THE USE OF PSYCHEDELICS IN DUTCH PSYCHIATRY 1950-1970:
THE PROBLEM OF CONTINUITY AND DISCONTINUITY
INTRODUCTION
It is an irony of Fate that in the technological advanced society in which we live, many researchers have started to study the achievements of cultures that used to be seen as 'primitive'. The study of the use of psychedelic substances (substances which produce changes in thought, mood and perception akin to dreams, religious exaltation, involuntary memory or psychoses) in these cultures is one of the most important examples of this development. After centuries of neglect and outright suppression of this use - a period so long, that historians and archeologists can hardly trace its manifestations in the past - Fate decreed that the rediscovery of psychedelics should find its first advance guard among members of the medical profession, a profession which is one of the main foundations of our technological society. The first culmination point of this rediscovery came after the discovery of LSD-25 in the 1950s and 1960s. The research done in this period offered great promises, especially (but not exclusively) in the fields of psychotherapy and biological psychiatry, promises that were unfulfilled because of the limitations which governments put on the experiments. The problems and themes that arose out of this research have, however, lost nothing of their importance. So, since we are witnessing in our days a revival of this kind of research, and since there is some historical distance with the 50s and 60s, it's about time to take a fresh look at those decades using the tools of historical research. Here I would like to discuss one of the themes which I have encountered in my study of the reception of the use of psychedelics in Dutch psychiatry in this period.
The theme which I want to discuss is that of continuity and discontinuity. In studies on the history of psychedelic research there is a tendency to stress the new elements and insights that the research with LSD and other psychedelics gave from the fifties onwards. This is logical if we look from the point of view of the overwhelming psychedelic experience itself. But I think that one of the key factors in the positive view on psychedelic research in the fifties is the existence of continuity with earlier tendencies in psychiatric research. The rediscovery of the use of psychedelic substances was made possible because it seemed to provide answers and research strategies to problems which arose out of earlier lines of research. Any introduction of new elements in society, how revolutionary it may seem, has to have some connection to existing elements. If not, then there is no way to connect the old and and the new. So first I want to trace some elements of continuity between the psychedelic research in Dutch psychiatry and earlier developments. I will do this by presenting these elements in the work of four key figures in this research. The limitations put on this research in 1966 is evidence of the existence of elements of discontinuity, elements which at that time could not be incorporated in Dutch society or its scientific community. I shall try to find out where the roots of this discontinuity are to be located. It is not my aim here to sketch the complete history of the use of psychedelics in Dutch psychiatry. That would not be possible in the context of this article. Besides, I must warn that my research is by no means completed. So my discussion of my theme is based on preliminary research.
By posing the problem of continuity and discontinuity, I hope to contribute to a history of the (non-)acceptance of psychedelics in society which escapes from a purely positive or a purely negative point of view. The history of psychiatry or the sciences in general is the last decades transcending black-or-white views, in which every development is seen in the context of the rise of a theory or school which is seen as the holder of truth. But whether or not there is such a thing as absolute truth (something which I'm not inclined to think),this is no way to ascertain the reasons why certain people acted in a certain way. To study this we must see them in their own time, with their own possibilities, believe systems and limitations. By this way we can study (to use a popular term) the 'paradigm shifts' which seem to rule the development of all sciences. And what's more, I think that only by this way we can contribute to a discussion on the use of psychedelics in society, which aims not at a confrontation between views, but at finding the ways in which a more general consensus on the subject can be achieved.
H. M. van Praag and biological psychiatry
My first example for the continuity mentioned before comes from the rise of biological psychiatry in the 1950s. The key figure in biological psychiatry has been Herman van Praag. Van Praag became in 1962 doctor of medicine. His thesis investigated the possible role of Monoamine Oxidase Inhibitors (MAO's), which inhibit the working of certain neurotransmittors like dopamine, noradrenalin and serotonin in the central nervous system, in the treatment of depressions. He came to the conclusion that two drugs used since 1958 as antidepressive medecines, Marsilid and Marsplan, could be (but where not always) effective against so-called 'vital' depressions.
