

It is, therefore, in the interest of all of us to find ways of bringing spirituality back into our individual and collective life. This would have to include not only theoretical recognition of spirituality as a vital aspect of existence, but also encouragement and social sanctioning of activities that mediate experiential access to spiritual dimensions of reality. And an important part of this effort would have to be development of an appropriate support system for people undergoing crises of spiritual opening, which would make it possible to utilize the positive potential of these states.

In 1980, Christina founded the Spiritual Emergency Network (SEN), an organization that connects individuals undergoing psychospiritual crises with professionals, who are able and willing to provide assistance based on the new understanding of these states. Filial branches of SEN now exist in many countries of the world.

Triggers of Spiritual Emergency

In many instances, it is possible to identify the situation that precipitated the psychospiritual crisis. It can be a primarily physical factor, such as a disease, accident, or operation. At other times, extreme physical exertion or prolonged lack of sleep may appear to be the most immediate trigger. In women, it can be childbirth, miscarriage, or abortion. We have also seen situations where the onset of the process coincided with an exceptionally powerful sexual experience.

In other cases, the psychospiritual crisis begins shortly after a traumatic emotional experience. This can be loss of an important relationship, such as death of a child or another close relative, divorce, or the end of a love affair. Similarly, a series of failures or loss of a job or property can immediatel precede the onset of spiritual emergency. In predisposed individuals, the "last straw" can be an experience with psychedelic substances or a session of experiential psychotherapy.

One of the most important catalysts of psychospiritual crisis seems to be deep involvement in various forms of meditation and spiritual practice. This should not come as a surprise, since these methods have been specifically designed to facilitate spiritual experiences. We have been repeatedly contacted by persons in whom extended periods of holotropic states were triggered by the practice of Zen, Vipassana, or Vajrayana Buddhist meditation, yogic practices, Sufi ceremonies, monastic contemplation, or Christian prayer.

The wide range of triggers of spiritual crises clearly suggests that the individual's readiness for inner transformation plays far more important role than the external stimuli. When we look for a common denominator or final common pathway o the situations described above, we find that they all involve radical shift in the balance between the unconscious and conscious processes. Weakening of psychological defenses or, conversely, increase of the energetic charge of the unconscious dynamics, makes it possible for the unconsciou (and superconscious) material to emerge into consciousness.

It is well known that psychological defenses can be weakened by a variety of biological insults, such as physical trauma, exhaustion, sleep deprivation, or intoxication. Psychological traumas can mobilize the unconscious, particularly when they involve elements that are reminiscent of earlier traumas and are part of a significant COEX system The strong potential of childbirth as a trigger of psychospiritual crisis seems to reflect the fact that delivering a child combines biological weakening with specific reactivation of the mother's own perinatal memories.

Failures and disappointments in professional and personal life can undermine and thwart the outward-oriented motivations and ambitions of the individual. This makes it more difficult to use external activities as anescape from emotional problems and leads to psychological withdrawal and turning of attention to the inner world. As a result, unconscious contents can emerge into consciousness and interfere with the individual's everyday experience or even completely override it.

Diagnosis of Spiritual Emergency

When we emphasize the need to recognize the existence of psychospiritual crises, this does not mean indiscriminate rejection of the theories and practices of traditional psychiatry. Not all states that are currently diagnosed as psychotic are crises of psychospiritual transformation or hav a healing potential. Episodes of nonordinary states of consciousness cover a very broad spectrum from purely spiritual experiences to conditions that are clearly biological in nature and require medical treatment. While modern psychiatrists generally tend to pathologize mystical states, there also exists the opposite error of romanticizing and glorifying psychotic states or, even worse, overlooking a serious medical problem.

Many mental health professionals who encounter the concept of psychospiritual crisis want to know the exact criteria by which one can make the "differential diagnosis" between a crisis of this kind ("spiritual emergency") and psychosis. Unfortunately, it is in principle impossible to make such differentiation according to the standards used in somatic medicine. Unlike diseases treated by somatic medicine, psychotic states that are not obviously organic in nature - "functional psychoses" or "endogenous" psychoses are not medically defined. The commonly used laboratory examinations of blood, urine, stool, and cerebrospinal fluid, as well as EEG, X-rays, and other similar methods do not yield any useful clues in this regard. It is actually highly questionable whether these conditions should be called diseases at all.

Functional psychoses certainly are not diseases in the same sense as diabetes, typhoid fever, or pernicious anemia. They do not yield any specific clinical or laboratory findings that would support the diagnosis and justify the assumption that they are of biological origin. The diagnosis of these states is based entirely on the observation of unusual experiences and behaviors for which contemporary psychiatry lacks adequate explanation.

The meaningless attribute "endogenous" (literally "generated from within") used for these conditions is tantamount to admission of this ignorance. At present, there is no reason to refer to these conditions as "mental diseases" and assume that the experiences involved are products of a pathological process in the brain yet to be discovered by future research. If we give it some thought, we realize it is highly unlikely that a pathological process afflicting the brain could, in and of itself, generate the incredibly rich experiential spectrum of the states currently diagnosed as psychotic. How could possibly abnormal processes in the brain generate such experiences as culturally specific sequences of psychospiritual death and rebirth, convincing identification with Christ on the cross or with the dancing Shiva, an episode involving death on the barricades in Paris during the French revolution, or complex scenes of alien abduction?

When similar experiences manifest under circumstances in which the biological changes are accurately defined, such as dministration of specific dosages of chemically pure LSD-25 the nature and origin of their content remain a deep mystery. The spectrum of possible reactions to LSD is very broad an includes reliving of various biographical events, experiences of psychospiritual death and rebirth, episodes of mystical rapture, feelings of cosmic unity, sense of oneness with God, and past-life memories, as well as paranoid states, manic episodes, apocalyptic visions, exclusively psychosomatic responses, and many others. The same dosage given to different individuals or repeatedly to the same person can induce very different experiences.

Chemical changes in the organism obviously catalyze the
experience, but are not, in and of themselves, capable of creating the intricate imagery and the rich philosophical and spiritual insights, let alone mediating access to accurate new information about various aspects of the universe. The administration of LSD and other similar substances can account for the emergence of deep unconscious material into consciousness, but cannot explain its nature and content.

Understanding the phenomenology of psychedelic states necessitates a much more sophisticated approach than a simple reference to abnormal biochemical or biological processes in the body. It requires a comprehensive procedure that has to include transpersonal psychology, mythology, philosophy, and comparative religion. The same is true in regard to psychospiritual crises.

The experiences that constitute psychospiritual crises clearly are not artificial products of aberrant pathophysiological processes in the brain, but manifestations of the deeper levels of the psyche. Naturally, to be able to see it this way, we have to transcend the narrow understanding of the psyche offered by mainstream psychiatry and use a vastly expanded conceptual framework. Examples of such enlarged models of the psyche are the cartography described in my own books and papers (Grof 1975, 2000, 2007a), Ken Wilber's spectrum psychology (Wilber 1977), Roberto Assagioli's psychosynthesis (Assagioli 1976), and C. G. Jung's concept of the psyche as identical with the world soul (anima mundi) that includes the historical and archetypal collective unconscious (Jung 1959). Such large and comprehensive understanding of the psyche is also characteristic of the great Eastern philosophies and the mystical traditions of the world.

Since functional psychoses are not defined medically but psychologically, it is impossible to provide a rigorous differential diagnosis between psychospiritual crisis ("spiritual emergency") and psychosis in the way it is done in medical practice in relation to different forms of encephalitis, brain tumors, or dementias. Considering this fact, is it possible to make any diagnostic conclusions at all? How can we approach this problem and what can we offer in lieu of a clear and unambiguous differential diagnosis between psychospiritual crisis and mental disease?

A viable alternative is to define the criteria that would make it possible to determine which individual, experiencing an intense spontaneous holotropic state of consciousness, is likely to be a good candidate for a therapeutic strategy that validates and supports the process. And, conversely, we can attempt to determine under what circumstances using an alternative approach would not be appropriate and when the current practice of routine psychopharmacological suppression of symptoms would be preferable.

A necessary prerequisite for such an evaluation is a good medical examination that eliminates conditions, which are organic in nature and require biological treatment. Once this is accomplished, the next important guideline is the phenomenology of holotropic state of consciousness in
question.

Psychospiritual crises involve a combination of biographical, perinatal, and transpersonal experiences that were described in another context, in the discussion of the extended cartography of the psyche (Grof 1975, 2000, 2007 a). Experiences of this kind can be induced in a group of randomly selected "normal" people not only by psychedelic substances, but also by such simple means as meditation, shamanic drumming, faster breathing, evocative music, bodywork, and variety of other nondrug techniques.

Those of us who work with holotropic breathwork see such
experiences daily in our workshops and seminars and have the opportunity to appreciate their healing and transformative potential. In view of this fact, it is difficult to attribute similar experiences to some exotic and yet unknown pathology when they occur spontaneously in the middle of everyday life. It makes eminent sense to approach these experiences in the same way they are approached in holotropic and psychedelic sessions – to encourage people to surrender to the process and to support the emergence and full expression of the unconscious material that becomes available.

Another important indicator is the person's attitude to the process and his or her experiential style. It is generally very encouraging when people who have holotropic experiences recognize that what is happening to them is an inner process, are open to experiential work, and interested to try it.

Transpersonal strategies are not appropriate for individuals who lack this elementary recognition, use predominantly the mechanism of projection, or suffer from persecutory delusions. The capacity to form a good working relationship with an adequate amount of trust is an absolutely essential prerequisite for psychotherapeutic work with people in spiritual crisis.

It is also very important to pay attention to the way clients talk about their experiences. The communication style, in and of itself, often distinguishes promising candidates from inappropriate or questionable ones. It is a very good prognostic indicator if the person describes the experiences in a coherent and articulate way, however extraordinary and strange their content might be. In a sense, this would be similar to hearing an account of a person who has just had a psychedelic session and intelligently describes what to an uninformed person might appear to be strange and extravagant experiences.

Varieties of Spiritual Crises

A question that is closely related to the problem of differential diagnosis of psychospiritual crises is their classification. Is it possible to distinguish and define among them certain specific types or categories in the way it is attempted in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-revised) and its predecessors used by traditional psychiatrists? Before we address this question, it is necessary to emphasize that the attempts to classify psychiatric disorders, with the exception of those that are clearly organic in nature, have been generally unsuccessful.

There is general disagreement about diagnostic categories among individual psychiatrists and also among psychiatric societies of different countries. Although DSM has been revised and changed a number of times, clinicians complain that they have difficulties matching the symptoms of their clients with the official diagnostic categories. Spiritual crises are no exception; if anything, assigning people suffering fro these conditions to well-defined diagnostic categories is particularly problematic because of the fact that their phenomenology is unusually rich and can have its source on all various levels of the psyche.

The symptoms of psychospiritual crises represent a manifestation and exteriorization of the deep dynamics of th human psyche. The individual human psyche is a multidimensional and multilevel system with no internal divisions and boundaries. The elements from postnatal biography and from the Freudian individual unconscious form a continuum with the dynamics of the perinatal level and the transpersonal domain. We cannot, therefore, expect to find clearly defined and demarcated types of spiritual emergency. And yet, our work with individuals in psychospiritual crises, exchanges with colleagues doing similar work, and study of pertinent literature have convinced us that it is possible and useful to outline certain major forms of psychospiritual crises, which have sufficiently characteristic features to be differentiated from others.

Naturally, their boundaries are not clear and, in practice, there are some significant overlaps among them. I will first present a list of the most important varieties of psychospiritual crises as Christina and I have identified them and then briefly discuss each of them.

1. Shamanic crisis
2. Awakening of Kundalini
3. Episodes of unitive consciousness (Maslow's "peak experiences")
4. Psychological renewal through return to the center (John Perry)
5. Crisis of psychic opening
6. Past-life experiences
7. Communication with spirit guides and "channeling"
8. Near-death experiences (NDEs)
9. Close encounters with UFOs and alien abduction experiences
10. Possession states
11. Alcoholism and drug addiction

Shamanic Crisis

The career of many shamans -- witch doctors or medicine men and women -- in different cultures, begins with a dramatic involuntary visionary state that the anthropologists call "shamanic illness." During such episodes, future shamans usually withdraw psychologically or even physicall from their everyday environment and have powerful holotropic experiences. They typically undergo a journey into the underworld, the realm of the dead, where they experience attacks by vicious demons and are exposed to horrendous tortures and ordeals.

