LSD in the supportive care of the terminally ill cancer patient

This open-label case study (1985, n=4) describes the experience of administrating LSD (100-400μg, multiple sessions) in supportive circumstances but without much knowledge of set & setting and effective therapeutic interventions.

Abstract

From the conclusion: “In the search for new techniques that might enhance the efficacy of psychotherapy, particularly in those patients whose motivational powers have been weakened or lost, a compound such as LSD may hold considerable promise. This is reinforced by the fact that the experiences in this study indicate that trained personnel can implement the psychedelic procedure with relatively high safety and replicate its major objective, the peak experience, to a degree that makes the phenomenon difficult to sweep under the experimental rug. At the same time, it underscores the need for controlled studies, an objective that may be very difficult to achieve in view of the unique nature of the drug experience and its therapeutic objective.”

Author: Albert A. Kurland

Summary

Please scroll down for article

Supportive care of the cancer patient frequently presents formidable challenges to the physician’s capacity to provide relief. Despite the justifications for this criticism, there are often major obstacles to using psychological intervention, including persistent pain and an extensive use of narcotic analgesics and sedatives.

In the play The Shadow Box by Michael Christofer (1977), three terminally ill people are depicted, and two themes are centered on: the importance of living the last days honestly and allowing the families to participate in such a relationship.

The growing recognition of the need to maintain the patient’s state of awareness while providing relief from pain and dysphoria has led to improved measures for adding to the effectiveness of supportive care.

Although the objective of using LSD in the supportive care of cancer patients is still some distance away, a step toward this goal may have been taken by the investigations focused on the use of LSD in the supportive care of cancer patients.

Kast (1966, 1964, 1963) and Kast and Collins (1964) administered LSD to cancer patients experiencing severe pain, and found that some experienced considerable relief.

Aldous Huxley used hypnosis to help his first wife die by guiding her toward memories of ecstatic experiences that had occurred spontaneously. Later, he used LSD and mescaline to help his character Lakshmi experience mystical states of consciousness.

Huxley’s second wife, Laura, stated that Aldous mentioned on several occasions that the last rites should make one more conscious rather than less conscious.

Aldous Huxley’s thinking on LSD was unrelated to the work of Kast, an anesthesiologist, who utilized LSD for this purpose on an experimental basis. Kast’s observations showed that LSD was capable of improving the lot of dying individuals by making them more responsive to their environments and families.

The peak reaction, induced by LSD, was viewed as a powerful instrument, and was used as a treatment form based on the concepts outlined in the work of William James and Thiebout.

James viewed conversion as a gradual or sudden process in which the self-formerly divided and consciously wrong, inferior and unhappy-becomes unified and consciously right, superior and happy. Maslow described these experiences as moments of pure, positive happiness.

Maslow (1959) viewed peak experiences as having therapeutic effects, changing a person’s self-image, changing their views of other people and the world, releasing greater creativity, spontaneity and expressiveness, and making them feel that life is worthwhile.

Psychotherapy with psychedelic drugs may change the way a patient views life by allowing them to face their shortcomings with less resistance, and by attenuating a sense of hatred and lack of love.

The use of LSD in this study was different from Kast’s study, because it was used in the context of an experimental treatment form that was conceptualized as psychedelic peak psychotherapy.

Methodology

The study included patients with physical pain, depression, tension, anxiety or psychological isolation related to their affliction, and a life expectancy of at least three months.

A psychiatrist discussed the nature of LSD treatment with the patient and family, and explained that it was not a cure, but might help manage the affliction. The treatment process consisted of three parts: a preparatory phase, a drug session, and an integration phase.

During the first phase, psychotherapeutic treatment was undertaken with the patient and family. The emphasis was on making life as meaningful as possible, rather than exploring deep conflict material, and on obtaining satisfaction from ordinary situations in life.

People who had negative feelings about organized religion may still have experienced spiritual or mystical experiences during the session.

One week prior to the drug session, all tranquilizing medications were discontinued, and the patient was introduced to the other members of the treatment team. The patient was encouraged to feel everything that emerged, to experience it fully, and to give full expression to the experiences.

The patient spent the second phase (the drug session) in a reclining position most of the day and was administered 200 to 300 micrograms of LSD orally, unless the patient was nauseous or vomiting.