These where characterized by symptoms such as unmotivated depressions, retardation of thoughts and actions, reduced receptiveness to psychic feelings, disturbances in conception of time, somatic disorders, and a fluctuation in intensity of complaints during the day (Van Praag 1962). With this thesis (which looked ahead to much research that is currently taking place, e.g. on Prozac) Van Praag became one of the figure heads in the movement of biological psychiatry, which looked for biochemical factors in the causation of psychic diseases. Van Praag himself stressed that the flourishing of this kind of research since the second half of the fifties was triggered by the research with LSD. He referred especially to the hypothesis which Woolley and Shaw published in 1954. Starting from a comparison of psychedelic and schizofrenic states of consciousness (a comparison which Van Praag himself thought superficial) they wrote that 'naturally occurring psychic states such as schizophrenia might well be pictured as resulting from a deficiency of serotonin in the brain, brought about not by drugs, but by failure of the metabolic processes which normally synthesize or destroy them' (Van Praag 1962:26). A hypothesis which soon turned out to be too simple, but which gave rise to an avalanche of comparable research. Van Praag himself experimented from 1958 to 1962 with LSD. As chef de clinique of the psychiatric department of hospitals in Rotterdam and Groningen from 1963 to 1968, and as lector and from 1970 professor in psychiatry at the State University Groningen, he continued to further biological psychiatry and to advocate scientific research in the effects of psychedelics (or 'psychodysleptics', as he preferred to call them). The research in psychodysleptics was according to him not only interesting for the psychopathologist, because 'model psychoses' could be created by their use, but also for the neurobiochemist and the neurophysiologist. The questions about the influence of psychodysleptics on brain metabolism, on the working of neurons and neurotransmitters, could give insight in the relation between material processes in the brain, and psychopathological syndroms (Van Praag 1966).
The openness with which scientists welcomed the research of biological psychiatry was not something that was new in the fifties. At the end of the 19th century there had been a theory in vogue that psychotisch disturbances are caused by selfpoisoning by the metabolism of abnormal products. Another Dutchman, Herman de Jong, had from 1921 on done research with different psychofarmacological substances, that produced catatonic states in animals: starting with bulbocapnine, the psychotoxic principle from Corydalis cava (which was used in the Middle Ages against certain forms of madness), he wenton to study the effects of mescalin and other chemical substances, but also of electrical and neuro-surgical methods. All these methods and procedures could, so concluded De Jong, probably together with psychogenic factors, end in catatonic states (De Jong 1945).
Besides the work of a pioneer like De Jong, the climate in the 1950s seemed to be ripe for the study of the role of biochemicals in the functioning of the human brain. A sign of this was the inaugural speech with which Joh. Booij accepted the professorate of psychiatry at the Free University in Amsterdam, in 1955. Psychiatry was in crisis. Different doctors did not agree about diagnosis. Treatment methods of endogenous psychoses, schizophrenia and manic depressive psychoses, like sleep-, insulin-, electroshock- and electrocoma-therapy, had not lived up to the expectations. Statistical research in the effects of psychotherapy showed that remissions after treatment did not occur more often than spontaneous remissions. It was according to Booij, time to center interest on the neurobiochemic processes, which lay at the foundation of psychic disturbances. In this context Booij saw hope in the study of the effects of LSD. In his view LSD caused psychotic images, and that could give a clue to the biochemical processes involved in psychoses (Booij 1955). Another professor of psychiatry, J. H. Gaarenstroom from the State University Groningen, held at this time similar hopes (Gaarenstroom 1956).
I certainly don't want to give the impression that this was the general or uncontested view point in Dutch psychiatry. Later on, I will return to the position of Van Praag in the discussion around the limitations on psychedelic research. But it is clear that the research in the biochemical effects of psychedelics was connected to larger developments. For the historian, there are clear signs of continuity. The same is true for the use of LSD in psychotherapy. To see the continuity at work in this sphere, I will give examples from the work of the three psychiatrists who did pioneer work in the development of the therapeutic use of psychedelics: J. Bastiaans, G. W. Arendsen Hein en C. H. van Rhijn.
Bastiaans, psychosomatic medicine and psychoanalysisJan Bastiaans, who became the most well-known Dutch psychiatrist who used psychedelics in his psychiatric practice, stands firmly in the tradition of Freudian psycho-analysis, and in that of psychosomatic medecine. From 1954 till 1961, he was president of the Psychoanalytic Institute in Amsterdam, a major bastion of psycho-analysis in the Netherlands. Before this time, from 1946 till 1954, he had been a collaborator of Groen, then head of the second department of internal medicine at the University of Amsterdam. Groen was influenced by American ideas on psychosomatic medecine, in particular the hypothesis of psychosomatic specificity. According to this hypothesis, specific psychic problems can lead to specific physical diseases among those people, who are vulnerable because of the structure of their personality. In 1949 Groen founded the Psychosomatic Working Party, in which Bastiaans took part as psychiatrist. It was his job to make a psychiatric examination of each patient and to deliver a psychiatric report and a biography which included youth, school years, relations with parents, and satisfaction in marriage and work (Dehue 1990:124-126).
