HALLUCINOGENIC DRUGS AND IN PSYCHOTHERAPYl Isaac Gubel, M.D.2

In the present-day state of medicine, comes a patient and comes to the phy- the physician engaged in psychother- sician seeking for psychological bal- apy still lacks therapeutic resources of ance by way of a prescription or by a unquestioned value in the treatment session of , we meet a of psychological disease. Perhaps, new anxiety. This time it is the anxi- rather than to use the term "disease," ety of the professional man, who, in maladjustment in relation to external most cases, if he is intelligent and has reality would be the better conceptual- a critical understanding of the possi- ization. bilities of his science, feels compara- Weare accustomed to hear said, tively unarmed in his fight against the with reference to emotional malad- psychogenic pain of his patient. justments, that these result from a One form of escape from the vicious lack of adaptation to the social and circle deriving from subjective reac- familial milieu of the person who suf- tions of therapeutic inadequacy and fers from them. This may be a mis- appreciation of the patient's anxiety is statement because there are circum- orientation of the therapist in terms of stances in which a human being can- a pre-established therapeutic formula- not be required to renounce his liber- tion with psychological over-weight- ties in favor of a world that imposes ing, or retreat into its opposite, dog- on him tasks and duties of which he, matic organicism. Thus, the basis for personally, has not approved. The so- the frequent apparent addiction to a cial milieu is essentially an artificial belief in the infallibility of a thera- creation. It comprehends dogma, pre- peutic system, however it may be judice, economical interests, sexual called, may lie in its unconscious taboo, etc., all of which exert an im- identification with primitive magical pact upon the sensibilities of man. thought. This may explain to some Some make an adjustment as if in extent the warm enthusiasm awakened psychobiological symbiosis, in a bal- by hypnosis, which, rescued from the ance of apparent mental health with dusty shelf of medicine, has become of their neurosis, while others cannot. vital interest to the physician because From the struggle between the hostile of the seeming promise it offers of all environment and the need of security, of the potentialities and mysteries of there arise feelings of isolation and the human personality itself. inadequacy expressed in anxiety. This Hypnosis, because of its spectacular anxiety may manifest itself in pho- phenomenology, may be accepted un- bias, depressions, or in definite soma- consciously both by the professional tizations. man and by his patient as an "all- The fact remains that the anxiety of powerful talisman," permitting both to a human being, in his peculiar lan- liberate themselves from their respec- guage, is a call for help, protection and tive anxieties, the one arising from care. When such a human being be- subjective medical inadequacy, and the ether, from his sense of vital inoper- 1Also being published in Spanish in La Revista Latino-Americana de Hipnosis ativeness. The hypnotic techniques Clinic a, issued in Argentina by La Socie- employed for psychotherapeutic pur- dad Argentina de Hipnoterapia. poses have, in most cases strong dra- 2 Montevideo 945, , Argen- tina. matic content, which, already being 169 170 GUBEL

experienced from the methodology of basine and basofortine the ethylamide induction, becomes further manifested of lysergic acid and the di-ethylamide in the subject matter of the catharsis of lysergic acid (L.S.D. 25). This lat- and in experiential regression. ter compound is possibly the most Frequently, the hypnotherapeutic pharmacologically active drug known. session takes place in a climate of The clinical picture of the response to tranquil relaxation. But also the pa- this drug has been compared by some tient may pass through spectacularly authors to a temporary irruption sim- intense experiences, characterized by ilar to schizophrenia, while others a subjective loss of his bodily rela- (Bonfanti, Gamma, Villata) deny that tionship with the environment, and the symptomatology of lysergic acid even a loss of body image and body intoxication has any resemblance to awareness. Many patients say that the psychotic disorders of schizo- under these circumstances they feel phrenia. themselves floating in space, becoming A similar action is found in mesca- only a head or a mind, losing the per- line which has been used from pre- ceptions of the existence of their limbs, Columbian times by the Indians of or having visions of an unusual per- northern and the southwest spective. In others, the world of area of the United States. The natives sounds and other sensory obtain it from peyote, a cactus grow- acquires subjective traits of an unreal ing in that region, ingesting it to in- quality. duce mystical visions which they inter- In my psychotherapeutic experi- pret as an approach to the "world of ence, I have often observed that when spirits." The followers of the Native the subjective experiences are in- American Church in the United States tense, either actively (dramatization) of America take this drug for the ef- or passively (relaxation) , a better fects of mystic exaltation during their therapeutic result can be expected. religious services. Some patients are scarcely or not at The drug was synthesized in the all hypnotizable because of rigid psy- Merck Laboratories, and thus became chological defenses built up to protect available for a study of its psycho- their neurosis. Many who are hypno- tropic properties and its possibilities tizable in spite of this, have little emo- for psychotherapy, together with tional plasticity to permit placing L.S.D. 25 (Delyside Sandoz). themselves adequately in an active or The first investigations on the use passive relationship within the hyp- of mescaline were published in 1926 notic subjective experience. by Routier. The first publications and This has led to a search for a group reports of major importance on the of psychotropic drugs, particularly the use of mescaline and lysergic acid hallucinogens by means of which, used appeared after 1938. Recent research- in alternation with sessions of hypno- es include Busch and Johnson (1950), sis, there might be a dissolution of this Sandison, Savage (1952), Abramson protective barrier, and a more rapid (1955) and, in Argentina, Tallafferro and at the same time, deeper psycho- (1956), Alvarez de Toledo, Fontana therapy. To this end, use was made and Perez Morales (1958), Abadi of lysergic acid and mescaline, both as (1958), J. M. David (1960), Gubel and presumed psychotherapeutic catalysts. Achavel (1960). Some years ago, Stoll and Hoffman Some of the aforementioned authors working in Switzerland with products used the hallucinogenic drugs as aux- derived from ergot, obtained by syn- iliaries in psychoanalytic work, both thesis from amino-alcohols like ergo- individually and in group therapy.

