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Thursday, August 2, 2012

Grof - Heuristic Value of LSD Research


Heuristic Value of LSD Research

    Stanislav Grof, M.D.

        An excerpt from Chapter 1 and the Epilog of Realms of the Human Unconscious,
        published by The Viking Press, ©1975Stanislav Grof and Joan Halifax Grof



    Before we discuss the theoretical implications of LSD research, it is necessary to justify the heuristic value of LSD as a tool for the exploration of the human unconscious and the legitimacy of drawing more general conclusions from the work with this compound. There has been a tendency among many professions to discard the experiences in LSD sessions as manifestations of a toxic alteration of the brain function (toxic psychosis) that have little, if any, relevance for the understanding of the human mind as it functions under more natural circumstances. This is a rather basic and serious objection that deserves special attention and careful consideration. The pivotal question that has to be dealt with in this context is whether there exist invariant, constant, and standard effects of LSD that are purely pharmacological in nature, are unrelated to the personality structure of the subject, and occur without exception in every subject who takes a sufficient dose of this drug.
    The phenomena that can occur in the course of LSD sessions cover an enormous range; there exist hardly any perceptual, emotional, or psychosomatic manifestations that have not been observed and described as part of the LSD experience. The extreme multiformity and interindividual variability of the LSD state is complemented by its equally striking intraindividual variability. If the same person takes LSD repeatedly, each of his consecutive sessions is usually very different from the others in its content, general character, and course. This variability certainly is in itself a serious objection to the idea that the LSD reaction has simple chemical and physiological determinants. The proportion to which various extrapharmacological factors participate in the LSD experience is both interesting and theoretically important.
    The search for the typical, mandatory pharmacological effects of LSD was an important aspect of my analytical work on the LSD data. The result of this quest was rather surprising; after analyzing over thirty-eight hundred records from LSD sessions, I have not found a single symptom that would be an absolutely constant component in all of them and could thus be considered truly invariant. Changes of optical perception are usually presented as a typical manifestation of the LSD state and thus were a serious candidate for pharmacological invariants. Although they occurred rather frequently in our records, there were a number of high-dose sessions where alterations in the optical realm were not present at all even though, in some of these sessions, the dosage amounted to 500 micrograms. Several of the LSD reactions without any visual phenomena had the form of intense sexual experiences; others were characterized by massive somatization manifested in various parts of the body, by feelings of general malaise and physical illness, or by experiences of excruciating pain. Special examples of sessions without optical perceptual changes were observed in advanced stages of psycholytic treatment and in some psychedelic sessions. These involved either a brutal and primitive biological experiential complex described by various subjects as reliving of their own birth or transcendental experiences with a paradoxical quality of being "contentless yet all-containing."
    Physical manifestations of the LSD state deserve special notice in this context, since, in the early reports, they were considered simple pharmacological effects and a result of direct chemical activation of the vegetative centers in the brain. Careful observations of a large number of sessions and analysis of the records did not support this explanation. The spectrum of the so-called "vegetative symptoms" is very broad and exceeds that of any known drug with the exception of some other psychedelics. Strangely enough, these symptoms include both sympathetic and parasympathetic phenomena, and they appear in clusters involving various combinations thereof. The physical concomitants of the LSD reaction vary considerably from session to session. They are practically independent of the dosage used, and there is no demonstrable dose-effect relationship. In many high-dose LSD sessions, physical manifestations were entirely absent, or they occurred intermittently and in close association with difficult and strongly defended unconscious material. Another aspect of these symptoms that could be mentioned here is their unusual sensitivity to various psychological factors; they can often be modified or even terminated by various external influences and specific psychotherapeutic interventions. One of the physical manifestations of the LSD reaction deserves special emphasis—namely, dilation of the pupils (mydriasis). It is so common that its presence has been used by many experimenters and therapists as a reliable indicator that the person is still under the influence of the drug. For a long time, mydriasis was also a serious candidate for an invariant manifestation of the LSD effect in my investigations. Later, I witnessed several LSD sessions, some of them very dramatic, in which the pupils of the subject appeared constricted, or in which they oscillated rapidly between extreme dilation and constriction. A situation similar to that of the