Groen and Bastiaans both became convinced advocates of the theory of psychosomatic specificity, even though there were (and still are) many researchers who reject this theory. Bastiaans started to apply the theory on the many victims of the Second World War: the survivors of the war who had been through extremely painful situations in the Nazi and Japanese prisons and concentration camps, many of whom had become as a consequence extremely traumatized. This were people for whom there were hardly any facilities for adequate treatment, nor more than a few psychiatrists who were competent to treat them. In his doctoral thesis from 1957, entitled "The psychosomatic consequences of oppression and resistance", Bastiaans enumerated the psychosomatic syndromes which he had found in war victims.
These syndroms seemed to be an aspect of delayed reactions to traumatizing stress, especially found under 'highly self-controlled personalities who had expended considerable will-power and energy on trying to control, suppress or repress the painful traumatic consequences of the war (Bastiaans a:112). But this confronted him with the definition of a psychotrauma. A somatic injury could be easily defined, but what was the essence of a psychotrauma? He came to the conclusion that 'A psychotrauma may be described as a mental injury marked by the fact that a human being is fixated in a state of "affect lameness", in a state of powerlessness usually associated with intense suppression and repression of anxiety, grief and anger. This state of partial mental isolation makes it impossible for the victim to cope in a healthy manner with the traumatising stress situation.' (Bastiaans b:3) Whether this would develop in a post-traumatic stress disorder was dependent on the inbuilt capacity of the traumatized person for adaptation, and on the severity of the stress situation. If the person couldn't cope, part of his past became undigested and he couldn't free himself. He became fixated in a state of powerlessness. This affected his relation with the world at large, resulting in loss of mental freedom and a state of mental isolation. 'Here the individual consciously or unconsciously locks himself into mental invulnerability-structures of a psychotic, psychoneurotic or psychosomatic nature. In psychopathology the reflection of this type of isolation is found in the concepts of autism, narcissism, character neuroses, depersonalization or psychosomatic character formation. The patient so affected becomes isolated from the world of his inner emotions by an excessive use of self restraint (Bastiaans c:1-2). As a result of actual traumatising stress, former traumatic experiences (i.e, from childhood) can be activatedand a very complex link between early and later traumatising experiences established.
How to treat these people? To start with use was made of the techniques of hypnoanalysis, narcoanalysis and psycho-analytic treatment. Narcoanalysis, using barbiturates to put patients in a kind of dream-sleep and to elicit their memories, was a highly acceptable method for exploring the human psyche in the years after the war. Bastiaans used Penthotal Sodium in combination with psycho-analysis and psychodrama. The patients were required to relisten systematically and regularly to the tape-recordings which were made of their expressions in their drug-induced sleep.
Although Bastiaans later claimed that in the right climate of safety and security, 'an average number of 8 sessions is usually sufficient to free the patient', he came to the conclusion that in the most rigid cases, there weren't sufficient results (Bastiaans b:5). Besides, people did not always remember actually saying the things they heard on tape. He began to look for other methods. This was stimulated by the conclusions of a research program on prognosis and effect of psycho-analysis and psychotherapy, which was conducted by the psychologist Johan Barendregt under supervision of Bastiaans as director of the Psycho-Analytic Institute. Barendregt concluded that there was no difference in the changes in neurotic patients after some years, whether or whether not they had gone through psychotherapy. It seemed that traditional psycho-analysis needed between 800 to 1000 treatment sessions to help patients with severe character neuroses (Bastiaans c:2-3; Dehue 1990:129-138).
In 1961, Bastiaans started to use psychedelics, or as he called it hallucinogenic drugs, to help these people: mainly LSD, but also psilocybin. From 1963 till 1985 he was professor of psychiatry at the State University of Leiden. Many patients were helped in the Jelgersmakliniek in Oegstgeest, where he worked until 1988. After some experience, he came to the conclusion that for three categories of patient treatment with LSD was advisable: psychosomatic patients with an intensive rigidity of their defence- and coping mechanisms; patients with survivor- or concentration camp syndroms, and patients who after many years of psycho-analysis did not achieve the prognosticated positive results. A concentration camp or KZ-syndrom was actually not a syndrom, but a process of four phases that contained different conventional syndroms: a shock phase with the feeling of extreme powerlessness; an alarm phase, with alarming emotions and fear which had the function of preparing the drive for solutions; an adaptian phase, with flight- or fight-mechanisms, and an exhaustion phase. The need for security drove patients with a KZ-syndrom to a psychological position of master or slave in relation to other people.
