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Thursday, August 2, 2012

Hoffer - Criticisms of LSD Therapy and Rebuttal


  Criticisms of LSD Therapy and Rebuttal

    Abram Hoffer & Humphrey Osmond

        from: THE HALLUCINOGENS  ©1967 Academic Press


Introduction
The following article is typical of the best of the scientific community's resistance to the prohibition of further use of psychedelics such as LSD, mescaline and psilocybin in research and psychotherapy. By the mid-1960's, several important studies had indicated not only the great safety of such use of psychedelic drugs, but also the great utility of these age-old medicines for a variety of modern curing techniques. The Canadian government, for example, had approved psychedelic therapy as by far the best and most effective treatment for alcoholism ever devised. Yet the prohibitionists both in government and the scientific establishment itself, soon carried the day and a Great Inquisition began, first in the United States but later around the world, in which even legitimate scientific research with psychedelic drugs was completely stifled. A very small and insignificant relaxation of these draconian restrictions has recently occurred, but the research permitted of late has only barely begun to re-trace the territory already well-covered in the 1950's. The article is taken from pp 197-205 of The Hallucinogens.
— Peter Webster       


Within a few months after LSD was introduced into North America the ideas generated by the LSD experience produced a good deal of criticism. The unhappy Harvard affair brought this situation to a boil and it spilled over into the popular press. Critics have been very effective in creating a climate of opinion hostile to the use of LSD. There is an inverse square law which states that the degree of hostile criticism varies inversely with the square of the distance from any first-hand experience and knowledge of the drug.
Thus, in Canada the greatest resistance against LSD came from the professors who were least familiar with it. Our criterion of familiarity is the number of research papers published in scientific journals.
This criticism seems entirely based on factors described by Barber (1961). These include (a) substantive concepts and theories held by scientists at any given time, (b) an antitheoretical bias, (c) religious ideas, (d) professional standing, (e) professional specialization, and (f) societies, schools, and seniority. The criticism has sometimes taken on a cultic attitude and there has been private circulation of papers which have been unavailable to the general reader (Tyhurst, 1964b). In addition, critics have issued public pronouncements to the press, radio, and television which have not been based upon published data. It is therefore important to list the criticisms and then examine them carefully in order to determine whether they need be taken seriously or not. Before doing so we will quote Michael Polanyi (1956) because he makes the case so well. If we are to convince our opponents of the potential value of LSD therapy they must be converted by exposing them to careful data, reasoned argument, and a firm determination to do our work as we see fit and not to become their laboratory technician trying to disprove every will of the wisp they may conjure up.
"Scientists—that is creative scientists—spend their lives in trying to guess right. They are sustained and guided therein by their heuristic passion. We call their work creative because it changes the world as we see it, by deepening our understanding of it. The change is irrevocable. A problem that I have once solved can no longer puzzle me; I cannot guess what I already know. Having made a discovery, I shall never see the world again as before. My eyes have become different; I have made myself into a person seeing and thinking differently. I have crossed a gap, the heuristic gap which lies between problem and discovery.
"To the extent to which discovery changes our interpretive framework, it is logically impossible to arrive at it by the continued application of our previous interpretative framework. In other words, discovery is creative also in the sense that it is not to be achieved by the diligent application of any previously known and specifiable procedure. Its production requires originality. The application of existing rules can produce valuable surveys, but they can as little advance the principles of science as a poem can be written according to rule. We have to cross the logical gap between a problem and its solution by relying on the unspecifiable impulse of our heuristic passion, and must undergo as we do so a change of our intellectual personality. Like all ventures in which we comprehensively dispose of ourselves, such an intentional change of our personality requires a passionate motive to accomplish it. Originality must be passionate.
"But this passionate quest seeks no personal possession. Intellectual passions are not like appetites; they do not reach out to grab, but set out to enrich the world. Yet such a move is also an attack. It raises a claim and makes a tremendous demand on other men; first it asks that its gift—its gift of humanity—be accepted by all. In order to be satisfied, our intellectual passions must find response. This universal intent creates a tension. We suffer when a vision of reality to which we have committed ourselves is contemptuously ignored by others. For a general unbelief threatens to evoke a similar response in us which would imperil our own convictions. Our vision must conquer or die.
"Like the heuristic passion from which it flows, the persuasive passion too finds itself facing a logical gap. To the extent to which a discoverer has committed himself to a new vision of reality, he has separated himself from others who still think on the old lines. His persuasive passion spurs him now to cross this gap by converting everybody to his way of seeing things, even as his heuristic passion has spurred him to cross the heuristic gap which separated him from discovery.