This painful initiation culminates in experiences of death and dismemberment followed by rebirth and ascent or magic flight to celestial regions. This might involve transformation into a bird, such as an eagle, falcon, thunderbird, or condor, and flight to the realm of the cosmic sun. The novice shama can also have an experience of being carried by such a bird into the solar region. In some cultures the motif of magic flight is replaced by that of reaching the celestial realms by climbing the world tree, a rainbow, a pole with many notches, or a ladder made of arrows.

In the course of these arduous visionary journeys, novice shamans develop deep contact with the forces of nature and with animals, both in their natural form and their archetypal versions -- "animal spirits" or "power animals." When these visionary journeys are successfully completed, they can be profoundly healing. In this process, novice shamans often heal themselves from emotional, psychosomatic, and even physical diseases. For this reason, shamans are frequently referred to as "wounded healers."

In many instances, the involuntary initiates attain in this experience deep insights into the energetic and metaphysical causes of diseases and learn how to heal not only themselves, but also others. Following the successful completion of the initiatory crisis, the individual becomes a shaman and returns to his or her people as a fully functioning and honored member of the community. He or she assumes the combined role of an honored priest, visionary, and healer.

In our workshops and professional training, modern Americans, Europeans, Australians, and Asians have often experienced in their holotropic breathwork sessions episode that bore close resemblance to shamanic crises. Besides the elements of physical and emotional torture, death, and rebirth, such states involved experiences of connection with animals, plants, and elemental forces of nature. The individuals experiencing such crises also often showed spontaneous tendencies to create rituals that were similar to those practiced by shamans of various cultures. On occasion mental health professionals with this history have been able to use the lessons from their journeys in their work and develop and practice modern versions of shamanic procedures.

The attitude of native cultures toward shamanic crises has often been explained by the lack of elementary psychiatric knowledge of the shaman's tribesmen and the resulting tendency to attribute every experience and behavior that these people do not understand to supernatural forces. However, nothing could be farther from truth. Shamanic cultures, which recognize shamans and show them great respect, have no difficulty differentiating them from individuals who are crazy or sick.

To be considered a shaman, the individual has to successfully complete the transformation journey and integrate well the episodes of challenging holotropic states of consciousness. He or she has to be able to function at least as well as other members of the tribe. The way shamanic crises are approached and treated in these societies is an extremely useful and illustrative model of dealing with psychospiritual crises in general.

The Awakening of Kundalini

The manifestations of this form of psychospiritual crisis resemble the descriptions of the awakening of Kundalini, or the Serpent Power, found in ancient Indian literature (Woodroff 1974, Mookerjee and Khanna 1977, Mookerjee 1982). According to the yogis, Kundalini is the generative cosmic energy, feminine in nature, which is responsible for the creation of the cosmos. In its latent form it resides at the base of the human spine in the subtle or energetic body, which is a field that pervades and permeates, as well as surrounds, the physical body. This latent energy can become activated by meditation, specific exercises, the intervention of an accomplished spiritual teacher (guru), or for unknown reasons.

The activated Kundalini, called shakti, rises through the nadis, channels or conduits in the subtle body; the pricipal three nadis rising along the body's vertical axis are called Ida, Shushumna, and Pingala. As Kundalini ascends, it clears old traumatic imprints and opens the centers of psychic energy, called chakras situated at the points where Ida and Pingala are crossing. This process, although highly valued and considered beneficial in the yogic tradition, is not without dangers and requires expert guidance by a guru whose Kundalini is fully awakened and stabilized. The most dramatic signs of Kundalini awakening are physical and psychological manifestations called kriyas.

The kriyas involve intense sensations of energy and heat streaming up the spine, usually associated with violent shaking, spasms, and twistingmovements. Intense waves of seemingly unmotivated emotions, such as anxiety, anger, sadness, or joy and ecstatic rapture, can surface and temporarily dominate the psyche. This can be accompanied by visions of brilliant light or various archetypal beings and variety of internally perceived sounds.

Many people involved in this process also have emotionally charged and convincing experiences of what seem to be memories from their past lives. Involuntary and often uncontrollable behaviors complete the picture: speaking in tongues, chanting unknown songs or sacred invocations (mantras), assuming yogic postures (asanas) and gestures (mudras), and making a variety of animal sounds and movements.

C. G. Jung and his co-workers dedicated to this phenomeno a series of special seminars (Jung 1996). Jung's perspective on Kundalini proved to be probably the most remarkable error of his entire career. He concluded that the awakening of Kundalini was an exclusively Eastern phenomenon and predicted that it would take at least a thousand years before this energy would be set into motion in the West as a result of depth psychology. In the last several decades, unmistakable signs of Kundalini awakening have been observed in thousands of Westerners. The credit for drawing attention to this condition belongs to Californian psychiatrist and ophtalmologist Lee Sannella, who studied single-handedly nearly one thousand of such cases and summarized his findings in his book The Kundalini Experience: Psychosis or Transcendence (Sannella 1987).

Episodes of Unitive Consciousness ("Peak Experiences")

The American psychologist Abraham Maslow studied many hundreds of people who had unitive mystical experiences and coined for them the term peak experiences (Maslow 1964). He expressed sharp criticism of Western psychiatry's tendency to confuse such mystical states with mental disease. According to him, they should be considered supernormal rather than abnormal phenomena. If they are not interfered with and are allowed to run their natural course, these states typically lead to better functioning in the world and to "self-actualization" or "selfrealization" -- the capacity to express more fully one's creative potential and to live a more rewarding and satisfying life.

Psychiatrist and consciousness researcher Walter Pahnke developed a list of basic characteristics of a typical peak experience, based on the work of Abraham Maslow and W. T. Stace. He used the following criteria to describe this state of mind (Pahnke and Richards 1966):

Unity (inner and outer)
Strong positive emotion
Transcendence of time and space
Sense of sacredness (numinosity)
Paradoxical nature
Objectivity and reality of the insights
Ineffability
Positive aftereffects

As this list indicates, when we have a peak experience, we have a sense of overcoming the usual fragmentation of the mind and body and feel that we have reached a state of unit and wholeness. We also transcend the ordinary distinction between subject and object and experience an ecstatic union with humanity, nature, the cosmos, and God. This is associated with intense feelings of joy, bliss, serenity, and inner peace. In a mystical experience of this type, we have a sense of leaving ordinary reality, where space has three dimensions and time is linear. We enter a metaphysical, transcendent realm, where these categories no longer apply. In this state, infinity and eternity become experiential realities. The numinous quality of this state has nothing to d with previous religious beliefs; it reflects a direct apprehension of the divine nature of reality.

Descriptions of peak experiences are usually full of paradoxes. The experience can be described as "contentless, yet all-containing." It has no specific content, but seems to contain everything in a potential form. We can have a sense of being simultaneously everything and nothing. While our personal identity and the limited ego have disappeared, we feel that we have expanded to such an extent that our being encompasses the entire universe. Similarly, it is possible to perceive all forms as empty, or emptiness as being pregnant with forms. We can even reach a state in which we see that the world exists and does not exist at the same time.

The peak experience can convey what seems to be ultimate wisdom and knowledge in matters of cosmic relevance, which the Upanishads describe as "knowing That, the knowledge of which gives the knowledge of everything." What we have learned during this experience is ineffable; it cannot be described by words. The very nature and structur of our language seem to be inadequate for this purpose. Yet, the experience can profoundly influence our system of values and strategy of existence.

Because of the generally benign nature and positive potentia of the peak experience, this is a category of spiritual crisis that should be least problematic. These experiences are by their nature transient and selflimited. There is absolutely no reason why they should have adverse consequences. And yet, due to the misconceptions of the psychiatric profession concerning spiritual matters, many people who experience such states end up hospitalized, receive pathological labels, and their condition is suppressed by psychopharmacological medication.

Psychological Renewal through Return to the Center

Another important type of transpersonal crisis was described by Californian psychiatrist and Jungian analyst John Weir Perry, who called it the "renewal process" (Perry 1974, 1976, 1998). Because of its depth and intensity, this is the type of psychospiritual crisis that is most likely diagnosed as serious mental disease. The experiences of people involved in the renewal process are so strange, extravagant, and far from everyday reality that it seems obvious that some serious pathological process must be affecting the functioning of their brains.

Individuals involved in this kind of crisis experience their psyche as a colossal battlefield where a cosmic combat is being played out between the forces of Good and Evil, or Light and Darkness. They are preoccupied with the theme of death -- ritual killing, sacrifice, martyrdom, and afterlife. The problem of opposites fascinates them, particularly issues related to the differences between sexes. They experience themselves as the center of fantastic events that have cosmi relevance and are important for the future of the world. Their visionary states tend to take them farther and farther back -- through their own history and the history of humanity, all the way to the creation of the world and the original ideal state of paradise. In this process, they seem to strive for perfection, trying to correct things that went wrong in the past.

After a period of turmoil and confusion, the experiences become more and more pleasant and start moving toward a resolution. The process often culminates in the experience of hieros gamos, or "sacred marriage," in which the individual is elevated to an illustrious or even divine status and experiences union with an equally distinguished partner. Thi indicates that the masculine and the feminine aspects of the personality are reaching a new balance. The sacred union can be experienced either with an imaginal archetypal figure, or i projected onto an idealized person from one's life, who then appears to be a karmic partner or a soul mate.

At this time, one can also have experiences involving what Jungian psychology interprets as symbols representing the Self, the transpersonal center that reflects our deepest and true nature and is related to, but not totally identical with, the Hindu concept of Atman-Brahman. In visionary states, it can appear in the form of a source of light of supernatural beauty, radiant spheres, precious stones and jewels, pearls, and other similar symbolic representations. Examples of this development from painful and challenging experiences to th discovery of one's divinity can be found in John Perry's books (Perry 1953, 1974, 1976) and in The Stormy Search for the Self, our own book on spiritual emergencies (Grof and Grof 1990).

At this stage of the process, these glorious experiences are interpreted as a personal apotheosis, a ritual celebration that raises one's experience of oneself to a highly exalted human status or to a state above the human condition altogether -- a great leader, a world savior, or even the Lord of the Universe. This is often associated with a profound sense of spiritual rebirth that replaces the earlier preoccupation with death. At the time of completion and integration, one usually envisions an ideal future -- a new world governed by love and justice, where all ills and evils have been overcome. As the intensity of the process subsides, the person realizes that the entire drama was a psychological transformation that was limited to his or her inner world and did not involve externa reality.

According to John Perry, the renewal process moves the individual in the direction of what Jung called "individuation" -- a full realization and expression of one's deep potential. One aspect of Perry's research deserves special notice, sinc it produced what is probably the most convincing evidence against simplistic biological understanding of psychoses. He was able to show that the experiences involved in the renewal process exactly match the main themes of royal dramas that were enacted in many ancient cultures on New Year's Day.

These ritual dramas celebrating the advent of the new year were performed during what Perry calls "the archaic era of incarnated myth." This was the period in the history of these cultures when the rulers were considered to be incarnated gods and not ordinary human beings. Examples of such God/kings were the Egyptian pharaohs, the Peruvian Incas, the Hebrew and Hittite kings, or the Chinese and Japanese emperors (Perry 1991).

The positive potential of the renewal process and its deep
connection with archetypal symbolism and with specific periods of human history represents a very compelling argument against the theory that these experiences are chaotic pathological products of diseased brains. They are clearly closely connected with the evolution of consciousness on the individual and collective level.

The Crisis of Psychic Opening

An increase in intuitive abilities and the occurrence of psychic or paranormal phenomena are very common during psychospiritual crises of all kinds. However, in some instances, the influx of information from nonordinary sources, such as astral projection, precognition, telepathy, or clairvoyance, becomes so overwhelming and confusing that it dominates the picture and constitutes a major problem, in and of itself.

