The Second International Conference on the Use of LSD in Psychotherapy and Alcoholism

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The Use of

LSD in Psychotherapy

and Alcoholism

Edited by Harold A. Abramson, M.D.

Introduction by Dr. Frank Fremont-Smith

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FROM THE TABLE OF CONTENTS

SOCIAL AND PARA-MEDICAL ASPECTS OF HALLUCINOGENIC DRUGS, William H. McGlothlin, Ph.D.,

Research Associate, Department

of Psychology, University of Southern California

DOLPHIN-HUMAN RELATION AND LSD 25, John C. Lilly, M.D.,

Director, Communication Research Institute, Miami; St.

Thomas, V.I.

THEORETICAL ASPECTS OF LSD THERAPY, Dr. John Buckman, M.R.C.S., L.R.C.P., D.P.M.,

Senior Hospital Medical Officer,

Marlborough Day Hospital, London

THE USE OF LSD 25 IN PERSONALITY DIAGNOSTICS AND THERAPY OF PSYCHOGENIC DISORDERS, Stanislaw Grof, M.D.,

Research

Psychiatrist, Psychiatric Research Institute, Prague

LSD FACILITATION OF PSYCHOANALYTIC TREATMENT: A CASE STUDY IN DEPTH, Charles Clay Dahlberg, M.D.,

Training and

Supervisory Analyst, William Alanson White Psychoanalytic

In-stitute, New York City

A CASE OF CHANGE AND PARTIAL REGRESSION FOLLOWING ONE LSD 25 TREATMENT, Jack L. Ward, M.D.,

Staff Psychiatrist, New

Jersey Reformatory at Bordentown, Mercer Hospital

A PROGRAM FOR THE TREATMENT OF ALCOHOLISM: LSD, MAL- VARIA AND NICOTINIC ACID, Abram Hoffer, M.D.,

Director, Psy-

chiatric Research, Department of Public Health, Saskatchewan

A COMMENT ON SOME USES OF PSYCHOTOMIMETICS IN PSYCHI- ATRY, Humphry Osmond, M.R.C.S., L.R.C.P., D.P.M., F.W.A.,

Director, Bureau of Neurology and Psychiatry, New Jersey

Neuropsychiatric Institute

IS LSD OF VALUE IN TREATING ALCOHOLICS?, Ruth Fox, M.D.,

Medical Director, National Council on Alcoholism

PSYCHOTHERAPY WITH LSD, Sidney Cohen, M.D.,

Chief, Psycho

somatic Medicine, Veterans Administration Hospital, Los

Angeles

PRELIMINARY METHOD FOR STUDY OF LSD WITH CHILDREN, Andre Rob, M.D.,

Director,

Leonard W. Krinsky, Ph.D.,

Direc-tor, Psychological Service,

Harold A. Abramson, M.D.,

Director

of Research,

L. Goldfarb, M.D.,

Clinical Director, South Oaks

Psychiatric Hospital, Amityville, New York

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continued from front flap

In May 1965, Dr. Harold A. Abramson called together at South Oaks Hospital, Amityville, N.Y., fifty doctors, scientists, and psychiatrists from all over the Western world (and from behind the Iron Curtain) to deliver papers on their work with this remarkable drug.

Included in the book are discussions of the thirty-six papers by the participants in the conference. Their questionings, agree-ments, and disputes lead inevitably to con-troversy, but it is an unmistakably pro-ductive one.

THE AUTHOR

Dr. Harold A. Abramson—Director of Re-search at South Oaks Hospital and a pioneer in the field of combined psychiatric and chemical research—practices psychi-atry in New York City. He has written sev-eral highly regarded professional books, edited eleven more for the Josiah Macy, Jr., Foundation, and is editor of the Journal of Asthma Research. Dr. Abramson served in the Office of the Chief, Chemical War-fare Service, from 1942 to 1946, and there-after for ten years was a consultant in psychology to the Department of the Army.

JACKET DESIGN BY QUENTIN FIORE

THE BOBBS-MERRILL COMPANY, INC. A SUBSIDIARY OF HOWARD W. SAMS & CO., INC.

PUBLISHERS / Indianapolis • Kansas City • New York

E $17.50

The Use of

LSD IN

PSYCHOTHERAPY

and Alcoholism

Edited by Harold A. Abramson, M.D.

Introduction by Frank Fremont-Smith, M.D.

In the midst of the nation-wide front-page furors over the indiscriminate public use of LSD (lysergic acid diethylamide) one fact remains clear. There is an interest un-precedented in recent history in the drug's

mind-damaging or, as most experienced and responsible investigators claim, perhaps the greatest breakthrough in psychotherapy in the last sixty years.

Beneath the near-hysterical headlines, beneath the allegations of thrill-seeking and cultism, it is sometimes mentioned that in-formed, expert, and methodical research into the therapeutic applications of LSD has been taking place for more than twenty years.

It is this thorough, important research and its meaningful findings that are re-ported, with neither preconceived bias nor sensationalism, in The Use of LSD in Psy-chotherapy and Alcoholism.

continued on back flap

effects—whether they are thought to be

Front

jacket

flap

Back

jacket

flap

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The Use of

LSD in

Psychotherapy

and Alcoholism

Edited by Harold A. Abramson, M. D.

Introduction by Frank Fremont-Smith, M. D.

T H E B O B B S - M E R R I L L C O M P A N Y , I N C .

A Subsidiary of Howard W. Sams & Co., Inc.

Publishers

—Indianapolis New York Kansas City

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ACKNOWLEDGMENTS

The paintings illustrating Dr. Charles Savage's paper are by Harriette Frances, and are reproduced with the permission of The International Foundation for

Advanced Study. Dr. Sidney Cohens paper, from his

with the author's permission.

Library of Congress Catalog Card Number 66: 25284 Printed in the United States of America

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To my wife Virginia

who assisted me in all w a y s during the early years of experiments with psychotomimetic compounds

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Introduction

In May, 1965, a group of investigators in the field of psychiatry met at South Oaks Hospital, in Amityville, New York. The purpose of the meeting was to exchange information and discuss problems regarding the use of a remarkable drug that has been a focus of research in psychiatry for more than twenty years. This drug, LSD-25, commonly called LSD, is a deriva-tive of d-lysergic acid. Lysergic acid itself is the basis of many ergot compounds used daily in medicine. But L S D has a unique property which differentiates it from all other drugs. Even in extremely small doses, L S D produces a disturbance in mentation—in thinking processes, in perception of sound, light and color, in emotional reaction, in ideation. This disturb-ance is reversible. After a certain number of hours, the effect of L S D itself wears off.

Contrary to assertions in the popular press, when L S D is administered as part of a therapeutic medical program, "irreversible psychotic changes" and "brain damage" do not occur. Certain irresponsible statements that it does produce such adverse effects have not been supported by valid scientific evidence.

The effect of L S D on many people resembles a psychotic state. The reason for this is that L S D creates an emotional storm during which a person frequently is able to recall forgotten—or repressed—events and early experience. Outwardly it may seem that the person is psychotic. Actually he is undergoing a complete re-evaluation of his self-image.