"We can now see the great difficulty that may arise in the attempt to persuade others to accept a new idea in science. To the extent to which it represents a new way of reasoning, we cannot convince others of it by formal argument, for so long as we argue within their framework we can never induce them to abandon it. Demonstration must be supplemented therefore by forms of persuasion which can induce a conversion. The refusal to enter on the opponent's way of arguing must be justified by making it appear altogether unreasonable.
"Such comprehensive rejection cannot fail to discredit the opponent. He will be made to appear as thoroughly deluded, which in the heat of the battle will easily come to imply that he was a fool, a crank, or a fraud. And once we are out to establish such charges we shall readily go on to expose our opponent as a metaphysician, a Jesuit, a Jew, or a Bolshevik, as the case may be or—speaking from the other side of the Iron Curtain—as an 'objectivist,' and 'idealist,' and a 'cosmopolitan.' In a clash of intellectual passions each side must inevitably attack the opponent's person."
Here are the current claims made by critics:
1. LSD is a dangerous drug.
2. Long-term personality changes cannot be produced by LSD.
3. No good can come from a chemically induced delirium or psychoses.
4. It "has not been proved to be effective or safe for any psychiatric condition" (Cole and Katz, 1964).
(a) because there are no detailed, carefully controlled studies designed to be free from possible distortions due to bias or enthusiasm,
(b) because explanations given are often formulations not common either to medicine in general or psychiatry in particular,
(c) because explanations have a mystical or philosophical sound which appeals to enthusiasts—but are likely to produce doubt or even violent disbelief and concern in physicians used to a more pragmatic approach,
(d) because components of the therapeutic process described may often have a bizarre—almost schizophrenic—component which tends to make serious investigators discount this whole area as a delusional belief shared by a group of unstable clinicians.
Please read Polanyi's argument again. The rebuttal to these criticisms is not difficult.
1. Is LSD a dangerous drug? Of course it is, so is salt, sugar, water, and even air. There is no chemical which is wholly safe nor any human activity which is completely free of risk. The degree of toxicity or danger associated with any activity depends on its use. Just as a scalpel may be used to cure, it may also kill. Yet we hear no strong condemnatory statements against scalpels, etc. When LSD is used as treatment by competent physicians who are trained in its use it is no more dangerous than psychotherapy. It certainly is less dangerous than ECT insulin subcoma, and the use of tranquilizers and antidepression compounds. Statements that LSD is dangerous really are meaningless as they stand. Every clinician working with LSD who has published his data uniformly agrees it must be used by physicians with proper safeguards for the safety of the patient. There are no known physical contraindications.
2. Long-term personality changes cannot be produced. There is a curious quality about these criticisms for while it is generally denied that patients who experience LSD can be permanently changed it is, on the contrary, assumed that psychiatrists very readily suffer permanent deformations of their personality, and it is claimed that they are now overly enthusiastic and even delusional and no longer competent to honestly judge their own therapeutic efforts. It has been stated that only claims made by therapists who have not themselves taken LSD are valid (see Cole and Katz, 1964). If this argument were generally accepted in medicine no surgeon who had recovered from an acute appendicitis by surgery would be competent to judge results of his surgery on patients.
The claims of many authors that the psychedelic experience could produce a permanent change in patients have been rejected by many psychiatrists whose orientation is psychoanalytic. It is basic to their belief to assume that each person has a stable personality which is altered with great difficulty. People become sick because their personality has been warped or not allowed to develop due to pathological relationships with their parents. The only sure way of changing these twisted personalities is by a thoroughgoing analysis of many years duration during which all the roots of the pathological personality are uncovered and treated. Any other treatment, psychotherapy, or drug therapy is considered merely symptomatic treatment which leaves the patient superficially better. Obviously these psychiatrists cannot accept rapid permanent personality changes. Another group are psychologists who have accepted the hypothesis that personality is a stable attribute to man.
This reluctance to believe that people can be permanently altered in a short time seems strange. History is replete with these sudden transformations. Religions and mass self-help movements, for example Alcoholics Anonymous, originated from these changes. William James described many of them in "The Varieties of Religious Experience" (1902). Unger (1963a) has given a particularly lucid account of the issue of rapid personality change. Maslow (1959) has described this phenomena as "peak" experience and Sargant (1957) tried to abstract those factors which make man susceptible to these rapid changes. According to Sargant two factors are essential, (a) a state of increased excitation in the subject, (b) persuasion. He included psychoanalysis as one of the conversion techniques together with religious conversions, etc.
We have already referred to research reports where permanent personality changes were demonstrated (McGlothlin, 1962, 1964; McGlothlin et al., 1964; Mogar et al., 1963, Mogar and Savage, 1964).