Among the most dramatic manifestations of psychic opening are out-of-body experiences. In the middle of everyday life, and often without any noticeable trigger, one's consciousness can detach from the body and witness what is happening in the surroundings or in various remote locations. The information attained during these episodes by extrasensory perception often proves to correspond to consensus reality. Out-of-body experiences occur with extraordinary frequency in near-death situations, where the accuracy of this "remote viewing" has been established by systematic studies (Ring 1982, 1985, Ring and Valarino 1998, Ring and Cooper 1999).

People experiencing intense psychic opening might be so much in touch with the inner processes of others that they exhibit remarkable telepathic abilities. They might indiscriminately verbalize accurate incisive insights into other people's minds concerning various issues that these individuals are trying to hide. This can frighten, irritate, and alienate others so severely that it often becomes a significant factor contributing to unnecessary hospitalization or punitive measures within the psychiatric facility. Similarly, accurate precognitions of future situations and clairvoyant perceptions, particularly if they occur repeatedly in impressive clusters, can seriously upset the persons in crisis, as well as alarm those around them, since they undermine their notion of the nature of reality.

In experiences that can be called "mediumistic," one has a sense of losing one's own identity and taking on the identity of another person. This can involve assuming the other person's body image, posture, gestures, facial expression, feelings, and even thought processes. Accomplished shamans, psychics, and spiritual healers can use such experiences in a controlled and productive way. Unlike the persons in psychospiritual crisis, they are capable of taking on the identity of others at will and also resuming their own separate identity after they accomplish the task of the session. During the crises of psychic opening, the sudden, unpredictable, and uncontrollable loss of one's ordinary identity can be very frightening.

People in spiritual crisis often experience uncanny coincidences that link the world of inner realities, such as dreams and visionary states, to happenings in everyday life. This phenomenon was first recognized and described by C. G. Jung, who gave it the name synchronicity and explored it in a special essay (Jung 1960). The study of synchronistic events helped Jung realize that archetypes were not principles limited to the intrapsychic domain. It became clear to him that they have what he called "psychoid" quality, which means that they govern not only the individual psyche, but also happenings in the world of consensus reality. I have explored this fascinating topic in my other writings (Grof 1988, 2006).

Any researcher, who seriously studies Jungian synchronicities, discovers that they are without any doubt authentic phenomena and cannot be ignored and discounted as accidental coincidences. They also can not be indiscriminately dismissed as pathological distortions of reality -- erroneous perception of meaningful relations where, in actuality, there are none. This is a common practice in contemporary psychiatry where any allusion to meaningful coincidences is automatically diagnosed as "delusion of reference."

In case of true synchronicities, any open-minded witnesses, who have access to all the relevant information, recognize that the coincidences involved are beyond any reasonable statistical probability. Extraordinary synchronicities accompany many forms of transpersonal crises, and in crises of psychic opening they are particularly common.

Past-Life Experiences

Among the most dramatic and colorful transpersonal phenomena occurring in holotropic states of consciousness are experiences that appear to be memories from previous incarnations. These are sequences that take place in other historical periods and often in other countries and are usually
associated with powerful emotions and physical sensations. They often portray in great detail the persons, circumstances, and historical settings involved. Their most remarkable aspect is a convincing sense of remembering and reliving something that one has already seen (déjà vu) or experienced (déjà vecu) at some time in the past. This is clearly the same type of experience that in Asia and many other places of the world inspired the belief in reincarnation and the law of karma.

The rich and accurate information that these "past-life memories" provide, as well as their healing potential, impels us to take them seriously. When the content of a karmic experience fully emerges into consciousness, it can suddenly provide an explanation for many otherwise incomprehensible aspects of one's daily life. Strange difficulties in relationships with certain people, unsubstantiated fears, and peculiar idiosyncrasies and attractions, as well as otherwise incomprehensible emotional and psychosomatic symptoms suddenly seem to make sense as karmic carry-overs from a previous lifetime. These problems typically disappear when the karmic pattern in question is consciously experienced and integrated.

Past-life experiences can complicate life in several different ways. Before their content emerges fully into consciousness and reveals itself, one can be haunted in everyday life by strange emotions, physical feelings, and visions without knowing where these are coming from or what they mean. Experienced out of context, these experiences naturally appear incomprehensible and irrational. Another kind of complication occurs when a particularly strong karmic experience starts emerging into consciousness in the middle of everyday life and interferes with normal functioning.

One might also feel compelled to act out some of the elements of the karmic pattern before it is fully experienced and understood or completed. For instance, it might suddenly seem that a certain person in one's present life played an important role in a previous incarnation, the memory of which is emerging into consciousness. When this happens, one may seek emotional contact with a person who now appears to be a "soul mate" from one's karmic past or, conversely, confrontation and showdown with an adversary from another lifetime. This kind of activity can lead to unpleasant complications, since the alleged karmic partners usually have no basis in their own experiences for understanding this behavior.

Even if one manages to avoid the danger of embarrassing acting-out, the problems are not necessarily over. After a past-life memory has fully emerged into consciousness and its content and implications have been revealed to the experiencer, there remains one more challenge. One has to reconcile this experience with the traditional beliefs and values of the industrial civilization. Denial of the possibility of reincarnation represents a rare instance of complete agreement between the Christian Church and materialistic science. Therefore, in Western culture, acceptance and intellectual integration of a past-life memory is a difficult task for an atheist as well as a traditionally religious person.

Assimilation of past-life experiences into one's belief system can be a relatively easy task for someone who does not have a strong commitment to Christianity or the materialistic scientific worldview. The experiences are usually so convincing that one simply accepts their message and might even feel excited about this new discovery. However, fundamentalist Christians and those who have a strong investment in rationality and the traditional scientific perspective can be catapulted into a period of confusion when they are confronted with convincing personal past life experiences that seriously challenge their belief system.

Communication with Spirit Guides and "Channeling"

Occasionally, one can encounter in a holotropic state of
consciousness a being, who seems to show interest in a personal relationship and assumes the position of a teacher, guide, protector, or simply a convenient source of information. Such beings are usually perceived as discarnate humans, suprahuman entities, or deities existing on higher planes of consciousness and endowed with extraordinary wisdom. Sometimes they take on the form of a person; at other times they appear as radiant sources of light, or simply let their presence be sensed. Their messages are usually received in the form of direct thought transfer or through other extrasensory means. In some instances, communication can take the form of verbal messages.

A particularly interesting phenomenon in this category is
channeling, which in several past decades received much attention from the public and mass media. A person who is "channeling" transmits to others messages received from a source that appears to be external to his or her consciousness. It occurs through speaking in a trance, using automatic writing, or recording of telepathically received thoughts. Channeling has played an important role in the history of humanity. Among the channeled spiritual teachings are many scriptures of enormous cultural influence, such as the ancient Indian Vedas, the Qur'an, and the Book of Mormon. A remarkable modern example of a channeled text is A Course in Miracles, recorded by psychologist Helen Schucman (Anonymous 1975, Grof 2006).

Experiences of channeling can precipitate a serious psychological and spiritual crisis. The individual involved can interpret the experience as an indication of beginning insanity. This is particularly likely if the channeling involves hearing voices, a well-known symptom of paranoid schizophrenia. The quality of the channeled material varies from trivial and questionable chatter to extraordinary information. On occasion, channeling can provide consistently accurate data about subjects to which the recipient was never exposed. This fact can then appear to be a particularly convincing proof of the involvement of supernatural realities and can lead to serious philosophical confusion for an atheistic layperson or a scientist with a materialistic worldview. Readers interested in this phenomenon will find much valuable information in special studies by Arthur Hastings and Ion Klimo (Hastings 1991, Klimo 1998).

Spirit guides are usually perceived as advanced spiritual beings on a high level of consciousness evolution, who are endowed with superior intelligence and extraordinary moral integrity. This can lead to highly problematic ego inflation in the channeler, who might feel chosen for a special mission and see it as a proof of his or her own superiority.

Near-Death Experiences (NDEs)

World mythology, folklore, and spiritual literature abound in vivid accounts of the experiences associated with death and dying. Special sacred texts have been dedicated exclusively to descriptions and discussions of the posthumous journey of the soul, such as the Tibetan Book of the Dead (Bardo Thödol), the Egyptian Book of the Dead (Pert Em Hru), the Aztec Codex Borgia, the Mayan Book of the Dead, and their European counterpart, Ars Moriendi (The Art of Dying) (Grof 1994, 2006b).

In the past, this eschatological mythology was discounted by
Western scholars as a product of fantasy and wishful thinking of primitive people who were unable to face the fact of impermanence and their own mortality. This situation changed dramatically after the publication of Raymond Moody's international best-seller Life After Life, which brought scientific confirmation of these accounts and showed that an encounter with death can be a fantastic adventure in consciousness. Moody's book was based on reports of 150 people who had experienced a close confrontation with death, or were actually pronounced clinically dead, but regained consciousness and lived to tell their stories (Moody 1975).

Moody reported that people who had near-death experiences
(NDEs) frequently witnessed a review of their entire lives in the form of a colorful, incredibly condensed replay occurring within only seconds of clock time. Consciousness often detached from the body and floated freely above the scene, observing it with curiosity and detached amusement, or traveled to distant locations. Many people described passing through a dark tunnel or funnel toward a divine light of supernatural brilliance and beauty.

This light was not physical in nature, but had distinctly personal characteristics. It was a Being of Light, radiating infinite, all-embracing love, forgiveness, and acceptance. In a personal exchange, often perceived as an audience with God, these individuals received lessons regarding existence and universal laws and had the opportunity to evaluate their past
by these new standards. Then they chose to return to ordinary reality and live their lives in a new way congruent with the principles they had learned.

Since their publication, Moody's findings have been repeatedly confirmed by other researchers (Ring 1982, Ring 1985, Sabom 1982, Greyson and Flynn1984).

Most survivors emerge from their near-death experiences
profoundly changed. They have a universal and all-encompassing spiritual vision of reality, a new system of values, and a radically different general strategy of life. They have deep appreciation for being alive and feel kinship with all living beings and concern for the future of humanity and the planet.

However, the fact that the encounter with death has a great positive potential does not mean that this transformation is always easy. Near-death experiences very frequently lead to psychospiritual crises. A powerful NDE can radically undermine the worldview of the people involved, because it catapults them abruptly and without warning into a reality that is radically different. A car accident in the middle of rush-hour traffic or a heart attack during morning jogging can launch someone within a matter of seconds into a fantastic visionary adventure that tears his or her ordinary reality asunder. Following an NDE, people might need special counseling and support to be able to integrate these extraordinary experiences into their everyday life.

Unfortunately, the approach of the personnel in most medical facilities to NDE survivors leaves much to be desired, in spite of the fact that in the last few decades this phenomenon has received much attention in the professional literature, as well as in the mass media. Few survivors
of NDEs receive professional counseling that most of them sorely need. It is also not yet mandatory to include the reports of the patients' NDEs in the medical folders, although it is well known that these experiences can
have profound impact on their emotional and psychosomatic condition. A comprehensive discussion of the problems related to NDEs can be found in my book The Ultimate Journey: Consciousness and the Mystery of Death (Grof 2006 b).

Close Encounters with UFOs and Alien Abduction Experiences

The experiences of encounters with extraterrestrial spacecrafts and of abduction by alien beings can often precipitate serious emotional and intellectual crises that have much in common with psychospiritual crises. This fact requires an explanation, since most people consider UFOs simply in terms of four alternatives: actual visitation of the earth by alien spacecraft, hoax, misperception of natural events and devices of terrestrial origin, and psychotic hallucinations. Alvin Lawson has also made an attempt to interpret UFO abduction experiences as misinterpretations of the memory of the trauma of birth, using my own clinical material (Lawson 1984).

Descriptions of UFO sightings typically refer to lights that have an uncanny, supernatural quality. These lights resemble those mentioned in many reports of visionary states. C. G. Jung, who dedicated a special study to the problem of "flying saucers," suggested that these phenomena might be archetypal visions originating in the collective unconscious of humanity, rather than psychotic hallucinations or visits by extraterrestrials from distant civilizations (Jung 1964). He supported his thesis by careful analysis of legends about flying discs that have been told throughout history and reports about various similar apparitions that have occasionally caused crises and mass panic.