LSD, if taken without proper supervision and under undesirable cir-cumstances, can produce a reaction in unstable people which presents an alarming appearance and can lead to dangerous behavior. Like any other drug, L S D belongs in the hands of responsible medical authorities. In responsible hands, L S D is a valuable tool in hastening successful results of psychotherapy, as seen particularly with alcoholics, a group notoriously difficult to treat.

How small is a small dose of L S D ? Throughout this volume the reader will encounter the abbreviation, mcg. Mcg stands for microgram, singular or plural, as mg stands for milligram and kg for kilogram. One mcg is one thousandth of a milligram, or one millionth of a gram. In terms of a familiar weight, one pound, one mcg equals about one-half a billionth of a pound. Micrograms are really too small to be visualized readily but it helps to remember that there are 300, 000 mcg of aspirin in the ordinary tablet. We now may ask how many mcg of L S D are needed for the drug to make itself felt? The first, or threshold dose, may be about 25 mcg. Under desirable conditions a dose of about 100 mcg produces a dramatic reaction, often

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resembling a psychotic state in nearly everyone. I use the term desirable because, if the setting in which L S D is given to the patient seems threat-ening, the reaction may be distressing to the patient and frightening to the people with him.

If 100 mcg of L S D is administered to a group of so-called normal subjects, each member of the group will react differently, according to his personality structure and to the setting, or milieu, in which the drug is given. The attitude of the physician who administers the drug exerts a significant influence. An anxious physician inevitably produces an anxious subject. The disagreements and opposition to L S D therapy voiced by inex-perienced or anxious investigators can easily be understood when seen in the context of these complicated variables.

In the results of experiments published more than ten years ago, my co-workers and I found that symptoms frequently reported by fourteen non-psychotic subjects who received L S D included memory difficulties, mood changes and difficulty in concentration. Feelings of unsteadiness, inner trembling and dizziness were reported as well as peculiar sensations in the hands, the feet and on the skin; dream-like feelings were common, as were heaviness in the hands and feet, drowsiness, and difficulty in focusing vision. Anxiety occurred often. Depersonalization was observed. There were occasional paranoid reactions. Some reported a peculiar sensa-tion of the lips being drawn back, as in an involuntary smile. With dosages as low as 100 mcg, hallucinations were rarely reported. As a matter of fact, I am still somewhat surprised when L S D is described as an hallucinogenic drug, since what is intended is, more accurately, heightened perception or illusion.

More important than the pseudo-hallucinations produced by the drug is the fact that L S D and similar compounds may be used in psycholytic and psychedelic therapy. Both forms of therapy are discussed at length in the papers which follow.

In spite of the complicated symptoms and signs produced by LSD, even when given in a suitable setting, the drug's action leads to an extraor-dinary and somewhat paradoxical integrative process in the patient's psyche, because of the nature of his relationship with the therapist. The unpleasant and peculiar storm taking place in the nervous system is accompanied by a remarkable state of ego enhancement occurring simul-taneously with ego depression. During the L S D reaction the therapist may manipulate this dual change in ego. The ego enhancement produced may be employed by the therapist for the benefit of the patient. In other words, the patient reacts to the L S D and to the therapist, not to the L S D alone. Some of the characteristics of the therapeutic process may include intense awareness of the treatment period with good memory of the experience; increased fantasy; limited regressive ideation; facilitated interpretation of symbolic processes; acute awareness of the need to maintain conscious control of self; mounting anxiety; difficulties in the struggle to control feelings; fluctuating depression and euphoria; fluctuating disturbances in perception; rare hallucinatory episodes, almost always accompanied by simultaneous awareness of reality and by mild sexual stimulation. The

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reader will see clearly that the therapist himself must be relatively free of anxiety if he is to be successful in treating the patient who is undergoing this multifaceted psychic upheaval.

The non-medical reader may wonder what compounds related to L S D are commonly used in medicine. These are familiar drugs: Ergonovine Maleate, Methyl Ergonovine Tartrate, Ergotamine Tartrate as well as Methysergide. Crude extracts of ergot were used by midwives as far back as the seventeenth century for its effect on the uterus. Other plant extracts have been employed for more than 3, 000 years for their effects on the mind, usually in connection with ritualistic, religious and sociological ex-periences. Perhaps the broad use by primitive peoples of the drugs similar to L S D in order to satisfy some need for cultural stability and adaptive processing may find a parallel in the modern use of L S D in psychoana-lytically oriented psychotherapy.

The stresses of modern living and the lengthy procedure of psycho-analysis have made us all aware of the need for less time-consuming tech-niques to give the patient the confidence and ability to face his own problems. The use of L S D to enable the patient to shorten this process has been termed psycholytic therapy in Europe. Low doses of L S D are used in psycholytic therapy. It was clearly distinguished from psychedelic therapy by the investigators present at the South Oaks conference. Psycholytic therapy has as its goal greater maturity, with increasing social and physi-ological adaptive mechanisms. Psychedelic therapy, the method usually applied in this country, commonly makes use of doses of at least 300 mcg of L S D and the doses may go as high as 2000 mcg. The principal focus in psychedelic therapy is to attain the extraordinary experience produced by the drug itself, which is essentially independent of psychoanalytic therapy. This experience is variously described as "mystical, " "ecstatic" or "apoca-lyptic. " Regardless of the description, the L S D experience leads to a symp-tomatic type of cure in terms of an immediate change in behavior. At least 2 5 % of alcoholics who have been treated by psychedelic L S D therapy have remained abstinent for six months following the treatment.

The reader of this volume will find considerable controversy concern-ing the use of statistical methods when evaluatconcern-ing the results of psycho-therapy with L S D and similar drugs. The term "double-blind" will be frequently encountered. The double-blind experiment is one that is ar-ranged with two groups of patients who are simultaneously treated. Neither patient nor doctor knows which group has received L S D while the matched group has been given another drug, or some harmless sub-stance. It should seem fairly obvious that it would be unlikely for a patient who had been given a placebo, or sugar pill, to believe that he had taken LSD. It is true that when studying the effect of the drug on the human organism the investigator should endeavor to be uninfluenced by his own expectations. The therapeutic nihilist rarely acknowledges the value of a drug. The enthusiastic therapist hopefully searches for a positive result. To minimize the anticipations of both nihilist and enthusiast, the double-blind type of experimental procedure in clinical trials has been widely adopted. The procedure and its results depend upon statistics. Personal

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bias is supposed to be eliminated. The method involves either a suitably large sample of subjects or special mathematical assumptions if the sample is small.