Patients who were what he called 'inhibited fighters', with intensive life experiences, but psychically traumatized, were usually the best candidates. They often suffered from alexithymia, and were unable to talk about their emotions. Under LSD, in a safe and secure environment and under the right guidance of the therapist, this would change completely. Bastiaans claimed that his most positive results were achieved with survivors from jails and concentration camps, and with people whose childhood could be compared with some kind of private concentration camp. Seldom were more than 7 sessions necessary, in one case there were 28 sessions. The therapist spent in average some 50 hours on sessions and interviews. So, according to Bastiaans, the psychotherapeutic process was facilitated by a combination of psychoanalysis with the use of hallucinogens (i.e., psycholytic therapy). But this was not a revolutionary new departure, but a logical follow-up of the earlier used forms of narco-analysis.
This doesn't mean that Bastiaans' methods were uncontested in the psychiatric world. On the contrary, he later complained bitterly that he was accused by analysts of giving up the gold of psycho-analysis for the silver of LSD-psychotherapy. These people, he wrote, did not understand that an LSD session is more than an abreaction procedure. Under LSD, the patient is confronted with his own resistances and defense mechanisms in an unescapable manner, whereas the repression or denial of experiences in traditional psychoanalysis is a common phenomenon. What's more, the therapist himself is confronted with the need to be so open and honest as possible. The patient under influence of LSD sees clearly the therapists' intentions. At the same time, the therapist is confronted with his own alexythimia in presenting his knowledge of the LSD-experience to his own colleagues, not to say to laymen. Bastiaans concluded that 'It does appear as if medieval fears for insanity or for the confrontation with psychotics are evoked again, leaving one with the impression that society has a need for eliminating as swiftly as possible that which seems to pose a threat to its own existence.' (Bastiaans c:16)
So although I'm stressing here the continuity of Bastiaans' work with earlier developments in psychotherapy, we're already faced with the problem of discontinuity which would raise its head in the 1960s and which resulted in the legal restrictions on the use of psychedelics in 1966. I will return to this theme later. For the moment I contend myself with giving the explanation of Bastiaans for the ultimate negative reaction of his professional colleagues, which had the result that after his retirement his work was not continued at Leiden University and at his clinique in Oegstgeest: 'Some [psychiatrists] have an intuitive feeling that the confrontation with the world of psychotics may be too much for them to bear, many others fear the misinterpretation of their efforts by their own scientific community (Bastiaans c:16).
G. W. Arendsen Hein
We have seen that the use of psycholytic therapy was for Bastiaans a way to solve problems in his therapeutic practice which he couldn't solve with the other methods he used. But the aims and even the method itself show a direct continuity with his earlier work. The same can be said of G. W. Arendsen Hein, another Dutch psychiatrist to which we shall now turn our attention. Arendsen Hein started to use psycholytic therapy to solve the problems of patients that couldn't adequately be reached by methods such as sociotherapy and narcoanalysis. His aims were in direct continuity with his earlier practice. But like Bastiaans he seemed to encounter negative reactions of his colleagues. Also interesting is his growing recognition of the role of religious factors in the human psyche, something which seems to be greatly encouraged by his experiences with LSD.
Arendsen Hein, Medical Doctor as wel as Master of Law, worked since 1953 in the Foundation Veluweland at Ederveen. In this foundation attemps were made at psychiatric treatment of criminal, mentally disturbed adult recidivists, who were classified as psychopaths. The therapy which was used was in the first place sociotherapeutic: the attempt was made to resocialize the patients by their participation in a community, guided by the psychiatric team, and, by group therapy and individual analysis, to free them from their neuroses. But it became clear to Arendsen Hein that a number of patients were hardly reached by the therapeutic procedures. Under them there were the refractory patients, who failed to respond to all the therapeutic efforts, and who were a nuisance to themselves and to their environment, even in forms of group therapy.
How to break through their barriers of resistance? How to elicit the banned memories and emotional contents from their unconscious and make psycho-analytic practice possible? Like Bastiaans, Arendsen Hein started to use chemical means. Co2-inhalation had little success. It proved to be a too violent method: release of emotions took place in complete unconsciousness and was after treatment readily forgotten. Narco-analysis had its worth for the reliving of recent traumatic experiences, but couldn't get at the level of the infantile roots of neuroses. Besides that, there could afterwards be complete amnesia of what had happened during the treatment. Methedrine looked promisable, and facilitated the proces of association and the verbal expression when the patient really wanted to express himself. If not, it had only superficial results, and besides that, it had the dangers of euphoria during the treatment, of addiction when frequently used, and of relapse in a state of resistance and amnesia or a bad hangover after the treatment.