vegetative symptoms existed in the area of gross physical manifestations, such as muscular tonus, tremors, twitches, seizure-like activities, and various twisting movements. None of these symptoms was standard and predictable enough to be considered a specific pharmacological effect of LSD. This does not mean that LSD per sedoes not have any specific physiological effects; these can be clearly demonstrated in animal experiments, which use incomparably higher dosages. My experience, however, indicates that, within the range of doses commonly used in human experiments or in psychotherapeutic practice, physical manifestations are not the result of a direct pharmacological stimulation of the central nervous system. They seem to reflect chemical activation of psychodynamic matrices in the unconscious and have a structure similar to those of hysterical conversions, organ-neurotic phenomena, or symptoms of psychosomatic disorders.
    As unpredictable as the content of the LSD reaction is its intensity; the individual responses to the same dosage level vary considerably. My experience indicates that the degree of sensitivity or resistance to LSD depends on complicated psychological factors rather than on variables of a constitutional, biological, or metabolic nature. Subjects who in everyday life have the need to maintain full self-control and have difficulties in relaxing and "letting go" can sometimes resist relatively high dosages of LSD (300 to 500 micrograms) and show no detectable changes. Occasionally, a person can resist a considerable dose of LSD if he has set this as a personal task for himself for any reason. He may decide to do this to defy the therapist and compete with him, to demonstrate his "strength" to himself and to others, to endure more than his fellow patients, or for many other reasons. Usually, however, more relevant unconscious motives can be found underlying such superficial rationalizations. Another cause for a high resistance to the effect of the drug may be insufficient preparation, instruction, and reassurance of the subject, a lack of his full agreement and cooperation, or absence of basic trust in the therapeutic relationship. In this case, the LSD reaction sometimes does not take its full course until the motives of resistance are analyzed and understood. Occasional sudden sobering, which can occur at any period of the session and on any dosage level, can be understood as a sudden mobilization of defenses against the emergence of unpleasant traumatic material. Among psychiatric patients, severe obsessive-compulsive neurotics are particularly resistant to the effect of LSD. It has been a common observation in my research that such patients can resist dosages of more than 500 micrograms of LSD and show only slight signs of physical or psychological distress. In extreme cases, it can take several dozen high-dose LSD sessions before the psychological resistances of these individuals are reduced to the point that they start having episodes of regression to childhood and become aware of the unconscious material that has to be worked through. The excessive resistance of obsessive-compulsive patients can be illustrated by the following clinical example.
Erwin, a twenty-two-year-old student, was referred to the LSD treatment program after four years of unsuccessful therapy for a severe obsessive-compulsive neurosis. Over the years, he had developed a very complicated system of obsessive thoughts and became so preoccupied with it that it paralyzed all his other activities. He was compelled to imagine in his mind's eye a geometrical structure with two coordinate axes and locate within this system all the problems and duties he encountered in his everyday life. At times he spent many hours desperately trying to find the proper location for some aspect of his existence, but always without success. Before admission, he felt that the center of gravity of his imaginary coordinate system was shifting to the left; this upset him enormously and resulted in feelings of tension, apprehension, anxiety, insecurity, and depression. In addition, Erwin suffered from various psychosomatic symptoms and tended to interpret them in a hypochondriacal way. He was referred for psycholytic therapy after several hospitalizations and unsuccessful treatment with tranquilizers, antidepressants, and drug-free psychotherapy. Erwin manifested a rather spectacular resistance to the effect of LSD. After psychological preparation of two weeks' duration, he started having regular LSD sessions in weekly intervals. The initial dose of 100 micrograms was increased by fifty to one hundred micrograms every week, since he barely showed any response. Finally, he was given 1500 micrograms intramuscularly, with the hope that this would overcome his resistance. Between the second and third hour of the session, when the effect of [SD usually culminates, Erwin felt bored and a little hungry; according to his description as well as external manifestations, nothing unusual was happening. He seemed to be so well composed and in such full control that he was allowed to go with the therapist to a kitchenette on the ward, cut a piece of bread with a knife, open a can of liver paste, and have a snack. After he was finished, he wanted to go to the social room in the ward and play chess, because he felt he needed some distraction from the uneventful and monotonous therapeutic experiment.
    It took thirty-eight high-dose sessions before Erwin's defense system was reduced to the point that he started regressing into childhood and reliving traumatic experiences.