The effects of drugs which are of importance to research in psycho-pharmacology can hardly be studied by the double-blind technique alone. Certainly, whenever the psyche is involved, at least equal weight must be given to the intensive study of drug effects in a single patient. It is difficult to understand how the result of extensive study, based on patient group averages rather than on individuals, can have direct implications with respect to improvement in the psychotherapy of patients. Judgments re-garding indications for treatment derived from the single case study may be more meaningful than those derived from a large sample. The psyche is always involved, whether we like it or not! It is important to remember that statistics developed from systematic observations of the patient under treatment may be more useful than statistics concerning a somewhat vague patient population. Only by direct clinical observations or clinical judg-ment can we really learn about the patient. This can be the focal point of many hypotheses, and it is such observations which may provide a proper basis for subsequent clinical research by statistical analysis.

Both clinical judgment and the double-blind method are important. However, the intensive study of the patient must be continued by the practicing physician. No rigid governmental or academic agency will ever take the place of the clinical judgment of the practicing physician. Without his clinical judgment dangerous shoals lie ahead.

Are we entering a new machine age of medicine, engendered not by the industrial revolution, but by the computer revolution? May physicians and investigators, unable to deal with the turbulent feelings of their patients, search for a fashionable refuge in statistics which provide a non-threatening haven? A recent article in one of the Sunday weekly supple-ments portrays how the author, a pathologist, and a reporter support their violent opposition to the use of L S D by distorting statistics and by rele-gating clinical observations to a minor position. It will be tragic, indeed, for all of us when a pathologist becomes our authority for the value of psychotherapeutic procedures!

It was important to arrange for those registered members of the South Oaks Conference who were coming from nine foreign countries to know in advance what would be the contributions of the other members. Papers on psychiatric subjects are necessarily lengthy and difficult to follow at meetings lasting several days. This obstacle to clarity of communication between the members of the conference was overcome in the following way. Almost all papers were sent to me well ahead of the meeting. Copies of the manuscripts then were sent to all members weeks in advance. In this way nearly all the data to be presented were familiar to the group before the conference. Language barriers were thus essentially overcome. Each author was given ten minutes to summarize his views. Twenty minutes were allotted to discussion. Thanks to the excellent way in which Dr. Frank Fremont-Smith chaired the conference, all the summaries were presented with suitable discussion periods.

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Although I had the pleasure and privilege for the second time of organizing a conference on L S D , without the active cooperation of Dr. André Rolo, Dr. Frank Fremont-Smith and the Board of Directors of South Oaks Hospital, the conference would have been well-nigh impossible. For their help with the infinite number of details connected with a project of this type, I wish to thank especially Miss Polly Andrews, Miss Cornelia Cassidy, Mrs. Gwen Neviackas, Mrs. Henriette H. Gettner and other members of the staff of South Oaks Hospital. Finally, I am grateful to my wife, Virginia, for her help in planning and organizing many of the experi-ments on LSD, its derivatives, and psilocybin reprinted here. Without her aid the conference could not have been held. Incidentally, in double-blind experiments designed to ascertain if non-psychotic normals could dis-tinguish between L S D and psilocybin, her distinction score was the highest of the observer's group. No statistics here—only clinical observation. May it be with us always.

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Address:

T H E S E C O N D I N T E R N A T I O N A L C O N F E R E N C E O N T H E U S E O F L S D

I N P S Y C H O T H E R A P Y A N D A L C O H O L I S M

A n d r é Rolo, M. D.

Please let me welcome you on behalf of the Board of Directors and the Staff of the South Oaks Psychiatric Hospital. It is a special pleasure for me to be host to this distinguished body of physicians, many of whom have traveled thousands of miles to discuss their pioneering research in the field of psychiatry. I cannot fail to be impressed, indeed awed, by the dedication and spirit of research which appear in the various articles and by the remarkable unanimity of findings in different parts of the world with regard to the use of such drugs as L S D in helping mentally disturbed patients of many types. These observations will develop, I am sure, during the course of this conference.

As you are aware, the conference is being held under the auspices of the South Oaks Research Foundation, a division of South Oaks Psychiatric Hospital. The parent organization of both these facilities is The Long Island Home, Limited. I would like to tell you about the background of our institution. South Oaks Hospital was founded in 1882. It is now one of the largest private psychiatric hospitals in the country. The daily census averages 200 patients. Approximately 900 patients are admitted yearly. The entire range of psychiatric disorders is treated.

In recent years, the Research Foundation was organized as an integral division of the hospital. Research by staff members has been encouraged. This conference is an outgrowth of one of the major research endeavors, the use of L S D as an adjunct to psychotherapy.

The active management of the conference will be under the direction of Drs. Frank Fremont-Smith and Harold A. Abramson. Each participant will receive a program that lists the order of the presentation of papers and describes the general organization of the conference.

I would be remiss if I did not take a few moments to thank our Re-search Director, Dr. Abramson. It is due largely to his efforts that this second international conference is taking place. He has given more than generously of his time, as I know you must be aware from the number of bulletins you have received.

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Drs. Randolf Alnaes of Norway, Keith S. Ditman of Los Angeles, Fred W. Langner of Albuquerque, and P. Oliver O'Reilly of Moose Jaw, Canada, unfortunately cannot be with us to discuss the papers they have written for the conference.

I now turn over the active direction of the conference to Dr. Frank Fremont-Smith. Dr. Fremont-Smith was for many years Medical Director of the Josiah Macy, Jr., Foundation and, in that capacity, supported the first international conference on uses of L S D at Princeton, New Jersey. He is past President of the World Federation of Mental Health and Director of the Interdisciplinary Communications Program, New York Academy of Sciences.

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Preface

F r a n k F r e m o n t - S m i t h , M.D.

Since the Second International Conference on the Use of L S D in Psycho-therapy was held, in May 1965, there has been a flood of highly emotional and often ill-considered discussion of L S D and the possible dangers inher-ent in its use. The article on L S D in the March 25, 1966, issue of Life is probably the most widely noted example.

Certain university health officials have been troubled by the extremes to which "far out" groups of students are likely to go in personal experi-mentation, and have been aroused to action by the understandable concern of parents who feared for their children. Such officials have issued grave warnings about L S D that have caused serious alarm. One would wish that these officials would be equally diligent in trying to eradicate the genuinely harmful use of alcohol and cigarettes.

Most statements which have appeared in the press are based princi-pally upon the undesirable experiences of a limited number of people who have bought L S D in the black market and administered it to themselves without medical supervision. The unfortunate publicity which ensued has resulted in violent attacks against L S D itself, even when used by physi-cians, in careful studies carried out in psychotherapeutically-oriented medical research and treatment. The federal government, in response to this ill-advised criticism on the part of unqualified individuals, has placed severe restrictions upon the availability of L S D to the medical profession. In some instances, these regulations have halted research on the value of L S D in the treatment of severe neurotic behavior patterns being conducted by precisely those physicians with the most extensive experience in the clinical and experimental use of LSD, leaving L S D research to the hostile and the ignorant.

On December 2, 1965, The New England Journal of Medicine, one of the most respected medical publications in this country, published an editorial under the title, " L S D — A Dangerous Drug. " This editorial ignored the entire body of published data, including the report published by the Josiah Macy, Jr., Foundation on the First International Conference on LSD, "The Use of L S D in Psychotherapy, " in stating " . . . today there is no published evidence that further experimentation is likely to yield invaluable data. " (Emphasis mine). Such unwarranted denigration is almost the ultimate expression of an anti-scientific attitude.