None of these methods lived up to the expectations. So it was a natural step for Arendsen Hein in 1959 to consider using LSD for his refractory patients, after studying the reports on its use by foreign colleagues like Leuner and Sandison. The medical team at Veluweland started to give LSD to patients who had the following indications: good physical health; no actual psychosis; average intelligence; some awareness of their disturbed mental state and a sincere wish to get well, but also insurmountable resistances and lack of introspective and integrative powers; and a failure of other therapeutic measures. Averagely ten doses LSD, ranging from 50 to 450 gamma, were given to 21 patients in ten or twenty weeks. And Arendsen Hein claimed results. Under LSD, patients developed notable reduction of resistance, intensive abreaction of repressed emotional material, allegoric and symbolic presentation of conflicts, a strong inclination to introspection, lucid insight into hitherto misunderstood attitudes, reorganization of values, marked improvement of behaviour, and intensification of interhuman contact. To critics who thought that this artificial break-down of barriers would lead to an insupportable flood of emotions, and so to desintegration of the ego and in the worst cases psychoses, Arendsen Hein replied that the ego seemed to have creative, auto-regulative and integrative powers, which could integrate the repressed material with help of the therapist, unless it concerned a case of manifest psychosis. Two years after the treatment, fourteen of the patients were registered as clinically improved (twelve) or much improved (two). (Arendsen Hein 1963a, 1963b). And in 1965 Arendsen Hein still thought that 'besides the unavoidable failures, there are in the Netherlands a handful of heavy guys about, who stayed afterwards free of recidivism and who have to thank, according to us and according to them, this LSD-group-pilot-project for their psychical recovery and rehabilitation in society (Arendsen Hein 1965:67).
But not everyone seems to have been enthusiastic about this project. As Arendsen Hein also wrote: 'Unfortunately a climate of suspicion and distrust arose around us in those days, which made a quiet unwinding of the therapeutic proces that was started, with the necessary after-care, impossible.' (Arendsen Hein 1965:67) What exactly did happen is for me impossible to say at this moment: it is not easy to get access to the relevant archives. Perhaps it was something similar to the reaction on the rehabilitation of criminals - with the help of psilocybin - project by Leary and his team in Harvard in 1963. But that's only conjunction. One important feature of Arendsen Heins work with LSD has still to be mentioned. That was his recognition of the role of the 'peak-experience' which patients got on LSD. An experience which transcended the normal ego-boundaries, an experience of what has been called the 'cosmic consciousness'. 'It is as if lightning strikes and the inner panorama is suddenly brightly illuminated.' (Arendsen Hein 1965:72) This peak-experience transformed according to Arendsen Hein the experiencer, it gave him something new instead of his negative self-image. It seems that the same thing happened to him on LSD, as he wrote: 'Have not most of us been living in a state of complete unawareness of our roots in the transcendental, until we saw this clearly under the influence of LSD?' (Arendsen Hein 1967:572) Arendsen Hein had started his medicine study under the inspiration of the theories of Alfred Adler with its stress on the social aspects of the human being. But already Adler had written of his social feeling developing towards a cosmic feeling, and the same seemed to happen to Arendsen Hein. In 1965 he had come to the conclusion thet besides the three dimensions of therapy which formed the common frame of reference: the patients' perception of the relations of himself with himself and his fellowmen, and the personal and archetypal symbols of his unconscious, recognition of a fourth dimension was necessary. This was the dimension of our cosmic and universal unconscious, which we could see under influence of LSD. Psychotherapists should investigate this dimension in their patients (Arendsen Hein 1967).
I do not think that this line of thought strengthened the position of the LSD-researchers in the debate about the advisability of their work against sceptic critics. But before I turn attention to this debate, I will mention my last example of the theme continuity and discontinuity with earlier developments in psychiatry: the work of C. H. van Rhijn.