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They found a considerable reduction the "Nirvana" or the "oceanic" feel- in the time of treatment due to an ings. increase in introspection and conse- In hypnosis, whether hetero- or auto- cuent insight following the use of the hypnosis, there is, practically always, hallucinogens. At the same time, it this type of depersonalization experi- has been indicated that these drugs ence. Such experiences are also prob- permit a more direct approach to the ably the most intense effects deter- unconscious and easier study of the mined by hallucinogens and, coinci- rich fantasies the patient experiences dentally, constitute, in their essence, under the effects of these substances. experiences comparable basically to The author of this work has been certain hypnotic subjective experi- studying not only the symbols rep~e- ences. sented in visual, auditory, and tactile It is interesting to note that the be- images and memories in the drugged havior of the patient under the action state but has also given equal consid- of these drugs undergoes a process of eration to postural attitudes and kin- "softening", that is, an increased re- etic manifestations which should not sponsiveness after each new intake, a be underestimated since these too can process which is usually repeated at be even more highly expressive than intervals of ten or twelve days. This facial expressions alone. psychological sensitization brings about This last point became most evident more frank, spontaneous and informa- to us in a patient whose behavior led tive conduct by the subject. to further and more extensive obser- Some patients abandon themselves vations in this direction. She present- ed an anxiety state which had, for a to an opiate-like dreaminess, where, for example, a musical stimulus can substratum an Oedipus component serve as a leit-motiv for an experien- that was symbolized by copulative-like tial flight of fantasy. Others, on the movements of the pelvis while she was other hand, having broken the barriers conversing with the observer of the and defences against imagination, may therapeutic session, Dr. Corazzi, and whom she had identified with a pater- pass through a Dante-esque experience of "inflation" by persecutory paranoid nal image. . . elements, not always revealed during It is interesting to note that kinetic history-taking, or there may be mani- dynamisms may also appe~r under festations of a sadistic, masochistic, hypnosis. These usually are m a more sado-masochistic, or verbally aggres- attenuated form, but sufficiently clear sive behavior (sometimes actively so) symbolizations to permit ready int.er- toward the therapist who is often iden- oretations for a better understandmg tified by the dynamics of the trans- ~f the psychological significances are ference situation with the bad environ- thereby expressed. ment, the destruction of which means The subjective experiences evoked liberation. by mescaline and lysergic acid do .not always develop into clearly hallucma- It is to be noted that in the hypnotic tory manifestations, as might be in- state there is also some degree of this ferred from their designation as "hal- "softening" or increased responsive- lucinogens". Many subjects experi- ness effected by repeated successive ence situations that may be compared re-hypnotizations, and during the deep- to a sensation of disintegration and er hypnotic state there are almost al- death. Others feel that they are ex- ways experiences of depersonaliza- periencing a feeling of unity with a tion, which are experienced in vary- totality or, using more adequate words, ing ways by the subject. 172 GUBEL