This editorial was based on an article that reported psychiatric

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plications which followed the unsupervised, self-administration of L S D by a group of individuals all of whom "had some degree of personality difficulty before taking the drug. Five were definitely psychotic before the L S D experience." As stated in my reply, "Pros and Cons Regarding LSD, " which appeared in the March 3, 1966, issue of the Journal: "This article

(on which the editorial was based) is an excellent warning against self-administration of this powerful agent, but has no bearing whatever on the potential value of further research." I stated further: "The study and better understanding of how such a powerful agent as L S D acts on the psyche of man is a valid and necessary approach to the physiologic mech-anisms underlying the higher functions of the central nervous system.

"Therefore, I would like to urge that studies of the effects of L S D in animals and man be intensively pursued under careful control by com-petent investigators and that current federal and state regulations restrict-ing the use of L S D under such circumstances be reviewed in the light of the published benefits, and the exceedingly few reports of adverse effects when L S D is administered under experienced medical supervision. "

It is to be hoped that the research and clinical studies reported in this volume will serve to bring into better perspective the use of L S D in particular and the proper management in general of governmental restric-tions upon drug research by qualified physicians.

Physicians, governmental agents, and the pharmaceutical industry must not lose sight of sound, medical tradition: only the responsible physi-cian can determine the needs of the patient and that, in the final analysis, the physician must accept, and bear the responsibility for his action whether he is using the scalpel, ionizing radiation, or a pharmaceutical agent. The government also has a responsibility to protect the public by requiring adequate study by research physicians before a new drug is made generally available. But for the government to undertake to prescribe treatment, or to proscribe therapeutic methods, would be to ignore the well-established fact that the state of the patient is as important as the nature of the therapeutic agent in determining the outcome of treatment. The withdrawal of a powerful therapeutic agent from clinical use should be resorted to only after the most careful study. Adverse reactions in animals, for instance, may not necessarily bear upon human response since there are well-known species differences. Even the occurrence of a few adverse reactions in man should not preclude the alerted physician's taking a calculated risk when dealing with serious illness for which there is no safer remedy available.

It is to be hoped that the reports of the present conference will serve to bring back into sharp focus the age-old responsibility of the physician, who alone, through his study of his individual patients, can determine what is most likely to be beneficial to them.

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REGISTERED P A R T I C I P A N T S T H E S E C O N D I N T E R N A T I O N A L C O N F E R E N C E O N T H E U S E O F L S D I N P S Y C H O T H E R A P Y M a y 8 t h - M a y 1 0 t h , 1 9 6 5 NAME

Abramson, Harold A., M.D.

Arendsen Hein, G. W., M.D. Baker, Edward F. W., M.D. Balestrieri, Antonio, M.D. Blair, Donald, M.D. Buckman, John, Dr., M.R.C.S., L.B.C.P., D.P.M. AFFILIATION (U.S.A. )

Director of Research, South Oaks Psychiatric Hospital, Amityville

(Holland)

Medical Director of Foundation Stichting, Veluweland Hospital

(Canada)

Attending staff, Toronto Western Hospital, University of Toronto, Departments of Medicine and Psychiatry (Italy) Professor of Psychiatry, University of Bari (England) Consultant Psychiatrist, St. Bernard's Hospital, London

(England)

Senior Hospital Medical Officer, Marlborough Day Hospital, London; now Assistant Professor of Psychiatry, University of Virginia, Charlotteville

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NAME

Chiasson, John, M.D.

Cohen, Sidney, M.D.

Dahlberg, Charles Clay, M.D.

Eisner, Betty Grover, PH.D.

Fox, Ruth, M.D.

Freedman, Daniel X., M.D.

Fremont-Smith, Frank, M.D.

Godfrey, Kenneth E., M.D.

Grof, Stanislav, M.D.

Hausman, Col. William, M.C.

Hertz, Mogens, M..

AFFILIATION

(Canada)

Director, Alcoholic Treatment Services, Psychiatric Services of Quebec

(U.S.A.)

Chief, Psychosomatic Medicine, Veterans Administration Hospital, Los Angeles

(U.S.A.)

Training and Supervisory Analyst, William Alanson White

Psychoanalytic Institute (U.S.A.)

Clinical Psychologist in private practice; Los Angeles

(U.S.A.)

Medical Director, National Council on Alcoholism

(U.S.A.)

Professor of Psychiatry, Yale University School of Medicine (U.S.A.)

Director, Interdisciplinary Communications Program, New York Academy of Sciences (U.S.A.)

Assistant Chief West Psychiatric Service, Topeka Veterans Administration

(Czechoslovakia)

Research Psychiatrist, Psychiatric Research Institute, Prague (U.S.A.)

Deputy Director, Division of Neuropsychiatry, Walter Reed Army Institute of Research

(Denmark)

Assistant Chief Physician, Frederiksberg Hospital, Copenhagen

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NAME

Hoffer, Abram, M.D.

Johnsen, Gordon H., M.D.

Ketchum, Maj. James S., M.C.

Kramer, Sol, M.D.

Krinsky, Leonard W., PH.D.

Kurland, Albert A., M.D.

Leuner, Hanscarl, M.D. Levine, Jerome, M.D. Lilly, John C., M.D. Ling, Thomas M., M.D. Ludwig, Arnold M., M.D. x i x AFFILIATION (Canada)

Director, Psychiatric Research, Department of Public Health, Saskatchewan

(Norway)

Chief Psychiatrist, Modum Bads

Nervesanatorium, Vikersund

(U.S.A.)

Chief, Psychopharmacology Branch, Directorate of Medical Research Chemical Warfare Service (U.S.A.)

Professor of Psychiatry and Biology, Behavioral Sciences Division, Department of Psychiatry, College of Medicine, Gainesville

(U.S.A.)

Director, Psychological Service, South Oaks Hospital, Amityville (U.S.A.)

Director of Research, Department of Mental Hygiene, Spring Grove State Hospital, Maryland (Germany)

Psychiatrische Klinik,

University of Göttingen; head of Psychotherapeutic Department (U.S.A.)

Research Psychiatrist, Psycho-pharmacology Service Center, National Institute of Mental Health (U.S.A.)

Director, Communication Research Institute, Miami; St. Thomas, V. I. (England)

Consultant Psychiatrist, Marlborough Day Hospital, London

(U.S.A.)

Director of Education and Research, Mendota State Hospital, Wisconsin

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NAME MacDonald, Donald C., M. D. MacLean, J. Ross, M. D. McCririck, Mrs. Pauline McGlothlin, William H., PH.D. Martin, A. Joyce, M.D.

Mogar, Robert E., PH.D.