C. H. van Rhijn
Cornelius H. van Rhijn worked in 1952 as psychiatrist at the Psychiatric Clinique at Brinkgreven, when the salesman of the pharmaceutic concern Sandoz brought with him some samples LSD-25. Already the next year Van Rhijn started to give LSD-therapy to chronic alcoholics. At Brinkgreven and since 1960 at his private practice in the city of Enschede, Van Rhijn has given LSD to patients in almost 1000 cases, and has acquired an enormous rich knowledge of the therapeutic process involved. He has made significant contribuitions to the discussions around psycholytic therapy, which he saw as having the following objects: to loosen up a stagnated situation; to strive for quick results in emergencycases; to alleviate a compulsionneurosis; to give love and security to acceptation-frustrated neurotics; to dig repressed elements from the subconscious; to loosen up infantile fixations; deliverance from ego-dominance, guilt and isolation; and to make experimental studies on the nature of psychosis. The best indication for treatment was according to him a good understanding with the patient (Van Rhijn 1967:208-209).
There is no space here to discuss his intricate theories about the effects of LSD. I will limit myself to two examples which show further light about our theme of continuity and discontinuity. The problem was explicitly posed by himself in 1965, and he placed psycholytic therapy not against, but next to other methods of psychotherapeutic treatment. Like these methods, psycholytic therapy tried to elicit presentational symbols which stood for the meaning which was given to all kind of experiences. A meaning which is composed of a trace of a sensual stimulus with evoked former experience, and evoked emotional relationship. The new thing about psycholytic therapy was the richness, the deepness, and the intensity of the produced hallucinations (on doses of 200 to 400 micrograms), which went much deeper than in dreams, hallucinations that revealed more to patent and therapist then dreams or phantasies (Van Rhijn 1963: 131-135).
I mention this insight from Van Rhijn to strenghten my own case about essential continuity between psycholytic therapy and earlier forms of therapy, and especially psycho-analysis. In the case of Arendsen Hein, we saw that his understanding of psychotherapy was deepened with the dimension of cosmic consciousness or peak-experiences. Although this was perhaps a less accepted dimension in psychiatry, it was by no means unknown. Van Rhijn had studied after the Second World War with Henricus Cornelius Rümke, a very influential professor of psychiatry at the State University of Utrecht. Rümke somewhere formulated the thesis, that an intense feeling of happiness could bring the ego to the borderline of dissolution in the whole of the Being. This was of course in line with the theories of Maslow on the peak-experience. Van Rhijn, who had also been interested in Tibetan yoga and who was intrigued by the manual of Leary, Metzner and Alpert on The Psychedelic Experience, which was published in 1964, tried this methods with a few 'introvert, strongly inhibited man': and had succes. But he did not pursue this method (Van Rhijn n.d.:23-24).
Opponents
My central thesis which I tried to adjust with the examples from the work of Van Praag, Bastiaans, Arendsen Hein and Van Rhijn, is that introduction and rediscovery of the use of psychedelics (or psycholytics, or hallucinogens) was possible because this use stood in a continuum with the development of psychiatry before that time. We now have to ask ourselves why this continuum was broken: why after 1966, not only in the Netherlands but also in other countries, there was such a fierce reaction against the scientific study of psychedelics. We now have to look for the things in which psychedelic research differed from other lines of research in psychiatry, and from the developments in society as a whole.
Until now I've used in this paper examples from the work of pioneers of psychedelic research to establish lines of continuity. Now I shall turn attention to examples from antagonists of psychedelic research in Dutch psychiatry. I will limit myself to antagonists who had a high degee of standing under their colleagues. It is noteworthy that they do not seem to have had any experience with LSD or other psychedelics, but this can't be seen as the reason for their opposition, as many other psychiatrist with as little experience did not turn against the research.
I've already mentioned H. Rümke, professor of psychiatry in Utrecht. His views on what Maslow called the peak-experience does not imply that he advocated any psychedelic method of reaching this state. On the contrary. In 1960 he published a text book on psychoses, and made also mention of 'experimental psychoses' like those which arose out of the use of LSD. He stressed the dangers of them. He mentioned two examples of results of treatment: one ending in a heavy depression of a few months, the other one in a succeeded suicide, and concluded that this kind of experiments were inadmissable (Rümke 1960:222). In the following volume of Rümke's text book, which was published just after his death in 1967, he repeated this opinion, and gave further examples: of a patient who became very instable, and even of patients of him who had never used LSD, but in whose paranoid delusions LSD started to appear. And he saw an added danger of using the drug in the 'movement' which had arisen in the United States around Leary and Alpert and their missionary International Federation for Inner Freedom. Rümke saw no therapeutic results which legitimized the use of LSD (Rümke 1967:321-323).