It has also been pointed out that the extraterrestrial beings involved in these encounters have important parallels in world mythology and religion, systems that have their roots in the collective unconscious. The alien spacecrafts and cosmic flights depicted by those who were allegedly abducted or invited for a ride resemble certain phenomena described in spiritual literature, such as the chariot of the Vedic god Indra or Ezekiel's flaming machine described in the Bible. The fabulous landscapes and cities visited during these journeys resemble the visionary experiences of paradise, celestial realms, and cities of light.

The abductees often report that the aliens took them into a special laboratory and subjected them to painful examinations and frightening experiments using various exotic instruments. This involved probing the cavities of the body, examination of the sexual organs, and taking samples of sperm and ova. There are frequent references to genetic experiments with the goal of producing hybrid offspring. These interventions are typically very unpleasant and occasionally border on torture. This brings the experiences of the abductees close to the initiatory crises of the shamans and to the ordeals of the neophytes in aboriginal rites of passage, such as circumcision and subincision of the penis.

There is an additional reason why a UFO experience can precipitate a spiritual crisis. It is similar to the problem we have discussed earlier in relation to spirit guides and channeling. The alien visitors are usually seen as representatives of civilizations that are incomparably more advanced than ours, not only technologically but also intellectually, morally, and spiritually. Such contact often has very powerful mystical undertones and is associated with insights of cosmic relevance. It is thus easy for the
recipients of such special attention to interpret it as an indication of their own uniqueness.

Abductees might feel that they have attracted the interest of superior beings from an advanced civilization because they themselves are in some way exceptional and particularly suited for a special purpose. In Jungian psychology, a situation in which the individual claims the luster of the archetypal world for his or her own person is referred to as "ego inflation."

For all these reasons, experiences of "close encounters" can lead to serious transpersonal crises. People who have experienced the strange world of UFO experiences and alien abduction, need professional help from someone who has general knowledge of archetypal psychology and who is also familiar with the specific characteristics of the UFO phenomenon. Experienced researchers, such as Harvard psychiatrist John Mack, have brought ample evidence that the alien abduction experiences are phenomena sui generis, that represent a serious conceptual challenge for Western psychiatry and materialistic science in general.

An aspect of the UFO phenomena that is particularly baffling is that they occasionally have definite psychoid features. This means that they are synchronistically linked with events in the material world. It has become clear that it is naive and indefensible to see them as manifestations of mental disease or dismiss all of them as misperceptions and misinterpretations of ordinary phenomena (Mack 1994,
1999).

Over the years, I have worked with many individuals who had experiences of alien abduction in their psychedelic or holotropic breathwork sessions and during spiritual emergencies. Almost without exception, these episodes were extremely intense and experientially convincing. In view of my observations, I share the opinion of many serious UFO researchers that these experiences represent fascinating and authentic phenomena that deserve to be seriously studied.

The position of traditional psychiatrists who see them as products of an unknown pathological process in the brain is clearly oversimplistic and highly implausible. It is equally improbable that we are dealing with actual visits of extraterrestrial beings. A civilization capable of sending spaceships to our planet would have to have technical means that we cannot even imagine. We have enough information about the planets of the solar system to know that they are unlikely sources of such an alien expedition. The distance of the earth from the nearest celestial bodies outside of the solar system amounts to many light years. Negotiating such distances would require velocities equaling or surpassing the speed of light or interdimensional travel through hyperspace.
A civilization capable of such formidable achievements would very likely have technology that would make it impossible for us to differentiate between hallucinations and reality. Until more reliable information is available, it seems therefore most plausible to see the UFO experiences as manifestations of archetypal elements from the collective unconscious.

Possession States

People experiencing this type of transpersonal crisis have a distinct feeling that their psyche and body have been invaded and that they are being controlled by an evil entity or energy with personal characteristics. They perceive it as coming from the outside of their own personality and as being hostile and disturbing. It can appear to be a confused discarnate
entity, a demonic being, or the consciousness of a wicked person invading them by means of black magic and hexing procedures. There are many different types and degrees of such conditions. In some instances, the true nature of this disorder remains hidden. The problem manifests as serious psychopathology, such as antisocial or even criminal behavior, suicidal depression, murderous aggression or selfdestructive behavior, promiscuous and deviant sexual impulses and actingout, or excessive use of alcohol and drugs. It is often not until such a person starts experiential psychotherapy that "possession" is identified as a condition underlying these problems.

In the middle of an experiential session, the face of a possessed person can become cramped and take the form of a "mask of evil," and the eyes can assume a wild expression. The hands and body might develop strange contortions, and the voice may become altered and take on an otherworldly quality. When this situation is allowed to develop, the session can bear a striking resemblance to exorcisms in the Catholic Church, or exorcist rituals in various aboriginal cultures.

The resolution often comes after dramatic episodes of choking, projectile vomiting, screaming, and frantic physical activity, or even temporary loss of control. Sequences of this kind can be unusually healing and transformative and often result in a deep spiritual conversion of the person involved. A detailed description of the most dramatic episode of this kind I have observed during my entire professional career can be found in my account of the case of Flora (Grof 2006 a).

Other times, the possessed person is aware of the presence of the "evil entity" in his or her body and spends much effort trying to fight it and control its influence. In the extreme version of the possession state, the problematic energy can spontaneously manifest and take over in the middle of everyday life. This situation resembles the one described earlier for experiential sessions, but the individual here lacks the support and protection provided by the therapeutic context. Under such circumstances, he or she can feel extremely frightened and desperately alone. Relatives, friends, and often even therapists tend to withdraw from the "possessed" individual and respond with a strange mixture of metaphysical fear and moral rejection. They often label the person as evil and refuse further contact.

This condition clearly belongs in the category of psychospiritual crises, in spite of the fact that it involves negative energies and is associated with many objectionable forms of behavior. The demonic archetype is by its very nature transpersonal, since it represents the negative mirror image of the divine. It also often appears to be a "gateway phenomenon," comparable to the terrifying guardians flanking the doors of Buddhist temples leading to radiant images of the Buddha. Encounter with an entity of this kind often immediately precedes a profound spiritual experience. With the help of somebody who is not afraid of its uncanny nature and is able to encourage its full conscious manifestation, this energy can be dissipated, and remarkable healing occurs.

Alcoholism and Drug Addiction as Psychospiritual Crisis

It makes good sense to describe addiction as a form of
transpersonal crisis ("spiritual emergency"), in spite of the fact that it differs in its external manifestations from more obvious types of psychospiritual crises. In addiction, like in the possession states, the spiritual dimension is obscured by the destructive and self-destructive nature of the disorder. While in other forms of spiritual crises people encounter problems because of their difficulty to cope with mystical experiences, in addiction the source of the problem is strong spiritual longing and the fact that the contact with the mystical dimension has not been made.

There exists ample evidence that behind the craving for drugs or alcohol is unrecognized craving for transcendence or wholeness (Grof 1987). Many recovering people talk about their restless search for some unknown missing element or dimension in their lives and describe their unfulfilling and frustrating pursuit of substances, foods, relationships, possessions, or power that reflects an unrelenting but vain effort to satiate this craving (Grof 1993).

The key to the understanding of addiction seems to be the fact that there exists a certain superficial similarity between mystical states and intoxication by alcohol or hard drugs. Both of these conditions share the feeling of dissolution of individual boundaries, dissipation of disturbing emotions, and transcendence of mundane problems. Although the intoxication with alcohol or drugs lacks many important characteristics of the mystical state, such as serenity, numinosity, and richness of philosophical insights, the experiential overlap is sufficient to seduce alcoholics and addicts into abuse.

William James was aware of this connection and wrote about it in Varieties of Religious Experience: "The sway of alcohol over mankind is unquestionably due to its power to stimulate the mystical faculties of human nature, usually crushed to earth by the cold facts and criticisms of the sober hour. Sobriety diminishes, discriminates, and says no; drunkenness expands, unites and says yes" (James 1961). James also saw the implications of this fact for therapy, which he expressed very succinctly in his famous statement: "The best treatment for dipsomania (an archaic term for alcoholism) is religiomania."

C. G. Jung's independent insight in this regard was instrumental in the development of the worldwide network of Twelve Step Programs. It is not generally known that Jung played a very important role in the history of Alcoholics Anonymous (AA). The information about this little-known aspect of Jung's work can be found in a letter that Bill Wilson, the cofounder of AA, wrote to Jung in 1961 (Wilson and Jung 1963). Jung had a patient, Roland H., who came to him after having exhausted other means of recovery from alcoholism. Following a temporary improvement after a year's treatment with Jung, he suffered a relapse. Jung told him that his case was hopeless and suggested that his only chance was to join a religious community and hope for a profound spiritual experience. Roland H. joined the Oxford Group, an evangelical movement emphasizing self-survey, confession, and service. There he experienced a religious conversion that freed him from alcoholism. He then returned to New York City and became very active in the Oxford Group there. He was able to help Bill Wilson's friend, Edwin T., who in turn helped Bill Wilson in his personal crisis. In his powerful
spiritual experience, Bill Wilson had a vision of a worldwide chain-style fellowship of alcoholics helping each other.
Years later, Wilson wrote Jung a letter, in which he brought to his attention the important role that Jung played in the history of AA. In his answer, Jung wrote in reference to his patient: "His craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God." Jung pointed out that in Latin, the term spiritus covers both meanings -- alcohol and spirit. He then expressed very succinctly his belief that only a deep spiritual experience can save people from the ravages of alcohol. He suggested that the formula for treatment of alcoholism is "Spiritus contra spiritum," James's and Jung's insights have since been confirmed by the experiences of the Twelve Step Program and by clinical research with psychedelics (Grof 1980).

Treatment of Psychospiritual Crises

Psychotherapeutic strategy for individuals undergoing spiritual crises is based on the realization that these states are not manifestations of an unknown pathological process, but results of a spontaneous movement in the psyche that engages deep dynamics of the unconscious and has healing and transformative potential. Understanding and appropriate treatment of spiritual crises requires a vastly extended cartography of the psyche that includes the perinatal and transpersonal region. This new model has been described at some length elsewhere (Grof 1975, 2001, 2007 a). The nature and degree of the therapeutic assistance that is necessary depends on the intensity of the psychospiritual process involved. In mild forms of spiritual crisis, the individual is usually able to function in everyday life and cope with the holotropic experiences as they emerge into consciousness. All that he or she needs is an opportunity to discuss the process with a transpersonally oriented therapist, who provides constructive supportive feedback, helps the client to integrate the experiences into everyday life, and suggests literature that contains useful information.

If the process is more active, it might require regular sessions of experiential therapy during which we use faster breathing, music, and bodywork to facilitate emergence of the unconscious material and full expression of emotions and blocked physical energies. The general strategy of this approach is identical with that used in holotropic breathwork sessions (Grof 2001, 2007 b). Allowing full expression of the emerging unconscious material in the sessions specifically designated and scheduled for this purpose reduces the possibility that it will surface and interfere with the client's life in the interim periods. When the experiences are very intense, all we have to do during the work with the clients is to encourage them to close their eyes, surrender to the process, observe what is happening, and find expression for the emerging emotions and physical feelings.

If we encounter psychological resistance, we might occasionally use releasing bodywork like in the termination periods of breathwork sessions. Holotropic breathwork as such is indicated only if the natural unfolding of the process reaches an impasse. Therapeutic work with this category of clients has to be conducted in a residential facility where supervision is available twenty-four hours a day. These intense experiential sessions can be complemented with Fritz Perls' Gestalt practice (Perls 1973), Dora Kalff's Jungian sandplay (Kalff 180 2004), Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro 2001), or bodywork with a psychologically experienced practitioner. A variety of auxiliary techniques can also prove extremely useful under these circumstances. Among them are writing of a log, painting of mandalas, expressive dancing, and jogging, swimming, or other sport activities. If the client is able to concentrate on reading, transpersonally oriented books, particularly those focusing on the problem of psychospiritual crises or on some specific aspect of the client's inner experiences, can be extremely helpful.