The latency period following LSD administration is spent relaxing, looking at pictures or listening to quiet music, and then the patient is encouraged to lie down and cover her/his eyes with an eyeshade.

The music used during an LSD session is intended to stimulate and guide the patient’s imagery as a transporter and suggestive device, and to provide structure without content. The music is played to help the patient release hidher usual ego controls and to stabilize the positive experience.

LSD results in a 10- to 12-hour period of striking, varied and anomalous mental function with multiform effects. The major dimension of therapeutic relevance of drug-altered reactivity is the affective sphere: intense, labile, personally meaningful emotionality is induced, with periodic episodes of overwhelming feeling.

During the drug experience, extended interviews may be used to attenuate counterproductive activity, especially when severe anxiety is aroused and communication is blocked. These experiences include a flight into ideas, a concentration on the physiological mechanisms, a state of confusion and perceptual distortion, and an awareness of a dual reality.

Staff suggested that psychedelic psychotherapy might be helpful to a patient who was tall, thin, gaunt and somewhat anxious. The patient underwent an experimental treatment in which she experienced a psychedelic peak experience.

The preparation for the LSD session involved exploring the patient’s personal identity and current interpersonal relationships. The patient was found to be permeated with a sense of fear, self-doubts and questions about her own worth as a person.

A woman who was preparing to die began to remake her relationships with her husband and children, and her negative feelings about herself began to lessen. She was administered a 100 pg dose of LSD and went on a vacation with her husband and children.

The day prior to LSD, I was fearful and anxious. After the preparatory session, I felt refreshed and eager, and arrived at the LSD building with the therapist.

A beautiful Happiness rosebud and a bowl of fruit were placed on the table, and I was given the first dose of LSD. I felt awkward and drowsy, and at some point the second dose was given to me.

At about this time, it seems, I fused with the music and was transported on it. I remember two experiences: being alone in a timeless world with no boundaries, and recognizing that I was a moment in time, created by those before me.

I was alone in the void, without the timespace boundaries, and I felt that the core of life is love. I wept long for the wasted years, the search for identity in false places, the neglected opportunities, the emotional energy lost in basically meaningless pursuits.

As I began to emerge, I felt joy for having been able to use the experience these people who cared for me wanted me to have. Later, my family noticed a change in me, and I felt at peace.

The Minnesota Multiphasic Personality Inventory (MMPI) indicated that the patient’s depression had reduced, and she returned to work after her vacation. Five weeks later, she died of ascites.

LSD therapy produced dramatic results in the treatment of this patient, which led to the treatment of three other patients.

Patient 2

A 58-year-old White, Jewish, married female with breast cancer was given 300 pg of LSD after six hours of preparatory psychotherapy. The patient had a few moments of intense positive psychedelic reactivity, but no complete psychedelic peak experience was attained.

During the latter part of the session, the patient was realistically told that it was unlikely that she would be able to walk again, but expressed her determination to try her best in physiotherapy.

The patient was discharged from the hospital after her LSD treatment and began intensive work with a physiotherapist. She made remarkable progress and was able to walk unaided within four months, but became depressed 10 months after her first treatment.

During the preparatory phase, she faced the fact that she was really sick and her fear of decaying flesh was symbolized by visions of vultures feeding on rotting meat. After confronting unpleasant feelings and experiences, the patient experienced passing through blue curtains, soaring in the sky, and being alone on a high mountain top with the snow falling. She experienced wonderful feelings of peace and harmony and visions of beautiful rainbow-like colors. The patient thought deeply about her family and resolved some of her ambivalence about her younger daughter. She resolved to make a more constructive attempt to relate to her in the future.

Several days after her surgery, the patient left the hospital in good spirits and participated actively in her daughter’s wedding.

Six months after her third LSD treatment, the patient experienced positive ego transcendence and felt that she had left her body, was in another world and was in the presence of God. She felt no pain at all and radiated a psychedelic afterglow of peace and beauty. The patient was discharged from the hospital in good spirits, and could push pain out of her mind by remembering her out-of-body LSD experience.

The patient did very well for about one month, but then injured her back and became sick with flu. She was readmitted for LSD therapy almost six months after her third treatment.

The patient asked a direct question about her diagnosis during the final preparation, and the family members became upset and angry. However, that very evening, most agreed with the answer.