LSD-assisted psychotherapy and the human encounter with death

This early study (1972; n=31) on LSD-assisted psychotherapy (200-500µg) showed the promise of using psychedelics in combination with therapy. The participants of the study were diagnosed with cancer and received therapy/preparation before (10 hours) and after (1-2 hours). Of these patients, 9 (29%) significantly improved on scores of emotional/mental health.

Abstract

“31 patients diagnosed at various stages of cancer progression were referred for therapy consisting of drug-free preparatory interviews totalling 6-12 over 2-3 wks, an all-day LSD session, and postsession interviews used to facilitate integration of the LSD experience. Assessment of LSD dosage was based on body weight and emotional defenses. Patients’ conditions pre- and postsession were assessed by therapist, cotherapist, physician, nurse, family member, and independent rater on scales of depression, anxiety, pain, fear of death, isolation, and management. Of 36 mean scores, 3 did not demonstrate any significant or strongly positive trend. 9 patients dramatically improved, 13 moderately improved, and 9 remained essentially unchanged. 2 cases are examined in depth. The mechanics and process of the LSD experience are discussed and suggestions are made for further research.”

Authors: William A. Richards, Stanislav Grof, Louis E. Goodman & Albert A. Kurland

Summary

I. INTRODUCTION

Aldous Huxley wrote these words after his first wife died of cancer in 1955. In his novel Island, he describes a similar scene during the death of his character Lakshmi, and in his second wife’s description of Huxley’s request for LSD a few hours before he died of cancer.

Two years after Huxley’s death, the attention of the Spring Grove research team was focused on the needs of terminal cancer patients. A middle-aged female staff member developed carcinoma of the breast associated with marked physical and emotional distress.

Eric Kast conducted the first experiments using LSD with terminal cancer patients in 1963. He reported that LSD had a significant analgesic effect superior to dihydromorphinone (Dilaudid) and meperidine (Demerol), and also relieved depression, improved sleep, and lessened apprehension concerning death.

After limited but encouraging observations, a staff member accepted LSD-assisted psychotherapy at Spring Grove, and underwent a brief period of preparatory therapy with Sidney Wolf. The outcome of this pioneering experiment was encouraging, and further research was conducted.

Sanford Unger treated three patients at Sinai Hospital in Baltimore, and Walter Pahnke treated five more patients there. Stanislav Grof is now treating 60 cancer patients with psychedelics, and a controlled study is being performed with financial support from the Babcock Foundation.

Each patient was interviewed by a psychiatrist from the Maryland Psychiatric Research Center. The patient and his family were informed of the potential benefits and risks of this form of psychotherapy.

The sample included 31 patients with various stages of cancer, ranging from early diagnosis to late stage. The mean age was 54.74 years and the mean time since the first diagnosis of cancer was 34 months.

The therapeutic procedure consisted of three phases: (1) a series of drug-free interviews; (2) the LSD session itself; (3) several subsequent drug-free interviews for the integration of the session experiences. Psychotherapeutic work with patients with advanced cancer focused on the present situation, including unresolved issues between the patient and family members, problems of confronting and accepting diagnosis, prognosis and death, and significant intrapsychic conflicts.

The therapist encouraged the patient to discuss his feelings about the approaching death and to increase their interaction on as many levels as were appropriate. The patient’s fear of upsetting the therapist and the fear of death itself were significant issues.

When the major issues had been explored and a good therapeutic relationship had been established, the patient was transferred into a private room, and a specially trained psychedelic nurse or cotherapist visited the patient to establish basic rapport and mitigate any anxieties about the routine nursing needs. The therapist met with the patient’s family to discuss the LSD treatment, to allay their anxieties, and to promote group cohesiveness.

The therapist used a eyeshade, classical music through stereophonic headphones, emotional support throughout session, and freedom of affective expression among family members.

The regular hospital staff gave the patient breakfast and routine care earlier than usual, so that the session could begin without undue delay. A sign was placed on the door to promote the patient’s sense of security.

As the patient began to feel the effects of LSD, the therapist put on an eyeshade and stereophonic headphones, played classical music, and remained with the patient throughout the LSD session. The patient was encouraged to explore external stimuli such as flowers or paintings during these periods.

The patient was drawn into the photograph and into new experiences. Family photographs were used to help resolve conflictual personal material.

LSD effects usually lasted 8-10 hours, and family members were permitted to visit the patient. The average amount of time spent with the patient by the therapist on the session day was 11-1,4 hours.

The therapist helped the patient to integrate the experiences he had encountered during the session and to apply any insights gained to everyday living insofar as was possible.

According to the original research design, patients were expected to complete psychological tests before and after treatment. However, this turned out to be an unrealistic expectation and instead external observers made ratings of the patients’ depression, psychological isolation, anxiety, difficulty in management, fear of death, preoccupation with pain and denial.