People whose experiences are so intense and dramatic that they cannot be handled on an out-patient basis represent a serious problem. There exist practically no facilities offering supervision twenty-four hours a day without the use of routine suppressive psychopharmacological intervention. Several experimental facilities of this kind that existed in the past in California, such as John Perry's Diabasis in San Francisco and Chrysalis in San Diego, or Barbara Findeisen's Pocket Ranch in Geyserville, were short-lived. The main reason for it was the fact that the insurance companies refused to pay for alternative therapy that was not officially approved. Solving the problem of such alternative centers is a necessary prerequisite for effective therapy of intense spiritual crises in the future.

In some places, helpers have tried to overcome this shortcoming by creating teams of trained assistants who took shifts in the client's home for the time of the duration of the episode. Management of intense acute forms of spiritual crises requires some extraordinary measures, whether it is conducted in a special facility or in a private home. Extended episodes of this kind can last days or weeks and can be associated with a lot of physical activity, intense emotions, loss of appetite, and insomnia. There is a danger of dehydration, vitamin and mineral deficiency, and physical exhaustion. Insufficient supply of food can lead to hypoglycemia that is known to weaken psychological defenses and bring additional material from the unconscious. This can lead to a vicious circle that perpetuates the acute condition. Tea with honey, bananas, or another form of food containing glucose can be of great help in grounding the process.

A person in intense psychospiritual crisis is usually so deeply
involved in his or her experience that they forget about food, drink, and elementary hygiene. It is thus up to the helpers to take care of the client's basic needs. Since the care for people undergoing the most acute forms of spiritual crises is unusually demanding, the helpers have to take shifts of reasonable duration to protect their own mental and physical health. To guarantee comprehensive and integrated care under these circumstances, it is necessary to keep a log and carefully record the client's intake of food, liquids, and vitamins. Sleep deprivation has similar effects as fasting; it tends to weaken the defenses and facilitate the influx of unconscious material into consciousness. This can also lead to a vicious circle that needs to be interrupted. It might, therefore, be necessary to occasionally administer a minor tranquilizer or a hypnotic. In this context, tranquilizing medication is not considered therapy, as it is the case in traditional psychiatric facilities. It is given solely for the purpose of securing the client's sleep. The administration of minor tranquilizers or hypnotics interrupts the vicious circle and gives the client the necessary rest and the energy to continue the following day with the uncovering process.

In later stages of spiritual crises, when the intensity of the process subsides, the person no longer requires constant supervision. He or she gradually returns to everyday activities and resumes the responsibility concerning basic care. The overall duration of the stay in a protected environment depends on the rate of stabilization and integration of the process. If necessary, we might schedule occasional experiential sessions and recommend the use of selected complementary and auxiliary techniques described earlier. Regular discussions about the experiences and
insights from the time of the episode can be of great help in integrating the episode.

The treatment of alcoholism and drug addiction presents some specific problems and has to be discussed separately from therapy of other psychospiritual crises. It is particularly the element of physiological addiction and the progressive nature of the disorder that requires special measures. Before dealing with the psychological problems underlying addiction, it is imperative to break the chemical cycle that perpetuates the use of substances. The individual has to go through a period of withdrawal and detoxification in a special residential facility.

Once this is accomplished, the focus can turn to the psychospiritual roots of the problem. As we have seen, alcoholism and drug addiction represent a misguided search for transcendence. For this reason, to be successful, the therapeutic program has to include as an integral part strong emphasis on the spiritual dimension of the problem. Historically, most successful in combating addiction have been the programs of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), fellowships offering a comprehensive approach based on the Twelve Step philosophy outlined by Bill Wilson.

Following the program step by step, the alcoholic or addict
recognizes and admits that they have lost control over their lives and have become powerless. They are encouraged to surrender and let a higher power of their own definition take over. A painful review of their personal history produces an inventory of their wrongdoings. This provides the basis for making amends to all the people whom they have hurt by their addiction. Those who have reached sobriety and are in recovery are then asked to carry the message to other addicts and to help them to overcome their habit.

The Twelve Step Programs are invaluable in providing support and guidance for alcoholics and addicts from the beginning of treatment throughout the years of sobriety and recovery. Since the focus of this collection of essays is the healing potential of holotropic states, we will now explore whether and in what way these states can be useful in the treatment of addiction. This question is closely related to the Eleventh Step that emphasizes the need "to improve through prayer and meditation our conscious contact with God as we understand God." Since holotropic states can facilitate mystical experiences, they clearly fit into this category.

Over the years, I have had extensive experience with the use of holotropic states in the treatment of alcoholics and addicts and also in the work with recovering people who used them to improve the quality of their sobriety. I participated in a team at the Maryland Psychiatric Research Center in Baltimore that conducted large, controlled studies of psychedelic therapy in alcoholics and hard drug addicts (Grof 1980). I have also had the opportunity to witness the effect of serial holotropic breathwork sessions on many recovering people in the context of our training. I will first share my own observations and experiences from this work and then discuss the problems involved in the larger context of the Twelve Step movement.

In my experience, it is highly unlikely that either holotropic
breathwork or psychedelic therapy can help alcoholics and addicts at the time when they are actively using. Even deep and meaningful experiences do not seem to have the power to break the chemical cycle involved. Therapeutic work with holotropic states should be introduced only after alcoholics and addicts have undergone detoxification, overcome the withdrawal symptoms, and reached sobriety. Only then can they benefit from holotropic experiences and do some deep work on the psychological problems underlying their addiction. At this point, holotropic states can be extremely useful in helping them to confront traumatic memories, process difficult emotions associated with them, and obtain valuable insights into the psychological roots of their abuse.

Holotropic experiences can also mediate the process of psychospiritual death and rebirth that is known as "hitting bottom" and represents a critical turning point in the life of many alcoholics and addicts. The experience of ego death happens here in a protected situation where it does not involve the physical, psychological, interpersonal, and social risks it would have if it happened spontaneously in the client's natural surroundings. And finally, holotropic states can mediate experiential access to profound spiritual experiences, the true object of the alcoholic's or addict's craving, and make it thus less likely that they will seek unfortunate surrogates in alcohol or narcotics.

The programs of psychedelic therapy for alcoholics and addicts conducted at the Maryland Psychiatric Research Center were very successful, in spite of the fact that the protocol limited the number of psychedelic sessions to a maximum of three. At a six-month follow-up, over one half of chronic alcoholics and one-third of hard-core narcotic drug addicts participating in these programs were still sober and were considered "essentially rehabilitated" by an independent evaluation team (Pahnke et al. 1970, Savage and McCabe 1971, Grof 1980). Recovering people in our training and workshops, almost without exception, see holotropic breathwork as a way of improving the quality of their sobriety and facilitating their psychospiritual growth.

In spite of the evidence of its beneficial effects, the use of
holotropic states in recovering people meets strong opposition among some conservative members of the Twelve Step movement. These people assert that alcoholics and addicts seeking any form of a "high" are experiencing a "relapse." They pass this judgment not only when the holotropic state involves the use of psychedelic substances, but extend it also to experiential forms of psychotherapy and even to meditation, an approach explicitly mentioned in the description of the Eleventh Step. It is likely that this extremist attitude has its roots in the history of Alcoholics Anonymous. Shortly before the second international AA convention Bill Wilson, the co-founder of AA, discovered after twenty years of sobriety the psychedelic LSD. He took it for the first time in 1956 and continued experimenting with it with a coterie of friends and acquaintances, including clergymen and psychiatrists. He was quite enthusiastic about it and believed that this substance had the ability to remove barriers, which keep us from directly experiencing God.

The AA board was shocked by his suggestion that LSD sessions should be introduced into AA program. This caused a major turmoil in the movement and was eventually rejected.
We are confronted here with two conflicting perspectives on the relationship between holotropic states and addiction. One of them sees any effort to depart from the ordinary state of consciousness as unacceptable for an addicted person and considers it a relapse. The contrary view is based on the idea that seeking a spiritual experience is a legitimate and natural tendency of every human being and that striving for transcendence is the most powerful motivating force in the psyche (Weil 1972). Addiction then is a misguided and distorted form of this effort and the most effective remedy for it is facilitating access to a genuine spiritual experience.

The future will decide which of these two approaches will be adopted by professionals and by the recovering community.

In my opinion, the most promising development in the treatment of alcoholism and drug abuse would be a marriage of the Twelve Step Program, the most effective strategy for treating alcoholism and addiction, with transpersonal psychology that can provide a solid theoretical background for spiritually grounded therapy. Responsible use of holotropic therapy would be a very logical integral part of such a comprehensive treatment.

My wife and I organized in the 1980s two meetings of the
International Transpersonal Association (ITA) in Eugene, Oregon, and Atlanta, Georgia, that demonstrated the feasibility and usefulness of bringing together the Twelve Step Programs and transpersonal psychology. The empirical and theoretical justification for such merging was discussed in several publications (Grof 1987, Grof 1993, Sparks 1993).

The concept of "spiritual emergency" is new and will undoubtedly be complemented and refined in the future. However, we have repeatedly seen that even in its present form, as defined by Christina and myself, it has been of great help to many individuals in crises of transformation. We have observed that when these conditions are treated with respect and receive appropriate support, they can result in remarkable healing, deep positive transformation, and a higher level of functioning in everyday life. This has often happened in spite of the fact that, in the present situation, the conditions for treating people in psychospiritual crises are far from ideal.

In the future, the success of this endeavor could increase
considerably, if people capable of assisting individuals in spiritual emergencies could have at their disposal a network of twenty-four-hour centers for those whose experiences are so intense that they cannot be treated on an out-patient basis. At present, the absence of such facilities and lack of support from the insurance companies for unconventional approaches to treatment represent the most serious obstacles in effective
application of the new therapeutic strategies.

* * *

Literature:
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Assagioli, R. 1976. Psychosynthesis. New York: Penguin Books.

Assagioli, R. 1977. "Self-Realization and Psychological Disturbances." Synthesis 3-4. Also in: Grof, S. and Grof, C. (eds). Spiritual Emergency: When Personal Transformation Becomes a Crisis. Los Angeles, CA: J. P. Tarcher.

Greyson, B. and Flynn, C. P. (Eds.) 1984. The Near-Death Experience: Problems, Prospects, Perspectives. Springfield, IL.: Charles C. Thomas.

Grof, C. and Grof, S.1990. The Stormy Search for the Self: A Guide to Personal Growth through Transformational Crisis. Los Angeles, CA: J. P. Tarcher.

Grof, C. 1993. The Thirst For Wholeness: Attachment, Addiction, and the Spiritual Path. San Francisco, CA: Harper.

Grof, S. 1975. Realms of the Human Unconscious: Observations from LSD Research. New York: Viking Press.

Grof, S. 1980. LSD Psychotherapy. Pomona, CA: Hunter House. (New edition: 1994, Sarasota, Fl.: MAPS Publications).

Grof, S. 1987. "Spirituality, Addiction, and Western Science." Re - Vision Journal 10:5-18.

Grof, S. 1988. The Adventure of Self-Discovery. Albany, NY: State University of New York (SUNY) Press.

Grof, S. and Grof, C. (eds.) 1989. Spiritual Emergency: When Personal Transformation Becomes a Crisis. Los Angeles, CA: J. P. Tarcher.

Grof, S. 1994. Books of the Dead. London: Thames and Hudson.

Grof, S. 2000. Psychology of the Future: Lessons from Modern Consciousness Research. Albany, NY.: State University of New York (SUNY) Press.

Grof, S. 2006 a. When the Impossible Happens: Adventures in Non- Ordinary Realities. Louisville, CO: Sounds True.

Grof, S, 2006 b. The Ultimate Journey: Consciousness and the Mystery of Death. Sarasota, FL: MAPS Publications.

Grof, S, 2007 a. "Psychology of the Future: Lessons from Modern Consciousness Research." In: Nove perspektivy v psychiatrii, psychologii, a psychoterapii. Breclav: Moravia Press.

Grof, S. 2007 b. "Holotropic Breathwork: New Perspectives in Psychotherapy and Self-Exploration." In: Nove perspektivy v psychiatrii, psychologii, a psychoterapii. Breclav: Moravia Press.