Typical examples in the patients' developed by exclusively psychological own words of these subjective changes means, the second, by chemical action may be given: A patient who present- with a possible interference in the ed psychogenic stammering as a symp- enzymatic processes of the cortex or tom, on being hypnotized for the first reticular system, cause, perhaps as a time, told me: corollary, the experience of deperson- "I feel, in general, as if my mind alization, (to which we have referred were paralyzed, as if I saw everything repeatedly in this article) and a new in white, and my brain were becom- self-image. This in turn produces a ing smaller till it floated within my feeling of disintegration-reintegration, head .... " which is experienced unconsciously as the effects of a "magical talisman" by Another patient (a phobic case), the subject, who then emerges from who received L.S.D. 25 by injection this strange chaos with a feeling of re- presented as his only response to the birth which may then acquire a ration- drug a sudden anxiety interpreted by al character through the interpreta- him as a feeling as if his "body was tions given by the therapist of the ma- becoming smaller and smaller, finally terial which comes to the surface dur- becoming infinitely small." ing the hypnotic or the lysergic acid Paul Schilder defined the corporal sessions. image or body schema as "the tridi- These interpretations are now given mensional mental representation each a new perspective through the action of us has of himself." Evidently, this of the therapeutic procedure, whereas "representation" does not have the the old or traumatic experiences come character only of a contemplative to belong to the previous but now al- schema of the somatic self, but also in- tered self-image. volves a unitary image of both the These facts were translated, in the psychical and the anatomical self, simplified words of one of my patients forming part of a synthesis. into: "I felt de-humanized, now I feel This concept of the patient (which something strange. Now I am not I, may perhaps be called ontological) but a new person." This suggests that may play a dynamic role in the self- hypnosis or hallucinogens - powerful image of that person, which is sudden- catalyzers of mental processes-may ly altered, either by the action of hyp- open for us new doors in which emo- nosis or by the action of the drugs em- tional experiences can integrate into a ployed. Both situations, the first one new psychological homeostasis.

REFERENCES

1. Abramson, H. A. Lysergic acid as an adjunct to psychotherapy, with eliminat- ing of fear of homosexuality. J. Psychol., 1955, 39, 127-155. 2. Abadi, M. Experiencias con acido Iisergico- (Trabajo present ado en la Soc. Psicol. MM., Psicoan, y Med. Psicornatica de la Asoc. Med. Arg.)-Buenos Aires, 1958. 3. Alvarez de Toledo, L. G. Sintesis informativa sobre LSD 25 y psicoterapia. Rev. de Psicoanalisis, 1950, 16, 258-262. 4. Alvarez de Toledo, L. G., Perez Morales, F., and Fontana, A. Psicoterapia de grupo y dietilamida del acido lisergico. Acta neuro-psiquiatrica Arg., 1958, 4, 258-261. 5. Busch, A. K., and Johnson, W. C. LSD 25 as an aid in psychotherapy, Dis. nerv. Syst., 1950, 11, 241-243. HALLUCINOGENIC DRUGS AND HYPNOSIS 173

6. David, J. M. Acci6n de la dietilamida del acido Dvlisergtco, (LSD 25) en las neursois obsesivas. La Semana medica, 1960, 117, 1373-1384.

7. Fontana, A. El uso clinico de las drogas psicotr6picas. (Relato del 20 Congreso Argentino de Psiquiatria.) 1960. 8. Gubel, I., and Achaval, A. Acido Iisergico en el alcoholismo; catalizador psico- terapeutico. (Relato del 20 Congreso Argentino de Psiquiatria.) 1960. 9. Schilder, P. Tratado de psicoterapia. Buenos Aires: Ed. Paid6s, 1947. 10. Sandison, R. A. Lysergic acid dyethylamide in experimental psychiatry. New York-London: Grune and Stratton, 1956. 11. Savage, Chas. Lysergic acid dyethylamide (LSD 25)-A clinical psychological study. Amer. J. Psychiat., 1952, 108, 896-900. 12. Stokvis, B. La hipnosis como un metado y principio de investigaci6n acerea de los fundamentos psicosomaticos. Revista latino-americana de Hip. din., 1961, 2, 22-28. 13. Tallaferro, A. Mescalina y LSD 25. Buenos Aires: Abeledo, 1956. 14. Tallaferro, A., Milano, J. A., Alturralde, G. D., Paz, D., and Polito, R. Accion de la mescalina y la LSD 25 segun el test de Funkenstein. Acta neuro-psiqui- atrica, 1959, 5, 19-21. 15. Taragana, F. Psicodinamismos del esquema corporal. Acta neuro-psiqui- atrica, 1959, 5, 9-18.