Murphy, Robert C., Jr., M. D. Osmond, Humphry, M. R. C. S., D. P. M. Pahnke, Walter N., M. D., PH.D. Rolo, Andre, M.D. Rinkel, Max, M.D. AFFILIATION (Canada) Psychiatrist, Consultant to Hollywood Hospital, British Columbia

(Canada)

Medical Director, Hollywood Hospital, New Westminster, British Columbia

(England)

Psychoanalyst; with Dr. A. Joyce Martin, Marlborough Day Hospital, London

Research Associate, Department of Psychology, University of Southern California

(England)

Senior Hospital Medical Officer, Marlborough Day Hospital, London

Assistant Professor of Psychology; Director of Research, San Francisco State College Private practice; Waverly, Pennsylvania

Director, Bureau of Neurology and Psychiatry, New Jersey

Neuropsychiatric Institute Resident Psychiatrist, Massachusetts Mental Health Center

Director, South Oaks Psychiatric Hospital Amityville

Senior Research Consultant Massachusetts Mental Health Center (U.S.A.) (U.S.A.) (U.S.A.) (U.S.A.) (U.S.A.) (U.S.A.) (U.S.A.)

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NAME

Savage, Charles, M. D.

Servadio, Emilio, M. D. Unger, Sanford, PH.D.

Van Rhijn, Cornelius H., M. D.

Ward, Jack L., M. D.

Weber, E. S., M. D.

Wicks, Miss Mary S.

x x i AFFILIATION

Director of Research, Spring Grove State Hospital, Maryland

(Italy )

Hon. Professor of Psychology, l. l. d.; President, Italian Psychoanalytic Society, Rome Acting Chief of Psychosocial Research, Spring Grove State Hospital, Maryland

(Holland )

Psychotherapist, private practice; Enchede

Staff Psychiatrist, New Jersey Reformatory at Bordentown, Mercer Hospital

Psychiatrist, private practice; Princeton

(England)

Probation Officer, Kidderminster, Worcester

(U.S.A.)

(U.S.A.) (U.S.A.)

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I

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Social and Para-Medical Aspects

of Hallucinogenic Drugs

W i l l i a m H. M c G l o t h l i n , PH.D. *

I . I N T R O D U C T I O N

The subject of this paper is somewhat outside the topic of the present conference, since it does not deal with psychotherapy. On the other hand, the use of L S D in psychotherapy, in the United States at least, is virtually prohibited, partly because of the controversy over the non-medical use of the drug. Much of the controversy has arisen over a sort of do-it-yourself drug therapy advocated by Leary and Alpert. (67) The observation that the hallucinogens may have beneficial effects is not limited to extremists, however; Cole and Katz point out that much of the literature embodies "an implicit or explicit attitude that the knowledge or the leverage for self-change allegedly effected by these drugs may be of value or benefit to indi-viduals not ordinarily considering themselves to be psychiatrically ill. " (37) On the other hand, a number of editorials and articles (including that by Cole and Katz) have warned that uncontrolled use of the drugs could pro-duce psychotic reactions, suicides and undesirable personality changes. (36, 47, 56, 57) Grinker writes, "Latent psychotics are disintegrating under the influence of even single doses; long-continued L S D experiences are subtly creating a psychopathology. " (56) Farnsworth warns that we have little information on the long-range effects when taken over a protracted period of time and that they may prepare individuals to "move up" to other, "more powerful drugs. " (47) In general, the critics have regarded L S D as a new and potentially dangerous drug which may produce long-term deleterious mental effects that are unknown at present.

The purpose of the present paper is to provide a perspective on the long-term effects and social implications of the protracted use of halluci-nogenic drugs through a review of the extensive literature on peyote and cannabis sativa (marihuana). Since hallucinogens are known to have been in use for over four thousand years, there is no need to restrict our data to the very limited information available on the uncontrolled use of the more recent additions to the hallucinogen family. The psychic effects of peyote * Department of Psychology, University of Southern California. Dr. Mc-Glothin is also associated with The RAND Corporation; but his views should not be interpreted as reflecting the views of The RAND Corporation or the official opinion or policy of any of its governmental or private research sponsors.

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especially are similar to those of LSD. The limitation of peyote to the American Indian culture and religious setting restricts to some extent the generalizing of peyote findings with regard to the current situation; how-ever, some interest exists in the use of L S D for religious purposes, (106) and one notable criticism in the present controversy is the formation of L S D cults. The effects of cannabis are less similar to those of LSD, but it has a history of use under much more varied conditions and motivations than does peyote. There are many other hallucinogens that have been used to alter mental states, * but only peyote and cannabis are sufficiently well-documented for the purposes of this paper.

Because peyote and cannabis have been freely available to certain groups for many years, studies on their use can help in predicting the ex-tent and conditions under which L S D and similar drugs would be utilized if accessible. Of particular interest is what proportion of the population would be attracted to their use and for what purpose. Also of interest is the likely frequency of use and tendencies toward the creation of addic-tion or emoaddic-tional dependence. The quesaddic-tion of the relaaddic-tion of occasional or continual use of hallucinogens to psychosis can be examined, as well as the possibility that such use predisposes users to other more addictive drugs. Questions can be raised concerning personality changes resulting from their long-term use, as well as economic, family and social effects.

In addition to the peyote and cannabis review, I shall briefly describe, in a final section, a controlled experiment on the long-term effects of L S D which is now being conducted. This study poses a fundamental question with regard to the para-medical use of L S D ; namely, can the subjective reports of reduced anxiety, attitude and value changes, and enhancement of creativity and aesthetic sensitivity in experimental (non-therapy) sub-jects be substantiated in a quantitative controlled experiment?

I I . P E Y O T E

History and Description

Peyote (Lophophora williamsii) is a small, spineless cactus that grows in Northeast Mexico and the Rio Grande Valley. It contains nine alkaloids; of these, mescaline is the principal one that gives rise to the hallucinogenic effects. Peyote is carrot shaped with only the top-most part extending above ground. This portion is cut off and, though it may be eaten fresh, usually is dried to form the peyote or "mescal" button.

The ritualistic use of peyote among the Mexican Indians was wide-spread at the time of the Spanish invasion and was documented as early as 1560. (64) Most evidence places the introduction into the United States (Texas) at around 1870. (104) Whereas peyotism was a seasonal affair in Mexico, peyote was used throughout the year in the Plains. Peyote meet-ings were held for a wide variety of reasons, most frequently for doctoring the sick. A few influential leaders were active in proselytizing neighboring * Shultes states that there are more than forty naturally occurring hal-lucinogens in North and South America alone. (97)

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5

tribes, and peyotism spread rapidly among the Plains Indians. The ritual procedures were standardized into a religious cult in contrast to the tribal nature they had in Mexico. As the cult spread northward, a number of Christian elements were added, and the religion was incorporated, under the name of "The First-Born Church of Christ, " in 1914. Later the name was changed to the present title, "The Native American Church. "

In 1919 the Indian Bureau conducted a formal census of peyotists and found that, out of a total of some 316, 000 Indians, 13, 345 were peyote users. (87) The Native American Church now claims to have 200, 000 members, and has penetrated almost every tribe in the United States and Canada. (41) La Barre, writing in 1947, states:

