Attenuation and anticipation: A therapeutic use of lysergic acid diethylamide

This open-label clinical study (n=128) investigated whether LSD (100μg) can alleviate death-anxiety in terminally ill patients by decreasing the anticipation of their illness, and found that the administration of LSD was universally well tolerated. Specific effects included a general lift of mood that lasted for 11-12 hours, acute pain relief that lasted 12 hours, decreased the total pain intensity for 3 weeks, and diminished concern over the anticipation of death for up to 3 days after administration.

Abstract

Introduction: Theoretical reasons for the use of LSD as an analgesic agent are elaborated. Two characteristics of the LSD experience which are of possible therapeutic use in situations where anticipation is of less use than in ordinary life: (1) the loss of the ability to anticipate, through the lessening of the power of words, and (2) the expansion of the immediate sensory life.

Method: Only one-dose administrations of LSD were undertaken in this study of 128 patients. All were informed of their diagnosis and were pre-terminal, meaning that death could be foreseen within
one to two months. The following observations were conducted: (1) Pain intensity, (2) Affective changes, (3) Approach to illness and death, (4) Sleep patterns, (5) Visual disturbances and hallucinations, (6) Fear and panic reaction.

Results: (1) A precipitous drop in pain occurred about 2-3 hours after LSD administration. This pain relief lasted 12 hours, but the total pain intensity was less for a protracted period (3 weeks). (2) There was a general lift of mood, almost euphoria, which lasted for about 11-12 hours, after which time the mood fell to its original level. (3) Under LSD, patients were so strikingly unconcerned about death ,or any other anticipatory concern that this seemed important. Rather often definite evidence of depression (like somatization or nagging attitudes by patients) associated with an air of unconcernedness was encountered. The patient was able to state that death was near, that the situation was hopeless, but felt that this did not matter. (4) The first night [of sleep] after LSD administration was almost invariably a good one. After that a meaningful reduction of disturbances up to .about 10 nights was noted, which is also the time when concern about the morbid condition returned. (5) At the height of the LSD reaction less than 10% of the patients ‘had actual hallucinations, while about 55% (75 patients) confessed to visual distortions. (6) Seven patients had panic, while 42 suffered mild anxiety reactions. None of the reactions was of sufficiently severe character to terminate the LSD reaction. All were amenable to psychotherapy.

Discussion: In a series of 128 patients the analgesic action of LSD is further confirmed, and the undesirable pharmacologic effects are discussed. The relative safety of the drug for that use is demonstrated, and further study is recommended.”

Authors: Eric Kast

Summary

LSD has profound and incisive impact on the mental and autonomic apparatus of human beings, and has aroused widespread interest in various fields. This study explores the therapeutic possibilities of LSD in the treatment of the painful terminal stages of serious disease.

The ability to anticipate is an extremely useful genetic development for human survival and dominance, but can also diminish the security and peace of patients. Pharmacologic help may be sought to reduce anticipation in situations where it can offer nothing to the welfare of the patient.

LSD causes the individual to lose the resonance of words, and to lose the ability to anticipate danger. The individual resembles a pre-verbal infant, who flutters from one pleasureful experience or fantasy to another, oblivious of consequence.

Modern western civilization depends on anticipation for orientation, defense, and procurement of food. In a desperate situation, the individual no longer needs anticipation for survival.

Thoughts, fantasies, and sensory input can resonate in the central nervous system along channels created by past experience. The “naming” of the experience can diminish this psychic resonance.

LSD has two characteristics that make it useful in situations where anticipation is less useful than in ordinary life: (1) the loss of the ability to anticipate, and (2) the expansion of the immediate sensory life.

LSD may have analgesic potential because it reduces the patient’s ability to concentrate on one specific sensory input, diminishes cortical control of thoughts, and obliterates the individual’s ego boundaries.

The Pare affect is the fundamental tension between the desire to distance oneself from the ailing part and the desire to remain whole. Pathologic pain can produce a specially unbearable tension, which is exacerbated by the psychic resonance of its inevitability.

Animals in a Skinner box will first behave like a patient with renal colic, but after a certain time interval they will become quiet and will display inhibited behavior. This behavior resembles that of a patient ha chronic pain due to metastatic malignant disease.

LSD reduces the impact of words on behavior, by diminishing the impact of anticipatory ability and reducing the survival content of immediate sensory input.

Methodology

In this study, 128 patients were given one dose of LSD. All were pre-terminal and suffered from malignant diseases with metastases.

The patients were observed daily by the same two observers, and a relationship was established with them. LSD was administered following breakfast to patients whose conditions permitted.

Diagnosis: CA of Breast with Metasteses CA of Cervix with Metasteses Carcinomatosis CA of Digestive Tract

Six patients died after one week of observation. The following observations were conducted: pain intensity, affective changes, approach to illness and death, sleep patterns, visual disturbances, fear and panic reaction.

A study of LSD cannot be conducted double-blind because the patients become immediately aware that something incisive has happened to them.

Results

About 30% of the patients said they would be unwilling to repeat the administration of LSD, and this percentage could not be lowered by co-administration of other psychotropic drugs. The reason for this increase in distress may have been due to the increased sensitivity of the patient to additional sensory input.

The pain of the patients was assessed by their statement, the observer’s opinion, their behavioral characteristics, and the opinion of the ward personnel. The pain relief lasted 12 hours, but the total pain intensity was less for a protracted period (3 weeks).

Patients with depression showed various symptoms, including soznatiations, a nagging attitude towards the ward personnel, motor hypo-ov hyperactivity, general lethargy, crying and discussions of hopelessness and doom. A cumulative index was calculated by numerically adding the degrees of depression.

A patient’s approach to illness and death was classified as rather unconcerned (0), concerned (1), or very concerned (2). A separate score was developed for patients who were strikingly unconcerned (0) about death or any other anticipatory concern.

The first night after LSD administration was almost invariably a good one, and after that a meaningful reduction of dis-urbanees up to about 10 nights was noted. The last two parameters concern aspects of the LSD reaction itself, namely the most disturbing and potentially alarming ones.

Seven patients suffered severe panic, while 42 suffered mild anxiety reactions. All were amenable to psychotherapy, which consisted of urging the patient not to fight the panic, not to atteml)t to maintain the control of his “reason,” but to engage in the experience and to surrender to whatever the LSD reaction might bring.

The fear of surrendering to sensory input is a response to the patient’s attempt to control the input, and the fear is increased by any attempt to maintain his defenses against submission.

LSD was well tolerated by all patients, even those who were critically ill. The therapist should encourage the patient to surrender to the experience and not emphasize the reality of the situation.

Summary and Conclusions

The theoretical reasons for the use of LSD as an analgesic are elaborated, and the undesirable pharmacologic effects are discussed.