    It became obvious after this and similar observations that high psychological resistance to LSD cannot be broken merely by an increase in dosage and that it has to be gradually alleviated by a series of sessions. It seems that there exists a saturation point for LSD somewhere between 400 and 500 micrograms; if the subject does not respond adequately to this dosage, additional LSD will not change anything in the situation.
    After demonstrating that LSD does not have any clear, invariant drug effects on the dosage level commonly used in experimental and clinical work with human subjects, we can ask what the effects of LSD actually are. According to my experience, they are rather unspecific and can be described only in very general terms. In a great majority of sessions, there is an over-all tendency toward perceptual changes in various sensory modalities. Consciousness is usually qualitatively altered and has a dreamlike quality. Emotional reactivity is almost always greatly enhanced, and affective factors play an important role as determinants of the LSD reaction. A rather striking aspect of the LSD effect is a marked intensification of all mental processes and neural processes in general; this involves phenomena of a different nature and origin. Pre-existing and recent psychogenic symptoms as well as those that the individual had suffered from in childhood or at some later period of his life can be exteriorized, amplified, and experienced in the LSD sessions. Traumatic or positive experiences from the past connected with a strong emotional charge are activated, brought forth from the unconscious, and relived in a complex way. Various dynamic matrices from different levels of the individual and collective unconscious can be brought to the surface and consciously experienced. Occasionally, phenomena of a neurological nature can be amplified and manifested in the sessions; frequently these are pains associated with arthritis, dislocation of vertebral disks, inflammatory processes, or postoperative and post-traumatic changes. Particularly common is reliving of sensations related to past injuries and operations; it is interesting from the theoretical point of view that LSD subjects seem to be able to relive even pains and other sensations related to past operations that were conducted under deep general anaesthesia. The propensity of LSD to amplify various neurological processes is so striking that it has been used with success by several Czech neurologists as a diagnostic tool for the exteriorization of latent paralyses and other subtle organic damage of the central nervous system. The negative aspect of this interesting property of LSD is the fact that it can activate seizures in patients suffering from manifest epilepsy or those who have a latent disposition to this disease.
    By and large, I have not been able to discover during the analyses of my data any distinct pharmacological effects of LSD in humans that would be constant and invariant and could therefore be considered drug specific. At the present time, I consider LSD to be a powerful unspecific amplifier or catalyst of biochemical and physiological processes in the brain. It seems to create a situation of undifferentiated activation that facilitates the emergence of unconscious material from different levels of the personality. The richness as well as the unusual inter-and intraindividual variability of the LSD experience can thus be explained by the decisive participation of extrapharmacological factors, such as the personality of the subject and the structure of his unconscious, the personality of the therapist or sitter, and the set and the setting in all their complexity. The capacity of LSD and some other psychedelic drugs to exteriorize otherwise invisible phenomena and processes and make them the subject of scientific investigation gives these substances a unique potential as diagnostic instruments and as research tools for the exploration of the human mind. It does not seem inappropriate and exaggerated to compare their potential significance for psychiatry and psychology to that of the microscope for medicine or the telescope for astronomy.
    In the following chapters, I have attempted to outline the cartography of the human unconscious as it has been manifested in LSD sessions of my patients and subjects. I have been quite encouraged by the fact that in various areas of human culture there are numerous indications that the maps of consciousness emerging from my LSD work are fully compatible and sometimes parallel with other existing systems. Examples of this can be found in C. G. Jung's analytical psychology, Roberto Assagioli's psychosynthesis, and Abraham Maslow's studies of peak experiences, as well as religious and mystical schools of various cultures and ages. Many of these frameworks are based not on the use of psychedelic drugs but on various powerful nondrug techniques of altering consciousness. This parallel between the LSD experiences and a variety of phenomena manifested without chemical facilitation provides additional supportive evidence for the unspecific and catalyzing effect of LSD.
    The description of the new model of the unconscious based on LSD research presents considerable difficulties. This model reflects a multidimensional and multilevel continuum of mutually overlapping and interacting phenomena. For didactic purposes, the object of discussion has to be dissected and its elements isolated from their broader contexts. Each attempt to communicate this model in a linear form necessarily results in a certain degree of oversimplification and artificiality. With full awareness of the disadvantages and limitations involved in such an undertaking, we can delineate for the purpose of our discussion the following four major levels, or types, of LSD experiences and the corresponding areas of the human unconscious: (1) abstract and aesthetic experiences, (2) psychodynamic experiences, (3) perinatal experiences, and (4) transpersonal experiences.