Without a doubt the most widely prevalent present-day religion among the Indians of the United States and Mexico is the peyote cult . . . the use of peyote has spread from group to group until today it has assumed the proportions of a great inter-tribal religion. (63) The Ritual

To understand the motivation for the repeated use of peyote by the Indians, and to determine what bearing it may have on the use of modern-day hallucinogenic drugs, it is necessary to learn something of the setting in which the ritualistic use occurs. * There are occasional protracted peyote meetings (lasting perhaps a week or more) during holidays, such as Thanks-giving or Christmas; however, by far the most common is the weekend meeting held on Saturday night and extending into Sunday. Meetings are generally sponsored by a single family, although the cost is sometimes de-frayed by a collection. The purpose of the meeting may be to doctor a sick member of the host family, to celebrate a birth or death anniversary, to ask for rain, or simply to gather for social reasons. All Indians are welcome re-gardless of tribe, and with today's improved transportation, participants often travel for distances of a hundred miles or more. (112)

Preparations prior to the meeting include bathing and rubbing with scented plants, and some tribes provide a sweat-bath lodge. Many tribes also observe the taboo of not eating salt on the day of the meeting. (64) The meetings are held in large tepees or in peyote churches, or sometimes in the home of a member. The ceremony begins in the evening with the members sitting in a circle around an altar and fire. Women sit on the outside of the circle. The altar, or "moon, " consists of a crescent-shaped design made on the ground or in clay, and is related to visions experienced by the early leaders of the cult. A large peyote button is placed on the altar and is called the "chief" or "father peyote. "

The principal official is the "road-chief"** who directs the ritual. Others are the drummer, "fire-chief" and doorman. The paraphernalia in-clude a staff, drum, gourd rattle, special feathers, tobacco, incense, sage,

* There are a number of excellent detailed descriptions of the peyote ritual in the ethnological literature. Most of the description given here is based on La Barre's account. (64)

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and a number of other articles. As the cult has become more Christianized, the Bible often is placed on the altar along with the "father peyote, " and

The ceremony begins with smoking tobacco and praying, each member staring at the "father peyote" and the flickering fire. The peyote is

passed and each participant takes four buttons. The leader then begins to sing to the accompaniment of the drum and rattle; later he exchanges his staff and rattle for the drum; the drummer now sings four songs. The staff and rattle are passed around the circle. Each member sings four songs, while the person on his left plays the drum. Women do not participate in the singing. Peyote buttons are eaten throughout, in the amount desired by each individual.

There is praying at intervals and some members rise and make pas-sionate confessions and declarations of repentance, accompanied by cry-ing and strong emotions. At midnight there is an elaborate water ritual too complex to describe here. If doctoring is to be performed, it normally takes place at this time. The singing continues until dawn when the "pe-yote woman" is summoned to bring the morning water and another cere-mony is performed, followed by the morning songs, prayers and the quitting song. A ceremonial breakfast of water, parched corn, fruit, and dried sweetened meat is served. The meeting is then formally over and participants spend the morning socializing and discussing their experiences and visions. The sponsoring family serves a large dinner at noon, after which the guests depart.

Motivation

A primary interest of this paper is the examination of the motives that cause persons to seek the hallucinogenic experiences; what are the attrac-tions and satisfacattrac-tions which result in submission to repeated exposures over a long period of time? In the case of peyotism, there are two sources of information: ( 1 ) direct observation of the ceremonies, and interviews with the Indians; and (2) the theoretical explanations offered by the ethnologists. To understand the former we must examine them in the context of the ritual setting. This is pointed out in La Barre's quotation of a remark by an Oto, who told him in "all seriousness" that "peyote doesn't work outside the meetings, because I have tried it. " (64)

The Indians stress the attitude with which peyote is approached. Slot-kin writes: "One must be conscious of his personal inadequacy, humble, sincere in wanting to obtain the benefits of peyote, and concentrate on it. "

(104) Petrullo writes in a similar vein:

In the approach to the Spirit-Forces, including peyote, humility and a pitiful attitude are characteristic. In the speeches of the road-chief herbs, which they interpret as peyote—a practice that is particularly irksome to the missionaries attempting to suppress peyotism. (104) The most frequently quoted is Romans 14: 2 and 3; "For one believeth that he may eat all things: an-other, who is weak, eateth herbs. Let not him that eateth despise him that eateth not; and let not him which eateth not, judge him that eateth. "

* The Indians have found a number of Bible references to the eating of rea d during the meeting. *

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in the meetings, in the prayers, and in the tales of conversion and other lore, the Delaware appears meek and humble, conscious of his insufficiency. He is "a poor boy" who needs help and guidance from peyote, the compassionate, the pitiful. It is important that aid is not sought for material success in worldly enterprises, but purely in the realm of the spiritual, and in the medicinal. This doctrine is common to all peyotists, irrespective of Moon affiliation. (91)

Spindler writes about the goal of acquiring power invested in the Great Spirit:

This power cannot be obtained by merely consuming peyote. It comes to one only when the person approaches it in a proper spirit of humility and after long preoccupation and c o n c e n t r a t i o n . . . . The humility of the Menomini peyotists is accompanied with declarations of worthlessness. (109)

Some consider the peyote-induced vision to be an important aspect, but others regard the visions as a distracting element to be suppressed:

Peyote should not be eaten for visions. The visions are the effect of peyote on the body; but if you put your mind on God no visions will come to disturb you. (91)

Slotkin also relegates visions to a minor role, stating that persons seeking a mystic state through peyote ignore visions. (105)

The peyotist not only seeks contact with the higher spirits, but also strives to resolve personal conflicts.

Each individual turned in upon himself, with the aid of the narcotic and the fire into which he stares, is not only concentrating upon the nature of the power to come to him, or upon the spirits of heaven, but also upon the personal self and its conflicts. (109)

Louise Spindler stresses the power of the concerted group effort in this regard:

During the recital of testimonials at meetings, the group reacts in unison, but one member, often crying uncontrollably, is the center of attention as he exposes his personal problems which he hopes peyote will help him solve. ( 1 1 0 )

Slotkin emphasizes that to get the most from the meeting, the per-son should not adopt a passive attitude of receiving from peyote, but must prepare through intensive prior concentration on his particular prob-lem. (103)

The peak of the experience is the surrender of the individual, or in more modern terms, the giving up of the ego—"ego death. " Petrullo writes, "Unless one decides to surrender himself completely to peyote no benefit will be derived. "* (91) There is also the recognition that psychic surrender may involve intense suffering. An informant reported to Sim-mons during the ceremony:

sential prerequisite of almost all natural conversion experiences. There is in-variably a "feeling of submission—of giving up, or giving to. " (32)

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es-If there is suffering, this is the time. That's the reason I took a good rest; so I could stand it. Many a time I have fallen over at this time. It's getting on to what they call the dark hour, the hour of the Cru-cifixion. Everyone here is suffering now. (Quoted in La Barre. ) (64) A related aspect of the ceremony is the role of public confession. La Barre stresses the importance of this aspect:

Many members rise and accuse themselves publicly of misdemeanors or offenses, asking pardon of persons who might have been injured by t h e m . . . that confession to the father peyote and his authority, and repentance before the group, are of profound significance can-not be doubted. (64)

Skinner describes meetings where the leader asks the members to rise and confess their sins; (102) and an informant of Stewart's insists that "no one can face it (peyote) and lie. " ( 1 1 2 ) La Barre writes:

The significance of a group ritual, as in the peyote cult (aided here by the awesome pharmaco-dynamic "authority" of a powerful nar-cotic) may serve to explain the age-long survival of this kind of primitive psychotherapy (public confession), and its re-emergence and spread in the modern religion of the Plains, the peyote cult. (63) La Barre goes on to interpret the functions of the father-peyote fetish: The psychological function of the fetish is to give physical form and locus to the projected "spiritual" entities, through which men

dis-claim responsibility for their own emotions, wishes and acts. T h e fetish may then serve as an externalized superego, or conscience, "projected" outside the individual. (63)

Whites who witness the peyote ceremonies typically come away very impressed with the sincerity of the participants. For instance, La Barre writes:

There can be no shadow of a doubt concerning the deep and humble sincerity of the worship and b e l i e f — a n d sincerity perhaps, even in the absence of other ingredients, is the chief component of a living religion. A n d if the chief function of a religion is the liquidation of the anxieties and the solutions of the fears and troubles of its ad-herents, then surely the peyote religion eminently qualifies as such. *

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Turning now to motivation for taking peyote, as stated by the Indians themselves, there are several hundred interviews with peyotists available in the ethnological literature and in testimony at the many legal hearings held in the last half century. T h e most frequent claim of benefit is that peyote has cured a physical illness. In addition, there are many claims of

ritual is typical, there are some noteworthy exceptions; Opler, in particular, describes the ritual in the Mescalero tribe as a struggle between rival shamans to gain power through the use of witchcraft, and there is a great deal of suspicion and distrust among participants. (88)

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9

having been freed from alcoholism and led to adopt the ethics of the "Peyote Road"—brotherly love, care of family and self-reliance—which are virtually identical with those of Christianity. The most strikingly con-sistent report made by the Indians is that ( 1 ) peyote teaches and (2) this teaching takes place by direct revelation from peyote to the devotee. Over and over the answer given to inquiries about the nature of the peyote experience is that the only way to learn is directly from peyote. Slotkin writes that one of the cardinal maxims of the Native American Church is that "the only way to find out about peyote is to take it, and learn from peyote yourself"; (103) and: "It may be interesting to know what others have to say; but all that really matters is what one has directly experi-enced—what has been revealed to him personally by peyote. " (104) John Wilson, one of the principal founders of the peyote religion, claimed that: The greatest teacher for the Indians is peyote communion which is possible to everyone provided he manifests the proper honesty of purpose to know peyote and learn its teachings. By eating the plant and concentrating on peyote and the ills that afflict mankind, by a proper show of humility and the desire to learn to "walk on the road, " this end can be attained. Thus, each individual is to learn the doc-trines of peyote through personal experience and revelation. (91) The concept of the direct teaching of peyote is probably expressed most succinctly by the often-quoted statement of Quanah Parker, one of the early peyote leaders: "The white man goes into his church house and talks about Jesus; the Indian goes into his tepee and talks to Jesus. " (104)

Other statements by Indians refer to the continued capability of peyote to teach: "Peyote is a lifetime education. You will learn new things every time you attend a meeting. " (41) One of Slotkin's informants, a peyotist for 30 years, claimed to be "just a beginner" in discovering what peyote had to teach. (103) The observation that peyote and its synthetic equivalent, mescaline, teach has not been limited to the Indians, as dem-onstrated in familiar statements by Ellis, Huxley, Osmond, and others.

(46, 60, 90)

I have dealt at some length with the issue of "learning" and the psychotherapeutic effect from the use of peyote because it is an important dimension in the consideration of all hallucinogenic drugs. It is this unique claim that sets these substances apart from other drugs that alter central nervous system functioning and makes their evaluation such a complex question—one seldom hears reports of learning from alcoholic intoxica-tion—save perhaps to observe more moderation.

Ethnological Explanation of Peyotism

Ethnologists have offered a variety of explanations for the diffusion of peyotism among the American Indians. Probably the best known is Ruth Shonle's hypothesis that the Plains Indians long had valued visions Produced by fasting and self-torture, * and accepted peyote as a more direct means to this goal. (100) At the time of her article (1925),

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tism was largely confined to the Plains. She postulated that an "under-lying belief in the supernatural origin of visions is important among factors contributing to the diffusion of peyote and in a general way defines the area of its probable spread. "

Barber (1941) and La Barre (1960) feel that Shonle's prediction has been at least partially confirmed by the subsequent diffusion of peyotism. (10, 65) The latter points out that where peyotism has spread beyond the Plains it has encountered more opposition; and, though the peyote leaders came from the old elite in the Plains, they did not do so in other areas.

Arth suggests that peyote may also appeal as a method of expressing indirect aggression toward the whites, because of the latter's continued op-position to the movement. (9) In addition, he and others have noted that the Indian nature of the peyote cult represents a return to the old way of life and a reaffirmation of in-group feelings. As evidence, Arth cites the preference for summer meetings in tepees to winter meetings in frame houses, and that the fire, drum, songs, sitting on the floor, and smoking all demonstrate strong ties with the past.

Finally, a number of writers contend that peyotism proved attractive because it was introduced at a time when the old culture was breaking up, and the Indians found themselves in an anxiety-producing transitional

state between the Indian and white cultures. Thus, the peyote cult offered unity and meaning at a time when it was greatly needed. Both Arth and Spindler support this argument with evidence that the cult has been much more enthusiastically accepted by men than by women. (9, 109) They argue, along with Margaret Mead, (81) that the breakdown of culture is almost always of more vital concern to the men than to the women, who continue to bear children, cook, etc. In addition, Spindler has made de-tailed studies of Indian acculturation processes, and concludes that peyo-tism is most attractive to the person in a transitional state. (109)

Of those who view the peyote cult as an attempt to adjust to a dis-integrating culture, Petrullo probably makes the most positive assessment:

It teaches acceptance of the new world, and makes possible an atti-tude of resignation in the face of the probable disappearance of the Indian groups as distinct people, culturally and racially, by insisting on the necessity of emancipation from mundane aspirations. The greater goal that the Indian should attempt to attain is a loftier spiritual realm which is beyond the reach of the white to destroy.