Data analysis was performed on pre- and post-session assessments of the clinical condition of each patient, and a global index was developed for each category of distress. The degree of improvement was assessed by comparing the global indexes from pre- to post-treatment.

Results showed that psychedelic therapy improved the emotional condition of cancer patients. The differences between mean scores were significant at the 0.001 level.

The results of this study should be considered as illustrations of the therapeutic efficacy of psychedelic treatment with terminal cancer patients, rather than conclusive statistical proof.

Table 4 shows the difference between the means of the pre-and post-treatment global indexes. The global index can be used to estimate the percentage of therapeutic success, and 9 patients showed dramatic improvement, 13 patients were moderately improved, and 9 patients were essentially unchanged.

The mean daily dose of narcotic medication decreased from 2.58 units before LSD administration to 2.24 units afterwards, although this decrease was not statistically significant.

Two case histories are presented that illustrate some of the unique aspects of this treatment approach to cancer patients, as well as some of the potential benefits that may be experienced indirectly by members of patients’ families.

III. DISCUSSION

When we began working with cancer patients, we thought they would be relatively “normal” persons with a physical illness. However, they had significant psychological conflicts that predated the diagnosis of their physical illness.

The phenomenological data reported by cancer patients after their LSD experiences were not substantially different from the data reported by other categories of patients with whom we have worked, such as alcoholics, neurotics, and narcotic drug addicts.

Cancer patients manifested more difficult physical symptoms and found their LSD sessions more fatiguing than other patients. They also reported more visions of deceased family members and a subjective comforting sense of the family member’s presence that sometimes continued after the LSD session.

Although extensive, controlled studies are necessary to determine the extent to which the therapeutic results of LSD administration can be attributed to the pharmacological effects of LSD per se, some hospital chaplains have obtained positive results without the aid of psychedelic drugs.

Kast’s study used 100 micrograms of LSD and terminated the sessions with chlorpromazine at the slightest signs of distress. Our study used 200-500 micrograms of LSD and encouraged patients to actively work through emotionally difficult psychodynamic experiences if these occurred in their sessions.

The therapeutic effects of LSD-assisted psychotherapy include the reliving of traumatic childhood memories, abreaction and catharsis, facilitation of emotional and intellectual insights, and intensification of the transference relationship.

The effect of LSD on severe physical pain is more difficult to explain. It may be due to increased pain tolerance, defocusing of attention from the site of pain stimulation, and an enhanced “here-and-now” orientation.

The ratings of pain decreased significantly after LSD treatment, whereas the consumption of narcotics did not. This may be due to the fact that some patients received other psychoactive substances in addition to narcotics, or to the fact that some patients found the same amount of narcotics more effective after treatment.

Psychedelic therapy patients sometimes report feeling a radical change in their attitude towards death as a result of their experience. These patients are often facing physical death and report feeling a state of mind where physical death appears irrelevant.

Kast suggests that the mechanisms that protect healthy persons from the realization of their doomed situation operate with greater force in terminal patients, and that the acceptance of and surrender to the inevitable loss of control experienced during and after LSD treatment are indications that LSD eases the blow to the fantasy.

Kast emphasizes that the infantile fantasy is important in relieving the experience of pain and the fear of death, but that anticipation can offer nothing to the terminal patient and can only accentuate his feeling of helplessness.

Some terminal patients undergoing psychedelic psychotherapy experienced ego-death followed by an experience of cosmic unity and rebirth, which changed their fundamental concepts of man’s relation to the universe. They developed a deep belief in the ultimate unity of all creation and experienced themselves as part of it without regard to the situation they were facing.

It is a purely academic question whether the changes of consciousness described are a merciful delusional self-deception or a profound ontological insight.

Psychedelic peak experiences change the patient’s value system, allowing them to realize the absurdity of exaggerated ambitions, orientation toward achievement, holding onto money, status, power, and other temporal values, and to appreciate human relations and resolve conflicts in present relationships.

Psychedelic therapy with terminal patients that includes the family members offers a unique opportunity to practice preventive medicine by easing the agony of death for the one who dies and helping those who go on living to absorb this deep trauma in a healthy manner.

The length of the LSD experience is a practical disadvantage of this psychotherapeutic approach. A shorter-acting drug with properties similar to LSD, DPT, is being investigated as a possible alternative, as well as MDA and the short-acting forms of psilocybin, CZ-74 and CEY-19.

In conclusion, psychedelic therapy for terminal cancer patients requires a quality human encounter, sensitive psychotherapeutic guidance, and the optimism of the therapist. The psychological power of the LSD reaction is enough to keep the therapist’s enthusiasm high.

The use of psychedelic drugs in terminal patients is not recommended without specialized training under supervision from those already familiar with the reactions facilitated by this powerful psychoactive drug.