3. No good can come from a chemically induced delirium or psychosis. This criticism so contradicts man's experience with drugs that it requires no answer.
4. LSD has not been proved to be effective or safe for any psychiatric condition (Cole and Katz, 1964). These critics assume that no therapy is "proved" unless a double blind comparison experiment is conducted. The word "proved" is a strange one in clinical science. Usually clinical scientists define the level of confidence or proof by a probability. That is, they will if they are statistically inclined, accept a 5% level of confidence. They will accept as proof a finding if there is only 5% chance the claims are wrong. Others may demand much stronger evidence and some may be satisfied merely with an indication. In general no statement demanding proof has any scientific meaning unless the author indicates which level of proof he would accept. Using a puristic point of view one could claim no psychiatric therapy has been "proven" to be effective for any psychiatric condition.
Criticism 4(a) really is a demand for double blind studies of LSD. The answer consists of two parts, (a) are double blind studies really superior to classical methods in proving drug efficiency and (b) is it possible to double blind LSD.
The majority of clinicians have not accepted the oft-repeated claim that double blind techniques are superior to classical clinical methods. As an example Baird (1964) stated "The insistence in recent years on 'blindness' or 'double blindness' in evaluating the effect of therapy is an insult to the intelligence of the average clinician." In addition a large number of scientists who have worked with double blind procedures have become increasingly disenchanted with it. It has been a clumsy expensive method which has; not convinced anyone of its value and which is readily dispensed with when decisive action is required. The toxicity of thalidomide was not proven by double blind studies nor have the many new drugs removed from the market been proven toxic by double blind studies. It appears that when firm action is indicated classical clinical methods are adequate, but when matters of efficiency are involved these methods suddenly become much too crude.
If Baird were unsupported one could ignore him, but when in fact he is supported by (a) eminent statisticians such as Hogben (1957), R. A. Fischer (1963), Chassan (1961, 1963, 1964), Bellak and Chassan (1964), and by others we have reported (Hoffer and Osmond, 1961a, 1962a,b), and by (b) eminent clinicians including S. Cohen, H. Lehmann, and many others, and also (c) eminent psychologists like H. Kluver, then we must ask the proponents of double blind methodology to prove at the usual 5% level of confidence that their methods are more apt to show which chemicals are effective for certain conditions and which are not effective. Until this is done no clinician need feel guilty about using the old-fashioned clinical methods including single case studies, for these were the methods which introduced into psychiatry ECT, tranquilizers, antidepression drugs, open wards, eradication of pellagra psychosis and of general pareses of the insane, and a host of other minor treatments. Better methods will and must be found and double blind methods are indeed useful in mopping up studies. They do serve a useful function as large-scale human toxicity trials and they are more convincing to inspectorial physicians concerned about global efficacy. However they have hung a millstone around our necks which is steadily becoming more burdensome. It is ironic that one man's observation (Lehmann on chlorpromazine) recently required one million dollars to be confirmed—see million dollar fizzle ( Margolis, 1964).
Some critics (see inverse square law, p. 197) have suggested that a placebo be used to double blind LSD. This betrays an extraordinary lack of experience with LSD. No experienced therapist would be in any doubt within one hour about determining whether distilled water or 200 mcg of LSD had been given even if he were blind and could not see the pupillary dilatation produced by LSD. Every scientist who has worked with LSD agrees with this. Only a person completely unfamiliar with psychiatry and with LSD could mistake situational anxiety for the LSD reaction in a nonpsychotic subject. It has been suggested further that a new compound should be developed which would produce the same (or similar) visual changes as LSD. But this is not helpful, since no such compound is known, and if it were, would not prove anything, for it is possible these visual changes are responsible for the therapeutic results. There is no valid reason to suppose LSD is more effective than psilocybin or mescaline. It is the experience not the compound which induces it which is responsible.
However if double blind studies were possible investigators would use them, not because they are better, but because they are more fashionable. Perhaps pretreatment with penicillamine would provide such a design. Statistically identical groups could be pretreated with penicillamine and with placebo. Then all would be given LSD in the usual way. The penicillamine would not interfere with the perceptual component of the experience but would dampen its emotional component. It would be very difficult for therapists to decide which patients had received placebo or penicillamine. One could then conclude that the normal LSD experience was or was not superior to penicillamine-LSD. Our data suggests that the improvement rates would be 10% after penicillamine-LSD and 50% after LSD. However, even such a controlled double blind experiment would not persuade the critics for by then they could have produced newer unverified suggestions.