Epilog to Realms of the Human Unconscious

    I am presenting this book to my professional colleagues and to the general public with somewhat mixed feelings and not without hesitation. I am fully aware how unusual and surprising some of its sections must seem to a reader who has not had a firsthand experience with psychedelics or some other type of altered state of consciousness. I know from my own personal development how difficult it was for me to consider seriously and accept the implications of some of the quite extraordinary observations from LSD sessions. I had resisted the influx of the revolutionary new data that I was exposed to in my everyday clinical work and kept trying to explain them within the accepted theoretical frameworks, until my tendency to defend traditional ways of thinking was defeated and overwhelmed by an avalanche of indisputable clinical facts. Whenever I violated the boundaries of tradition, conventional thinking, and commonly shared assumptions, it was only because rather convincing evidence made the old concepts incomplete, unsatisfactory, implausible, or untenable. I would like to emphasize in this context that I did not indulge in iconoclastic pleasure in opposing the existing concepts and theories. On the contrary, having been rather conservative by nature, I experienced a considerable amount of discomfort when the accepted systems proved inadequate. I had to suffer through a long period of rather unpleasant conceptual chaos, with a painful lack of any meaningful guidelines. This lasted until I developed a broader theoretical framework that seemed to introduce new order into the research data and made possible a simplifying integration and synthesis of the most important observations.
    Looking for an appropriate form to communicate my findings, I rejected what seemed to be a tempting alternative, namely censoring or truncating some of the most unusual observations in order to avoid disapproval and harsh criticism. In addition to being personally and professionally dishonest, such an approach would have defeated the very purpose for which this book was written. It seemed important to share the data in their true form, including the challenge that they represent to our common sense and to scientific thinking. I have therefore decided to take the risk of attacks, fierce criticism, and possible ridicule for the sake of integrity and accurate reporting.
    I do not anticipate that it will be easy for the reader to accept the ideas expressed in this book; it is reasonable to expect that the skepticism of others in regard to the data will not be less acute than that which I experienced myself. The most conclusive confirmation or rejection of the presented material will have to come from similar studies conducted by other researchers. Theoretically, of course, the research described in this book is replicable, even if the present political and administrative situation in regard to drug investigations makes such a task rather difficult. Indirectly, the validity of the presented concepts can be tested in the situation of the uncontrolled experiment happening on a large scale in the contemporary United States, namely the unsupervised use of psychedelic drugs. The persons who have taken LSD and those mental-health professionals who have worked with such individuals will be able to judge to what extent the described cartography of the unconscious is congruent with their experience. Another indirect way of testing the new conceptual framework is to apply it to various states in which the activation of the unconscious material is induced by powerful nondrug techniques. Numerous examples can be found in religious scriptures, mystical writings, and anthropological books and journals, as well as in contemporary literature on experiential psychotherapeutic techniques and laboratory mind-altering procedures.
    The significance of the LSD observations transcends the framework of psychiatry and psychology and extends to many other scientific disciplines. It is far beyond the capacity of a single individual to outline and evaluate all the implications and consequences of the findings in their entirety. Detailed study of psychedelic phenomena would require a long-term systematic team cooperation of experts from diverse disciplines, such as psychology, psychiatry, neurophysiology, neuropharmacology, ethnobotany, modern physics, zoology, ethology, genetics, internal medicine, obstetrics and gynecology, anthropology, history of art, theology, philosophy, and comparative study of religion and mythology.
    At the present time, the future of psychedelic research is problematic, and it is uncertain whether it will be possible to replicate the study of serial LSD sessions described in this book. In any case, it will undoubtedly take a long time before such studies will be completed and will generate new data. In the meantime, I would like to offer the material on which this book is based for detailed analysis to every serious researcher who finds it of interest from the point of view of his own discipline. In turn, I would appreciate any critical comments and suggestions from the specialists of various disciplines that would help to clarify the findings described in this volume.

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