Hastings, A. 1991. With the Tongues of Men and Angels: A Study of Channeling. New York: Holt, Rinehart, and Winston.

James, W. 1961. The Varieties of Religious Experience. New York: Collier.

Jung, C. G. 1959. The Archetypes and the Collective Unconscious. Collected Works, vol. 9,1. Bollingen Series XX, Princeton, NJ.: Princeton University Press.

Jung, C. G. 1960. "Synchronicity: An Acausal Connecting Principle." Collected Works, vol. 8, Bollingen Series XX. Princeton: Princeton University Press.

Jung, C.G. 1964. Flying Saucers: A Modern Myth of Things Seen in the Skies. In: Collected Works, vol. 10. Bollingen Series XX. Princeton: Princeton University Press.

Jung, C. G. 1996. The Psychology of Kundalini Yoga: Notes on the seminars given in 1932 by C. G. Jung (Soma Shamdasani, ed.). Bollingen Series XCIX. Princeton: Princeton University Press.

Kalff, D. and Kalff, M. 2004. Sandplay: A Psychotherapeutic Approach to the Psyche. Cloverdale, CA: Temenos Press.

Klimo, J. 1998. Channeling: Investigations on Receiving Information from Paranormal Sources, Berkeley, CA: North Atlantic Books.

Lawson, A. 1984. "Perinatal Imagery In UFO Abduction Reports." Journal of Psychohistory 12:211.

Mack, J. 1994. Abductions: Human Encounters with Aliens. New York: Charles Scribner Sons.

Mack, J. 1999. Passport to the Cosmos: Human Transformation and Alien Encounters. New York: Crown Publishers.

Maslow, A. 1964. Religions, Values, and Peak Experiences. Cleveland, OH: Ohio State University.

Moody, R.A. 1975. Life After Life. New York; Bantam.
Mookerjee, A. and Khanna, M. 1977. The Tantric Way. London: Thames and Hudson.

Mookerjee, A. 1982. Kundalini: Arosual of Inner Energy. London: Thames and Hudson.

Pahnke, W. N. 1963. "Drugs and Mysticism: An Analysis of the Relationship Between Psychedelic Drugs and the Mystical Consciousness." Ph. D. Dissertation.

Pahnke, W. N. and Richards, W. E. 1966. "Implications of LSD and Experimental Mysticism." Journal of Religion and Health. 5:175.

Pahnke, W. N.. Kurland, A. A., Unger, S., Grof, S, 1970. "The Experimental Use of Psychedelic (LSD) Psychotherapy." Journal of American Medical Association (JAMA) 212:856.

Perls, F. S, 1973. Gestalt Approach and Eyewitness to Therapy. Palo Alto, CA: Science and Behavior Books.

Perry, J. W. 1953. The Self in the Psychotic Process. Dallas, TX: Spring Publications.

Perry, J. 1991. Lord of the Four Quarters: The Mythology of Kingship. New York: Holt, Rinehart, and Winston.

Perry, J. W. 1974. The Far Side of Madness. Englewood Cliffs, NJ: Prentice Hall.

Perry, J. W. 1976. Roots of Renewal in Myth and Madness. San Francisco, CA: Jossey-Bass Publications.

Perry, J. 1998. Trials of the Visionary Mind: Spiritual Emegency and the Renewal Process. Albany, NY: State University of New York (SUNY) Press.

Ring, K. 1982. Life at Death: A Scientific Investigation of the Near-Death Experience. New York: Quill.

Ring, K. 1985. Heading Toward Omega: In Search of the Meaning of the Near-Death Experience. New York: Quill.

Ring, K. and Valarino, E. E. 1998. Lessons from the Light: What We Can Learn from the Near-Death Experience. New York: Plenum Press.

Ring, K. and Cooper, S. 1999. Mindsight: Near-Death and Out-of-Body Experiences in the Blind. Palo Alto, CA: William James Center for Consciousness Studies.

Sabom, M. 1982 Recollections of Death: A Medical Investigation. New York: Harper and Row Publishers.

Sannella, L. 1987. The Kundalini Experience: Psychosis or
Transcendence? Lower Lake, CA: Integral Publishing.

Savage, C. and McCabe, L. 1971. "Psychedelic (LSD) Therapy of Drug Addiction." In: C. C. Brown and C. Savage, eds. The Drug Abuse Contrroversy. Baltimore, MD: Friends Medical Science Research Center.

Shapiro, F. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. New York: Guilford Press.

Sparks, T. 1993. The Wide Open Door: The Twelve Steps, Spiritual Tradition, and the New Psychology. Center City, MN : Hazelden Educational Materials.

Weil, A. 1972. The Natural Mind: An Investigation of Drugs and the Higher Consciousness. Boston, MA: Houghton Mifflin Company.

Wilber, K. 1977. The Spectrum of Consciousness. Wheaton, IL: Theosophical Publishing House.

Wilson, W. and Jung, C. G. 1963. Letters republished in: Grof, S. (ed.): Mystical Quest, Attachment, and Addiction. Special edition of the Re -Vision Journal 10 (2):1987.

Woodruff, Sir John (Arthur Avalon). 1974. Serpent Power: The Secrets of Tantric and Shaktic Yoga. New York: Dover Publications.

Dr. Rick Doblin - MAPS

2009-08-11T02:24:00.000-07:00

Psychedelic Science

2009-08-11T02:15:00.000-07:00

LSD's psychological effects (colloquially called a "trip") vary greatly from person to person, depending on factors such as previous experiences, state of mind and environment, as well as dose strength. They also vary from one trip to another, and even as time passes during a single trip. An LSD trip can have long term psychoemotional effects; some users cite the LSD experience as causing significant changes in their personality and life perspective. Widely different effects emerge based on what has been called set and setting; the "set" being the general mindset of the user, and the "setting" being the physical and social environment in which the drug's effects are experienced.

Timothy Leary and Richard Alpert considered the chemical to be of potentially beneficial application in psychotherapy. If the user is in a hostile or otherwise unsettling environment, or is not mentally prepared for the powerful distortions in perception and thought that the drug causes, effects are more likely to be unpleasant than if he or she is in a comfortable environment and has a relaxed, balanced and open mindset.

Some psychological effects may include an experience of radiant colors, objects and surfaces appearing to ripple or "breathe," colored patterns behind the eyes, a sense of time distorting (time seems to be stretching, repeating itself, changing speed or stopping), crawling geometric patterns overlaying walls and other objects, morphing objects, a sense that one's thoughts are spiraling into themselves, loss of a sense of identity or the ego (known as "ego death"), and powerful, and sometimes brutal, psycho-physical reactions interpreted by some users as reliving their own birth.[9][40]

Many users experience a dissolution between themselves and the "outside world".[41] This unitive quality may play a role in the spiritual and religious aspects of LSD. The drug sometimes leads to disintegration or restructuring of the user's historical personality and creates a mental state that some users report allows them to have more choice regarding the nature of their own personality.

Some experts hypothesize that drugs such as LSD may be useful in psychotherapy, especially when the patient is unable to "unblock" repressed subconscious material through other psychotherapeutic methods,[42] and also for treating alcoholism. One study concluded, "The root of the therapeutic value of the LSD experience is its potential for producing self-acceptance and self-surrender,"[43] presumably by forcing the user to face issues and problems in that individual's psyche. Many believe that, in contrast, other drugs (such as alcohol, heroin, and cocaine) which are used to escape from reality, LSD is seen as more of an introspective experience. Studies in the 1950s that used LSD to treat alcoholism professed a 50% success rate,[44] five times higher than estimates near 10% for Alcoholics Anonymous.[45]

Some LSD studies were criticized for methodological flaws, and different groups had inconsistent results. Mangini's 1998 paper reviewed this history. She concluded that the efficacy of LSD in treating alcoholism remains an open question.[46] Dr Abram Hoffer referred to Mangini's paper as "a good review of the literature" but said that, in common with many other scientists, the author has failed to grasp the important point that psychedelic therapy is a therapeutic experience.

The critics of psychedelic therapy have not taken this into account. Thus the Toronto studies studied the drug. They made no attempt whatever to induce a psychedelic experience. I saw at least two of the patients many years after they had been treated in Toronto and they told me that it was the most horrible experience they had ever had. It was in fact a true psychotomimetic experience and probably reproduced delirium tremens more than anything else. Not surprisingly their patients did not do well. They gave them 800 micrograms which is too heavy, gave them a barbiturate in advance to prevent convulsions, tied them to the bed so that they could not run away, and had sitting with them a psychologist who wrote notes all the time and did not interact with the patients.

With $1.4M Grant From NIH, LSUHSC's Nichols To Use LSD And Fruit Flies To Identify Novel Genes For Psychosis/Schizophrenia

2009-08-11T01:05:00.000-07:00

With $1.4M Grant From NIH, LSUHSC's Nichols To Use LSD And Fruit Flies To Identify Novel Genes For Psychosis/Schizophrenia

22 July 2009

Charles Nichols, PhD, Assistant Professor of Pharmacology at LSU Health Sciences Center New Orleans, has been awarded a grant in the amount of $1.4 million over four years by the National Institutes of Health's National Institute of Mental Health to find and characterize novel genes involved in psychosis and schizophrenia, using novel research methods. Dr. Nichols' approach is innovative, combining discovery studies with functional and behavioral studies in two different models to determine how mental disorders like psychosis and schizophrenia develop. By studying both a new rodent model of psychosis that he is co-developing, which involves treating rats with the powerful hallucinogenic drug lysergic acid diethylamid (LSD), and the fruit fly, Drosophila melanogaster, analysis of gene function relative to whole animal behavior can be accomplished more rapidly than with traditional rodent models alone. "We believe that changes in gene function, influenced by abnormal activity in specific regions of the brain regulated by the neurotransmitter serotonin, contribute to neuropsychiatric disorders. The effects of LSD can be very similar to aspects of psychosis in people, but no one really understands how LSD works other than it changes how serotonin functions in the brain," notes Dr. Nichols. In preliminary studies, Dr. Nichols has shown that, remarkably, both serotonin and hallucinogenic drugs like LSD influence many complex behaviors in the fly directly relevant to those that are abnormal in humans with psychosis and schizophrenia, including aggression, learning and memory, social interaction, and sensory perception. The LSUHSC research team will probe specific regions of rat brains that correspond to key cognitive centers of the human brain using advanced genomic and proteomic methods to identify abnormally functioning genes and proteins. Additional studies will translate these results to the fruit fly, where the functional role of both the native and mutant forms of the fly version of these genes and proteins will be examined in behaviors relevant to psychosis. Genes and proteins that are abnormally turned on or off by LSD in the rat brain, and found to participate in causing relevant behaviors in the fruit fly, may represent novel therapeutic targets for neuropsychiatric disorders. Schizophrenia is a debilitating neuropsychiatric disorder that affects about one out of every 100 Americans, and mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a 2008 study funded by the National Institute of Mental Health. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings. While treatments are improving, there are still people who do not respond or only partially respond. "Our results may lead to new avenues for therapeutics to treat such devastating diseases as schizophrenia and psychosis," says Dr. Nichols.

Source: Leslie Capo Louisiana State University Health Sciences Center

Effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in Santo Daime members

2009-08-11T01:03:00.000-07:00

Effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in Santo Daime members.

Bia Labate• Mar 10th, 2008 •
J Ethnopharmacol. 2007 Jul 25;112(3):507-13. Epub 2007 Apr 25Santos RG, Landeira-Fernandez J, Strassman RJ, Motta V, Cruz AP.
Departamento de Processos Psicológicos Básicos, Instituto de Psicologia, Universidade de Brasília, Asa Norte, Brasília-DF 70910-900, Brazil.