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Bromberg, a physician, specifically attacks Petrullo's interpretation: Peyote, as with all drugs, is taken because it produces a change in the feelings and emotions of the user. Thus sedatives allay anxieties and restlessness; alcohol reduces the sharpness of frustrations; morphine and heroin ease the pain of isolation; marihuana, by producing other-worldly sensations, neutralizes the frustrations of this life. So peyote acts not so much to support a cultural drive, but as an anodyne to ease the pain of conflict which the clash of cultures engenders. In this sense, peyotism as spiritual therapy implies a negative attitude to-wards emotional problems. To seek to gain permanence for a culture

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by the repression of conflicts through narcotics and mysticism is not a "constructive" way of life! (25)

The positions of Petrullo and Bromberg quite clearly delineate the two poles of the peyote issue. The former feels that the peyote cult repre-sents a positive adjustment, though one more compatible with an Eastern than a Western value system. The latter adopts a pragmatic Western view, and feels that the ceremonial use of peyote is a non-constructive avoidance of the problem.

Frequency of Use and the Question of Addiction

The average consumption of peyote buttons at a meeting is around twelve to twenty a person according to La Barre, with occasional indi-viduals claiming to have eaten as many as eighty to one hundred. (64) Shultes and Slotkin both report the average number to be about twelve. ( 1 1 7 , 103) Stewart puts the average at eight to twelve, and Skinner re-ports that the Iowas take about two to eight. ( 1 1 2 , 102) Women par-ticipants consume considerably less, typically from two to four buttons.

The frequency of meetings varies, the upper limit generally being once a week; meetings may be much less frequent due to lack of a host, inclement weather, or unavailability of peyote. La Barre estimates that "one or two meetings a month in each tribe might be an average number when the whole year is considered. " (64) Individual attendance at meet-ings also varies; some persons only attend occasionally.

In rare instances a meeting will last for two or three days, particularly if the purpose is to cure a serious illness. The incidence of peyote intoxica-tions sustained for several days is of interest because it bears on the ques-tions of addiction or excessive use under uncontrolled condiques-tions. Radin reports an incidence of a dramatic conversion resulting from taking peyote on three successive days, (92) and John Wilson, the principal founder of the peyote cult, withdrew to an isolated spot and took peyote frequently over a two-week period at the time of his revelations. (64) Such cases, however, are relatively rare, the normal interval between ritualistic peyote ingestion being at least a week.

Concerning non-ritual use of peyote, some tribes strictly forbid its use outside the ceremonial setting; (88) however, others use it as medi-cine, generally in the form of peyote tea. (103) Louise Spindler reports that in the Menomini tribe women peyotists often keep a can of ground peyote for brewing tea, which they use "in an informal fashion for such things as childbirth, earaches, or for inspiration for beadwork patterns. "

( n o ) She also mentions one woman who "takes peyote several times a week and often sinks into a state of complete withdrawal while taking it. "

La Barre writes that his informants admitted "that there were some individuals who show signs of addiction, in the sense that they consumed the plant often and abundantly, but these are not clear uncomplicated instances of drug addiction. " (64) In spite of occasional cases such as these, there is general agreement that peyote should not be included under the vague labels of psychologically addicting or habit-forming drugs. (66)

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In a 1959 summary article on peyote in the Bulletin on Narcotics it was concluded: "Most of the authors consulted... including scientists, chem-ists, doctors, and ethnologists long familiar with these substances (peyote and mescaline) state roundly that they do not cause either habituation or addiction. " (6) Also, peyote was discussed by the Twenty-First Session of

the League of Nations Advisory Committee on Traffic in Opium and Other Dangerous Drugs and was not included on the list of narcotic drugs. (6) Finally, the 1962 White House Conference on Narcotic and Drug Abuse concludes that:

Careful anthropological and sociological studies indicate that the ritualistic use of peyote does not carry with it significant danger, nor is it abused continuously.... In order to qualify this drug as an "addictive" agent one must clearly distort the definition. ( 1 2 1 ) As mentioned above, peyote meetings are frequently a month or more apart. Individuals often try the peyote cult for a period and then drop out, and though peyotism has steadily increased, there are tribes where it has flourished and then completely disappeared. (89, 1 1 2 )

Physical Effects

Peyote often causes nausea and vomiting, but otherwise the immedi-ate physiological effects are minor compared to the psychological. The major concerns are the long-term physiological effects resulting from re-peated use, and more especially the incidence of psychoses. Unfortunately, there has never been a medical study of the long-term effects on humans, in spite of the fact that the question has been raised repeatedly at the many legal hearings. The 1944 Congressional Hearing Committee specifically recommended that such a study be conducted and the Taos Indians of-fered to provide the subjects. ( 1 1 7 ) Thus, information is limited to the observations of ethnologists, and the pro and con testimony at the legal hearings.

The issue of the effect of peyote on physical health is somewhat clouded by the Indians' practice of doctoring severe illnesses in meetings. Stewart reports that the anti-peyotists among the Washo and Paiute Indians claimed a number of deaths resulted from peyote, and the gov-ernment doctor made several post-mortem investigations:

All believers allegedly killed by peyote demonstrably suffered from disease or senility which might at any moment have brought death and which figured as the cause in official reports. It is probable, how-ever, that the rigors of peyote meetings hastened the deaths of a few dangerously ill individuals. ( 1 1 2 )

Most observers regard the introduction of alcohol to the Indians to be much more devastating than peyote. (94) This seems likely, since alcoholism involves frequent intakes of large amounts of alcohol, and is known to cause various physical pathologies, whereas peyote is typically taken at much less frequent intervals.

The Second International Conference on the Use of LSD in Psychotherapy and Alcoholism

The Use of

LSD in Psychotherapy

and Alcoholism

Edited by Harold A. Abramson, M.D.

Introduction by Dr. Frank Fremont-Smith

FROM THE TABLE OF CONTENTS

Research Associate, Department

of Psychology, University of Southern California

Director, Communication Research Institute, Miami; St.

Thomas, V.I.

Senior Hospital Medical Officer,

Marlborough Day Hospital, London

Research

Psychiatrist, Psychiatric Research Institute, Prague

Training and

Supervisory Analyst, William Alanson White Psychoanalytic

In-stitute, New York City

Staff Psychiatrist, New

Jersey Reformatory at Bordentown, Mercer Hospital

Director, Psy-

chiatric Research, Department of Public Health, Saskatchewan

Director, Bureau of Neurology and Psychiatry, New Jersey

Neuropsychiatric Institute

Medical Director, National Council on Alcoholism

Chief, Psycho

somatic Medicine, Veterans Administration Hospital, Los

Angeles

Director,

Direc-tor, Psychological Service,

Director

of Research,

Clinical Director, South Oaks

Psychiatric Hospital, Amityville, New York

The Use of

LSD IN

PSYCHOTHERAPY

and Alcoholism

Front

jacket

flap

Back

jacket

flap

The Use of

LSD in

Psychotherapy

and Alcoholism

Edited by Harold A. Abramson, M. D.

Introduction by Frank Fremont-Smith, M. D.

A Subsidiary of Howard W. Sams & Co., Inc.

Publishers

—Indianapolis New York Kansas City

Introduction

Address:

Preface

Contents

I

Social and Para-Medical Aspects

of Hallucinogenic Drugs