Another professor I've already mentioned, who took the same position as Rümke, was Joh. Booij of the Free University of Amsterdam. Booij had been hopeful in the 1950s about the results of LSD-research: in 1968 he had become a declared opponent. In articles in the influential journal of medicine Nederlands Tijdschrift voor Geneeskunde, Booij 'proved' his opposition against LSD-therapy by giving all kinds of examples of patients who became psychotic or tried to commit suicide, and even of a pregnant woman who 'went out and murdered by stabbing the man who had made her pregnant' (Booij 1968a, 5). In the same article where he mentioned this example, Booij showed his incomprehension of the psychedelic experience. He wrote not to know what he had to understand under the term 'expanded consciousness', although he readily classified it as the delusional experience of the psychotic, either schizophrenic or suffering of a degenerative psychosis. Besides stressing the dangers, Booij based his opposition to use of LSD by mentioning the lack of controlled studies proving positive effects of LSD, and by suggesting that the role of the therapist and the invested time was all-important in any positive effects that were achieved. With this last argument he answered the psychiatrist C. J. Schuurman, who wrote in a reaction about his positive results in the treatment of patients who were severely neurotic with the help of LSD (Schuurmans 1968; Booij 1968b).
This discussion was part of a long discussion in 1968 in the Nederlands Tijdschrift voor Geneeskunde. With Booij sided the psycho-analyst J. Tas, who saw little result in a LSD-therapy which did not prepare the patient for the repressed material which was dug from his unconscious by a long proces of psycho-analysis (Tas 1968). Interesting is that Tas based himself on the position of classical psycho-analysis, while Booij had doubts about the effects of psycho-analysis or other treatment methods themselves. He tended to believe that neurobiological elements were decisive in the genesis of neuroses and psychoses. For Herman van Praag, who took part in the debate on the side of defenders of LSD-research, this was an important reason for continuing the biological research of hallucinogens. For him, 'the hullabaloo about the hallucinogenic drugs entails the danger of this substances falling unnecessarily into disrepute. However objectionable their use by laymen may be, from the medical point of view they seem to hold a promise in two different fields, the field of psychotherapy [inwhich the results were still uncertain] and that of biological psychiatry (Van Praag 1968, 1988).
The case of Van Praag is interesting, while he atthe same time carefully delineated his own position from any associationwith the so-called propaganda for LSD which was conducted by formerscientists like Leary and Alpert. This is important, because the discussion on LSD was for a large part taking place under the shadow of the rise of the psychedelic subculture in society, which was beyond the control of the medical profession and by definition characterized by recreative use. This point was put forward by G. Ladee, professor of psychiatry in Rotterdam, who had taken LSD himself and had a clear eye for the religious effect, or the peak-experience which LSD could give. But this effect resulted according to him in the great objections which psychiatrists developed against LSD. Therapists who believed in LSD got results with it; therapists who didn't did not. This led to an 'LSD-administrationsyndrom' in some therapist, with resulting resistances in others. These resistances were stimulated by all the talk about 'Love', the use in the youth culture, and the fact that psychedelics were not accepted drugs in western society like alcohol. Ladee himself continued to advocate controlled studies (Ladee 1968).
The rise of the psychedelic subculture and its association with revolutionary tendencies in society brought LSD clearly in a climate of discontinuity with existing traditions. In other words, they became seen as dangerous to society. This development had little to do with the discussions within psychiatry. On the contrary: it added a totally non-scientific and even irrelevant element to this discussion. Because what had the value of LSD within psychotherapy and biological psychiatric research to do with the missionary zeal of Leary or his Dutch congenials to change society?
The discussion within psychiatry about the permissibility of LSD-therapy was a draw. Some were against it, some for. And even the last ones advocated strict medical supervision and control, and did not (or said they did not) approve of recreative use of hallucinogens. If Rümke took in 1960 a position against LSD-therapy, a report of the General Inspection of Mental Health came in 1962 to the conclusion that under the right supervision it was no more dangerous than other forms of therapy (Meijering 1962). The Inspection of Mental Health saw no need in further restrictions. In that period, LSD was still respectable. This changed abruptly in January 1966, with the threat of the anarchist Provo movement to poison the drink water of Amsterdam with LSD on the occasion of the marriage of the Crown Princess with a former German soldier. This threat was not meant for real. It was part of the provocing tactics with which Provo fought against the existing order in society. But it led to a giant reaction of panic. Within weeks, the sale and use of psychedelics was prohibited by law. Researchers and therapists had to have special permission to use the substances: a permission which was only granted to a few (among whom Bastiaans and Arendsen Hein).