The use of the hallucinogenic brew ayahuasca, obtained from infusing the shredded stalk of the malpighiaceous plant Banisteriopsis caapi with the leaves of other plants such as Psychotria viridis, is growing in urban centers of Europe, South and North America in the last several decades. Despite this diffusion, little is known about its effects on emotional states. The present study investigated the effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in members of the Santo Daime, an ayahuasca-using religion. Standard questionnaires were used to evaluate state-anxiety (STAI-state), trait-anxiety (STAI-trait), panic-like (ASI-R) and hopelessness (BHS) in participants that ingested ayahuasca for at least 10 consecutive years. The study was done in the Santo Daime church, where the questionnaires were administered 1h after the ingestion of the brew, in a double-blind, placebo-controlled procedure. While under the acute effects of ayahuasca, participants scored lower on the scales for panic and hopelessness related states. Ayahuasca ingestion did not modify state- or trait-anxiety. The results are discussed in terms of the possible use of ayahuasca in alleviating signs of hopelessness and panic-like related symptoms.

PMID: 17532158 [PubMed - indexed for MEDLINE]

The complete PDFhttp://www.maps.org/w3pb/new/2007/2007_Santos_22932_1.pdf

Ayahuasca, Neurogenesis and Depression

2009-08-11T00:57:00.001-07:00

Ayahuasca, Neurogenesis and Depression

Daniel Mirante • May 4th, 2008 •

Recent scientific research suggests that neurogenesis – the growth of new brain cells – is a key to curing depression.
People suffering depression have an enlarged amygdala, a structure deep in the brain, which produces amongst other things stress hormones. An enlarged, overactive amygdala may produce too much cortizol, a fight-or-flight stress hormone. Too much cortizol can whittle away neural structures - especially in the hippocampus which is the cortizol shut off valve. In depressed people, this structure can be 15% smaller than the statistical average.
With the hippocampus function reduced and the amygdala enlarged and in overdrive, a damaging positive feedback loop gets established and eventually other neural structures such as the prefrontal cortex get damaged - the dentrites (the connections) get sheared away, leading to a tragic reduction of the full potential of a person.
Thus, depression is both a somatic and psychologically self-reinforcing cycle that requires intervention on several levels. The commonly persued course of action is via anti-depressants such as SSRI’s which increase serotonin.
The old theory for administering selective serotonin reuptake Inhibitors is that the brain is suffering from a lack of available serotonin, and that Prozac and other drugs in its class help by increasing the amount of serotonin circulating in the brain by reducing their uptake. However, it is well known such drugs take weeks to take effect, despite the fact that serotonin levels are boosted straight away.
Scientists are discovering that the mechanism is a lot more complicated than a simple lack of serotonin, but is rather enmeshed in the damage rendered by cortizol and related stress hormones, and impeded function of the hippocampus.
Serotonin can promote neurogenesis, the birth of new brain cells, and Prozac seems to work by promoting neurogenesis in the hippocampus. And not only SSRIs, but other antidepression treatments affect a type of protein that is involved in neurogenesis. It is established that SSRI’s help to increase levels of brain-derived neurotrophic factor (BDNF) in the hippocampus. A neurotrophic factor is a protein, such as nerve growth factor, that promotes nerve cell growth and survival.
BDNF is a growth, sustainer and protector factor in the brain ; a neurogenesis hormone. Antidepressants apparently help keep hippocampal cells alive by boosting BDNF levels, inducing neurogenesis. Raising serotonin ups a protein known as CREB inside nerve cells, which also give rise to neurogenesis. This means that SSRI’s help to regenerate the hippocampus thus keeping the amygdala in balance.
This path of action restores the neurological balance which contributes (or else, determines) a healthy emotional life.
Banisteriopsis caapi, the Ayahuaca vine, is regarded by many that use it as an antidepressant. The mono-amine oxidase inhibiting beta-carbolines in the vine reduce the clearing of serotonin from the synaptic cleft : i.e MAOI is another angle from which serotonin can be boosted, which qualifies the use of MAOI in the treatment of depression back in the mid twentieth century.
It has been indicated that one of the constituents of the vine, THH, actually causes an increase in the density of platelet serotonin uptake sites in long-term users. It is likely that the increase of density of serotonin uptake sites in longterm users be an adaption to more monoamines in the system. . Increases in serotonin transporters could well be an adaptation to increased serotonin levels caused by MAO inhibition.
The additional power of Ayahuasca over commonly prescribed SSRI’s is that it allows people to experientially approach the early causal factors to their depression and work to symbolically resolve them, and cathart the primal pain and energies bound up in those repressed early experiences. After all, whilst we can address the run-away neurological consequences of deep trauma or chronic stress, the experiential gestalts themselves must be catharted and integrated. Ayahuasca allows conscious realization of how those experiences effect ones constitution and patterns of behaviour, giving beneficial insights into how the effects of the damaging influences on ones life can be greatly negated by changes of attitude and lifestyle.

Blending Traditions - Using Indigenous Medicinal Knowledge to Treat Drug Addiction

2009-08-11T00:49:00.000-07:00

Blending Traditions - Using Indigenous Medicinal Knowledge to Treat Drug Addiction

Jul 18th, 2009 •

By Jacques Mabit, M.D.

Abstract
Ancestral medical practices are based on a highly sophisticated practicalknowledge and view the controlled induction of non-ordinary states ofconsciousness as potentially beneficial, even in the treatment of themodern phenomena of drug addiction. These ancestral practices stand incontrast to the clumsiness with which Western peoples induce alteredstates of consciousness. Drawing from his clinical experience in the HighPeruvian Amazonian forest, the author describes the therapeutic benefitsof the wise use of medicinal plants, including non-addictive psychoactivepreparations, such as the well-known Ayahuasca tea. Within aninstitutional structure, a therapeutic system combining indigenouspractices with contemporary psychotherapy yields highly encouragingresults (positive in 2/3 of the patients). This invites us to reconsiderconventional approaches to drug addiction and the role of the individual’sspiritual journey in recovery.

The Backwards Approach

Moving beyond the strict position that the final objective of drugaddiction therapy is complete abstinence, the Western world has respondedto its failures and limitations by considering the possibility of merelyreducing risks. The notion of substitution, as in methadone therapy forheroin addiction, indicates a certain tolerance towards altered states ofconsciousness. In this model, which treats these states as “inevitable” insome sense, one would now be satisfied with limiting their negativesecondary effects. In the face of a Puritanism resigned to an almostconstant failure, this attitude opens new possibilities in treating drugaddiction. It now seems thinkable that drug addiction is an attempt,certainly clumsy and sometimes extremely dangerous, of self-medication.Users may be responding to a real need to escape the constricting mud of adry and devitalized lifestyle, one lacking exciting perspectives or roomto blossom.
Some take this new tolerance of drug use further, for example by proposingto ravers that they learn about the drugs they consume, the risks thatthey run, and the best way to avoid the negative consequences of theirconduct3. In this model, the drug user is considered a thinking andconsenting subject, who is invited to take responsibility for his actions.The “repressive machine” that tends to substitute itself for the subject,making his decisions, revoking his responsibility, and, in the end,reinforcing an internal pattern of dependence, gives way to an approachwhich appeals to the user’s intelligence. This model accepts theauthenticity of the user’s quest, even if it is often unconscious, for atrue liberty that can be confused with caprice.
While this attempt at finding meaning by exploring new realms ofconsciousness can be chaotic and confused outside of a controlled setting,it is reminiscent of more purposeful undertakings among traditionalpeoples. In fact, one finds the induction of altered states ofconsciousness for the purposes of initiation and therapy in alltraditions. Such experiences, always guided by a ritual frame, oftendepend upon a fine understanding of the animal and vegetable substancesthat serve as their catalysts. One may also affirm that, sometimes, thesame substances that serve as the “remedy” in indigenous cultures are the“poison” in Western society. Hence the coca leaf, which is well integratedinto daily life in the Andean world, becomes a highly addictivecocaine-based paste when taken out of context. Similarly, cannabis, poppy,and tobacco may generate either remedy or poison according to the mode ofconsumption and the context of ingestion.
It is noteworthy that biologists observe that all animal species consumenatural psychoactive substances with great eagerness when possible(Siegel, Ronald, 1990). In fact, Siegel considers this conduct a fourthinstinctual instance of animal biology, as if life tends spontaneouslytowards a broadening of perceptions and a concomitant amplification ofconsciousness. It becomes difficult, then, to extract man from this vastbiological movement that embraces all animal life.
Indigenous Knowledge

Our observations in the Peruvian Amazon yield a supplementary fact: notonly do the natural psychoactive substances used by indigenous peoples notgenerate dependence, they are utilized to treat the modern phenomenon ofdrug addiction. This changes the way we understand toxicity; the Westernobsession with “substances” (drugs) is replaced, or at least accompaniedby, the concepts of the set (the subject, including geneticpredispositions, life history, and preparation) and setting (ritualized ornot). Indeed, psychoactive substances may be a treatment for “drugaddicts,” a fact that still seems paradoxical or impossible even to thespecialists in question. And yet, the facts speak for themselves.
This phenomenon also works for ethnic groups strongly affected bysubstances such as alcohol, which represents for them, inversely, animported product removed from its context. Hence, the healers of thePeruvian coast treat their alcoholics through the ritual use of themescaline cactus with a high rate of success (around 60 per cent, afterfive years) (Chiappe, Mario, 1976). The Native North Americans reduce theincidence of alcoholism on their reservations considerably and quiterapidly by reviving their ancestral practices, including the ritual use ofpeyote and tobacco (Hodgson, Maggi, 1997).

The ritualization of induced modifications of consciousness, with orwithout substances, establishes a universal symbolic frame within whichthese experiences acquire significance by allowing the individual toinscribe himself within a model of cultural integration. In indigenousgroups, then, such experiences frequently accompany rites of passage,particularly at adolescence, permitting the youth’s appropriation of thediscourse, images, and myths generated by the community. It is evidentthat the fundamental lack of cultural consensus in our fragmentedpost-modern society, along with the desacralization of the lived interiorand exterior, and the disappearance of all authentic rites of passage,leaves us without the means to integrate experiences of altered states ofconsciousness into our daily lives. In other words, the drug user sets offrandomly with neither compass nor map, often finishing badly.
These considerations lead to the following conclusion: not only must we nolonger take a position of passive tolerance toward an inevitableconsumption of psychoactive substances, but, on the contrary, we mustactively explore the coherent therapeutic use of psychoactive substanceswithout the outcome of dependence. Even more broadly, we must be open toevery induction of altered states of consciousness through diverse methods(such as music, dance, fasting, isolation, breathwork, physical exercise,pain, etc.) This calls for the application of therapeutic techniques thatcreate both a space of temporary containment and an authentic symbolicframe which, as in the indigenous ritual space, integrates therapists andusers. Traditional peoples also teach us that substances consumed in theirnatural form, used with respect to the body’s digestive natural barriers(that is, orally), do not induce dependence, in spite of their powerfulpsychoactive effects. The risk of toxicity is also lower because theiractive principles are similar, if not identical, to the neuromediatorsnaturally secreted by our bodies. In case of overdose (which is generallydifficult to produce given the extremely disagreeable flavor of thebeverages), these substances are eliminated naturally by vomiting. Thisself-regulating phenomenon provides for safe prescription and is anintegral part of the expected effects of ingestion, as well as those ofpurgation-detoxification (hence their special role in the domain of drugaddictions). The context of ingestion requires rigorous dietary, postural,and sexual regulations. In the course of successive ingestions,sensitivity increases instead of creating a habit. As a result, the dosesgradually decrease: their use in addiction therapy is not, then, a simplesubstitution.

It is remarkable that no visionary natural substance is addictive. Visionsseem to be the proof of sufficient cortical integration, of ametabolization of the symbolic charge revealed during the experience ofaltered consciousness. Entheogenic substances (also misnamedhallucinogens) are hence among the best of those that may be used in atherapeutic setting. This has already been attempted in psychotherapy(LSD, MDMA, Harmaline, DMT, etc.), but generally without an integratingsymbolic framework (or ritual space), without engaging the therapist inthe method, with synthetic or semi-synthetic substances or extracts, andthrough processes of assimilation that violate physiological barriers(i.e., injections).