Criticism 4(b) means little. Any new explanation if it is to be new must be uncommon in medicine or in psychiatry. Commonality of ideas is usually not appealed to by scientists. It applies more to legal and ethical requirements in a court of law. However we find Cole and Katz' (1964) statement most surprising. Presumably they are unfamiliar with the enormous range of theoretical formulations from conservative Freudism to radical biochemical reasoning. We find it difficult to understand how modern psychiatry which bases so much on random events, dreams, ideas, and lapsae linguae can find any formulation uncommon.
Criticism 4(c) is very like 4(b). It is an inevitable consequence of any new idea that it should produce violent disbelief and concern in physicians We should remember that many novel ideas of our past are commonplace today. Just a few examples will demonstrate how science has reversed itself at times. Mendelian theory was resisted from 1865 until about 1900 because Mendel's conceptions ran counter to predominant conceptions of inheritance (were not common to medicine in general). Mendel's peers condescendingly considered his work insignificantly provincial (not common to medicine).
The application of mathematics to biology was seriously questioned for many years. In his biography of Galton, Pearson reported that he sent a paper to the Royal Society in 1900 which used statistics. Before it was published the Council of the Royal Society passed a resolution "that in future papers mathematics should be kept apart from biological applications." Galton founded a new journal and in its first issue wrote "a new science cannot depend on a welcome from the followers of the older one." Harvey, Pasteur, Magendie, Lister, Funk and Fleming all found their ideas severely tested by unreasoning hostile criticism because their ideas were uncommon. It seems new ideas rarely are accepted with an open mind.
Criticism 4(d) is another variant of 4(b) and 4(c). Any new explanation, however sound it may eventually prove to be, seems bizarre, almost schizophrenic, to the defenders of the faith. But it goes a bit further by the adhominem diagnosis of scientists who use LSD for therapy as having states of paranoia (that is sharing a delusional belief). This is, of course, a redundant non sequitur for the definition of delusion is an uncommon idea from which its possessor will not part when confronted with common ideas. This is what these authors have already said in 4(b) and 4(c).
Many factors have been suggested which could account for the therapeutic results claimed by LSD therapists. The usual ones include faith, bad samples, bias in observers, etc. These are possible factors but are they merely possible or are they likely? Before they can be seriously accepted it must be shown that these variables do improve a proportion of alcoholics. Where are the double blinds which prove that faith, bias, etc. can produce equivalent results? We suggest that proponents of these variables should provide data for their favorite hypothesis before they expect others to work them into their clinical studies. The critics of LSD therapy would enormously strengthen their position if they would demonstrate a double blind study of placebo or faith.
The scientific literature [excluding editorials (Grinker, 1963, 1964) and review articles] is singularly affirmative. Every worker who has studied LSD's use for treating alcoholism is in unusual agreement. The only study recorded where there is some disagreement is the study of Ditman et al. (1962). They examined the duration of claims for improvement made by subjects who had been given LSD. The authors stated "the subjects had originally been given 100 mcg of LSD-25 orally in a permissive but non-treatment(1) setting in order to compare the LSD experience with that of delirium tremens." Ditman and Whittlesey (1959) again stated "our subjects received no intended psychotherapy during the LSD experience." Questionnaires were sent to their subjects about 1/2 to 1 1/2 years after their last LSD experience and of those who responded, 27 were alcoholics. Of this group of 27, 18 subjects claimed they were better, that they were in more comfortable circumstances, earning more money, and had decreased or stopped drinking.
In as much as this group had not been given LSD as therapy or in a therapeutic setting and had only received 100 mcg of LSD, which we have found is relatively ineffectual for most alcoholics, this is indeed a surprising result.
However, a second questionnaire two years later was answered by only 16. Of the other 11, 4 had died, 3 from drinking. Of this group of 16, 11 still claimed periods of abstinence ranging from 1 to 1 1/2 years and twelve claimed lasting benefit. These authors state that this indicated fewer claims but a chi square analysis of their own reported data does not support this contention. Thus, in their first questionnaire, 18 out of 27 claimed improvement; in their second questionnaire, 11 out of 16. Chi Square is less than 0.5. These results are practically identical. However, none had maintained their sobriety. We interpret this to mean that although nearly 2/3 of the group maintained they were improved at the time of the second questionnaire, three- and-one-half years after having had received an ineffectual dose of LSD, none had been continuously sober that entire period.
We mention this report in some detail because other people have made claims based on this report not made by Ditman et al., that is, that LSD was not an effective therapy for alcoholism. Their concluding statement merely stated "Three and one-half years after exposure to LSD there remained only claims of slight improvement and none of the alcoholic subjects had maintained their sobriety." Had they given 200 mcg or more with a therapeutic objective in a therapeutic setting by therapists interested in the therapeutic experience and had they used the community resources including A.A., perhaps at three and one-half years about 50% of their subjects or better would have been sober.
  1. Emphasis is ours, not the author's.

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