Psychedelics were now firmly connected with discontinuity and with subversion. Paradoxically, this only increased their popularity in the emerging youth subculture (Snelders 1995). But the discussion in psychiatry had little effect on this. As we have seen the problem was only largely debated in 1968. Since then, no serious follow-up study of the results of psycholytic therapy has been conducted, no major research program after the effects of psychedelics on the human brain started. By way of conclusion, I would think that a reappraisal of psychedelics in western society, and renewed research in their possible function in psychiatric research and in society, is only to be expected if the advocates of this research could find some way to stress the continuity of their work within western society, and to avoid the association with subversion and discontinuity.
REFERENCES
(note: NTG = Nederlands Tijdschrift voor Geneeskunde)
Arendsen Hein, G.W. 1963a. LSD in the treatment of criminal psychopaths. in Hallucinogenic drugs and their psychotherapeutic use. Edited by R. Crocket, R.A. Sandison en A. Walk, pp. 101-106. London.
Arendsen Hein, G.W. 1963b. Treatment of the neurotic patient, resistant to the usual techniques of psychotherapy, with special reference to LSD. Topical problems of psychotherapy 4 II:50-57.
Arendsen Hein, G.W. 1965. LSD als hulpmiddel bij de behandeling van psychisch gestoorden. Nederlands Tijdschrift voor Criminologie 7:61-77.
Arendsen Hein, G.W. 1967. Dimensions in psychotherapy. in The use of LSD in psychotherapy and alcoholism. Edited by H.A. Abramson, pp. 569-576. Indianopolis.
Bastiaans, J. a. Life against life. The psychosomatic consequences of man-made disasters. N.p., n.d.
Bastiaans, J. b. The psychiatric and psychosomatic dimensions of trauma. N.p., n.d.
Bastiaans, J, c. Mental liberation facilitated by the use of hallucinogenic drugs. N.p., n.d.
Booij, J. 1955. Neuro-biochemie en haar relatie tot het domein van de zenuwarts. Amsterdam.
Booij, J. 1968a. Farmacotherapie en psychotherapie. LSD als adjuvans bij de psychotherapie?. NTG 112:2-7.
Booij, J. 1968b. Vraagstukken rondom de psychotherapie. NTG 112: 1621-1624.
Dehue, T. 1990. De regels van het vak. Nederlandse psychologen en hun methodologie 1900-1985. Amsterdam.
Gaarenstroom, J.H. 1956. De invloed van pharmaca op de hersenen. NTG 100:1070-1074.
Jong, H.H. de 1945. Experimental catatonia. A general reaction-form of the central nervous system and its implications for human pathology. Baltimore.
Ladee, G.A. 1968. Gebruik en misbruik van LSD. NTG 112:879-884. Meijering, W.L. 1962. Rapport over het gebruik van LSD in de psychiatrie. Utrecht.
Praag, H.M. van 1962. Een kritisch onderzoek naar de betekenis van monoamineoxydase-remming als therapeutisch principe bij de behandeling van depressies. Nijmegen.
Praag. H.M. van 1966. Psychofarmaca. Een leidraad voor de praktiserend medicus. Assen.
Praag, H.M. van 1968. Hallucinogenen, het paard van Troje?. NTG 112:1985-1989.
Rhijn, C.H. van 1963. Significant hallucinations. in Hallucinogenic drugs and their psychotherapeutic use. Edited by R. Crocket, R.A. Sandison en A. Walk, pp. 131-135. London.
Rhijn, C.H. van 1967. Variables in psycholytic treatment. in The use of LSD in psychotherapy and alcoholism. Edited by H.A. Abramson, pp. 208-222. Indianopolis.
Rhijn, C.H. van n.d. Een begripskader voor de psycholytische therapie.
Rümke, H.C. 1960. Psychiatrie II. Amsterdam.
Rümke, H.C. 1967. Psychiatrie III. Amsterdam.
Schuurman, C.J. 1968. Letter in NTG 112:1095-1096.
Snelders, S. 1995. Het gebruik van psychedelische middelen in de jaren zestig in Nederland. Een hoofdstuk uit de sociale geschiedenis van druggebruik. Tijdschrift voor Sociale Geschiedenis 21:37-60.
Tas, J. 1968. Letter in NTG 112:325-326.
This paper is a lecture by Stephen Snelders on the Congress of the Arbeitsgruppe Ethnomedizin, oct. 1995, München.
Stephen Snelders is editor in chief of the Dutch magazine PAN - forum.
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