Ayahuasca

This highly psychoactive ancestral beverage is situated at the heart ofboth the empirical medicinal practices of Amazonian cultures and,recently, of explorations into the therapeutic potential of medicinalplants, in particular in the domain of psychopathology, including drugaddiction therapy. The pharmacological sophistication of this preparationreflects the high degree of understanding of the Amazonian peoples, whoare proven to have discovered Monoamine Oxidase Inhibitors (MAOIs) atleast three thousand years before Westerners. Tryptamines andbeta-Carbolines, the major active principles of Ayahuasca, are present inmany natural secretions as well as in the central nervous system (pinealgland) (Mabit, Campos, Arce, 1993).
The entheogenic or visionary effects of this beverage have been hastilycalled “hallucinogenic,” stigmatizing a compound which could be asignificant topic of research. Its potential as such risks being dismissedby the academic community due to a stance less indebted to scientificrationality than to society’s collective fears. We have argued that theimages stimulated by the use of Ayahuasca in a therapeutic contextsymbolically manifest the content of the unconscious. Moreover, theseimages are not without an object, whether it be psychological orotherwise, which differentiates them completely from the “illusionswithout object” that are by definition “hallucinations” (Mabit, 1988). Theexploration of the unconscious through Ayahuasca permits the rapidextraction of extremely rich and highly coherent psychological material,which can then be worked through with various psychotherapeutic methods.Visions, like dreams, indicate the beginning of an integration at thesuperior cortical level. The effects of Ayahuasca are not merely visual,but embrace the entire perceptual spectrum, as well as the non-rationalfunctions tied to the right brain and to the paleoencephal or so-calledreptilian brain. The patient’s clinical experience fosters the developmentof not only the projective but also the integrative functions ofsymbolization, enabling the progressive readjustment of personalitystructures. These explorations touch cross-cultural psychological depthsand, hence, may be applied in extremely broad and varied contexts of humanlife.

After the observation for fifteen years of more than eight thousandinstances of Ayahuasca ingestion under specific conditions of preparation,prescription, and therapeutic follow-up, we can affirm that the ingestionof these preparations has a wide range of indications, with a totalabsence of dependence. The expansion of the perceptual spectrum, whichsimultaneously engages body, sensations, and thoughts, permits thede-focalization of the ordinary perception of reality, thus allowing thesubject to confront his habitual problems on his own and from a new angle.The intense acceleration of cognitive processes which accompanies thisprocess may permit the subject to conceive of original solutions that fithis unique personality and situation.

The Center: A Pilot Project

Our ignorance in regard to the controlled induction of altered states ofconsciousness could greatly benefit from ancestral medical knowledge. Themaster healers of various traditions are ready to transmit their heritageto those willing to learn and to embark upon a path of initiation. Sixyears of teaching beside Amazonian healers has led us to develop atherapeutic method using the controlled modification of states ofconsciousness. Our system is based on ancestral techniques involvingmedicinal plants and natural methods of detoxification, sensorystimulation, and sensory deprivation. This pilot project attempts tocombine ancestral knowledge with contemporary psychotherapeutic practices,working under the guidelines of ethical considerations and therequirements of the Western mentality.
The program, in which no method of coercion is exercised, accepts groupsof no more than fifteen voluntary patients. The location is a five acrepark bordered by a river, just outside the city of Tarapoto, in thePeruvian High Amazon, in the piedmont of the Andes (Mabit, Giove, Vega,1996).
The therapy is based on a three-part method which includes the use of theplants, psychotherapy, and community life. The guided experiences ofaltered consciousness generate psychological material which issubsequently discussed and evaluated in the psychotherapy workshops andthen directed towards expression in community life. In reverse, everydayactivities supplement the therapeutic sessions (with or without plants).
The initial use of purifying, sedative, and purgative plants reduceswithdrawal syndromes, rendering any return to prescription medicationduring the stay unnecessary. Then, the psychoactive plants intervene,powerfully facilitating the psychotherapy. From the brief sessions to theeight day isolation in the forest with rigorous rules pertaining to food,sex, external contacts and daily activities, each ingestion ofpsychoactive plants is governed by specific conditions. Each session isalso facilitated by a trained therapist, and clearly inscribed into aprecise and rigorous symbolic frame, which improves the chance of successfor the session and its subsequent integration into the subject’s life.

These techniques permit the exploration of buried memories and there-emergence of censured situations or events. These “revelations” bothrelieve the addict’s conscience and motivate him to face his sickness. Atemporary reduction of critical functions and discriminations facilitatesthe cathartic expression of emotions. These experiences, with the help ofpsychotherapeutic work, may then correct the defective formation of thesubject’s emotional expressions and ideals. By plunging under the veils ofordinary consciousness and unblocking the paths of access to the deep Ego,this exploration of the subject’s interior universe brings out richmaterial, in contrast to these patients’ often insufficient symbolization.During the subsequent sessions, the subject will learn to translate and tointerpret this material in order to explore subsequent dreams on his own.Dream life is stimulated by these practices, also benefiting the patient.One also observes an acceleration of cognitive processes and anamplification of the attention-span and of the depth of mentalconcentration. The clearly defined context, supplemented by a carefullyregulated lifestyle, invites the resident to implement the knowledgeobtained by this work. Hence, the space constitutes a laboratory in whichthe residents are at once the observers and the subjects of theirobservation. The medicinal plants play the central psychotherapeutic role,while caretakers offer guidance and security. The users are guided intoliminal, or symbolically transitional, experiences in which they visittheir interior gods and demons. These experiences simultaneously involvethe subject’s psychological state, the whole range of emotionalsensations, and the spectrum of his psychological perceptions. In theseexperiences, existential questions may come to light and demand an engagedresponse. The guided and cathartic process can help the individual totranscend his or her ordinary mindset and access somatic memories. In thebest cases, the individual is able to transcend the Ego, which can allow ahealthy deflation of the Ego, a reconciliation with human nature, and anacceptance of our modest inscription in time and in matter, which isnevertheless exciting because of its perceived meaning. In other words,this is a process of initiation; it is a semantic experience which carriesmeaning that can respond to the chaotic and disorderly quest of the drugaddict, which may be seen as a path of counter-initiation or as a savageinitiation (Mabit, 1993). This therapeutic method does not, then, simplyfocus on abstinence, but also offers an adequate alternative. Thisalternative method, which respects altered states of consciousness, isable to respond to the drug addict’s quest by furnishing it with clearends and with non-dangerous means to reach them. This process supposes aninternal structural change which goes beyond the palliative of a simpleexternal behavioral change, which is never totally satisfying and mostoften ineffective.

The duration of the stay is, in general, nine months, and the follow-up isideally two years. The centre has received patients of all social andcultural origins. The techniques, which mainly demand self-explorationthrough the senses, do not require any analytic verbalization orintegration, which represents an enormous therapeutic advantage. One mayeven say that these experiences of altered consciousness give access toineffable, inexpressible trans-verbal spaces, which are as muchpre-logical or infra-verbal as they are ecstatic or supra-verbal. Here,the local alcoholic peasant meets the European college student dependenton pot, the urban bourgeois who functions on cocaine, the dealer addictedto a cocaine-based paste, or the delinquent pathological liar who smokescrack. To the contrary of what certain theorists say, the exploration ofthe interior universe by these methods does not require that either thetherapist or the subject belong to the native culture of these practices.Rather, these practices give access to personal intra-psychical symbolswhich remain coherent to the subject and which touch depths that could becalled transcultural by virtue of reaching universal psychologicalcomplexes (love, hate, rejection, abandon, fear, peace, etc.). At the sametime, the accompanying psychotherapy allows the patient to betterunderstand the experience of the session, to integrate it, generate newquestions, and enrich the following session. We have now mastered thesetechniques ourselves, and we make use of them with patients from culturesother than our own. They are accessible to any Western therapist willingto fulfill the requirements of their long apprenticeship.
Results

Since its founding in 1992, the center has received more than 380patients. One study has just been made (Glove, not yet published) of thefirst seven years of activity (1992-1998), examining drug addicts oralcoholics having completed at least one month of treatment and with atleast two years of time out of the clinic - a sample of 211 courses oftreatment (175 first-time patients and 36 returning patients). Note thatthe results of this study do not include data on the 32% of patients wholeave during the first month before the first ayahuasca session, when thetreatment is not yet considered to have started. 28% reached the sixthmonth of treatment, and 23.4% finished the entire treatment.
Two-thirds of the patients consumed mainly a highly addictive anddebilitating cocaine-based paste. 80% consumed alcohol alone or inaddition to other drugs. More than half of the patients (53.5%) hadalready tried treatment, one-third of which had tried psychiatricservices. For 49%, the gateway drug was alcohol, and for 42%, cannabis.The average age was thirty years and the average duration of consumptionof psychoactive substances at the time of entrance was 12.5 years. At31.3%, with a tendency to augmentation, the index of retention (percentageof prescribed exits out of total exits) gives proof of the relativeacceptance of this therapeutic method. The voluntary exits make up themajority (52%) compared to prescribed exits (23%), runaways (23%), and therare expulsions (3%).

The evaluation of the results integrates qualitative givens, as well asthe incidence of abstinence or relapse due to poor prognostic criteria.One should note that the patients leave free of any post-residentialmedication. In addition to evaluating the relation to addictivesubstances, especially those that the subject consumed before, we considerpersonal evolution (internal structural change), the indications of socialand professional reintegration, and the capacity for familialrestructuring. According to these criteria, we may distinguish threecategories:

* “good”: favorable development, problems apparently resolved thanksto a true structural change manifested upon several life levels.

* “better”: favorable development with evident structural changes, butvestiges of the original problem still present.

* “same or bad”: relapse of consumption of substances, although oftenmore discrete, no convincing structural change, frequent abandonmentof substances for alcohol.

Out of the total, then, 31% were “good” and 23% “better,” while 23% werethe “same or bad” and 23% unknown. With hindsight, we can affirm thatabout 35% of those who have lost contact with the Center are, in the end,“good” or “better” (that’s 8% of the total), which means that about 62% ofthe patients have, in the end, positively benefited from the follow-up ofthe model proposed at the center. When one only takes into account thesample of the patients with “prescribed exit,” (those who have completedthe entire program) the positive results are raised to 67%.

When the patients relapse or simply re-offend, 55.5% return to the centerand 26% find other local practitioners of traditional medicine, whichdemonstrates their high opinion of this approach. When this occurs,purgative plants are more solicited than psychoactive plants. This choicedemonstrates the absence of dependence on the psychoactive substances.
This method, officially recognized by the Peruvian authorities, hasexpanded into a number of programs including educational programs (forstudents), psychiatric and anthropological research, and outreach (writtenand audio-visual media, and seminars for personal development).

Conclusion

The mere repression of drug consumption represents a simplistic approachto the problem, with demonstrated ineffectiveness as a therapy. We maywell call it illogical and even immoral since it omits the substances thatare currently the most deadly (alcohol and tobacco). In addition, theaccelerated development of new substances on the market outstrips anyrepressive attempt at control and relegates the game of penalinterdictions to failure. We are hence condemned to approach the problemunder another angle, whether we want to or not. Similarly, if harmreduction and substitution only indicate proof of failure and a last-ditcheffort of pure social convenience, they are also, in our view,reprehensible and morally dubitable. This is because they consecrate atacit rejection of healing, and the officialization, in a manner ofspeaking, of a population of second class citizens tolerated for lack of atherapeutic alternative.
The high degree of diffusion of the drug phenomenon in the 50’s and 60’swas born of the contact between a few intellectuals with traditionalpeoples, and, in particular, of North Americans with Amazonian Indians(Ginsberg, Leary, Alpert, etc., — see Leary, Metzner, Alpert, 1964).These intellectuals believed that they could appropriate ancestralknowledge while only retaining the physical substance, reducing “theapproach of the gods” to the consumption of an active principle, playingneurochemists like apprentice sorcerers (see Leary’s delirious work,1979). This oversimplified view of substances and their potential hasgenerated a terrible drama. The phenomenon of substance addiction ischaracteristic of Westernized societies and continues to be practicallyunknown in indigenous populations or among peoples free from prolongedWestern influence.

By approaching this ancient knowledge with respect and careful study, itseems possible to reinstate an authentic relation with the Mystery of Lifeby returning to true paths of initiation. By validating the legitimatequest of the drug user and redirecting it into a structured, meaningfulexperience, perhaps we may avoid the lax defeatism of the “anything goes”attitude as well as the rigid and useless bellicosity of “everything isforbidden.”

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