Crisis Intervention in Situations Related to
Unsupervised Use of Psychedelics
Stanislav Grof, M.D.
Appendix I., LSD Psychotherapy: Hunter
House Publishers, Alameda California.
©1980, 1994 by Stanislav Grof, M.D.
Since the mid-sixties, when experimentation with LSD and other psychedelics
moved from psychiatric institutes and clinics to private homes and public places
the role of mental health professionals in regard to these substances has been
drastically redefined. Instead of being in the forefront as experimenters and
researchers they have become the rescuers and undertakers called upon to deal
with the casualties of the psychedelic scene. This development has contributed
considerably to the present attitudes of most professionals toward these drugs;
the primary focus of psychiatrists and psychologists has shifted from the therapeutic
potential of psychedelics to their dangers. In the highly emotional atmosphere
created by sensational publicity, professionals have allowed their image of LSD
to be shaped by journalists and newspaper headlines rather than scientific data
generated by research. Consequently, the casualties and complications of unsupervised
experimentation with LSD, instead of being attributed to irresponsible and ignorant
use, have been interpreted as reflecting dangers inherent in the drug itself.
Restrictive legislation has practically destroyed scientific research
of psychedelic substances, but has not been very effective in curbing unsupervised
experimentation. While samples of psychedelic drugs of doubtful quality are readily
available in the streets and on college campuses, it is nearly impossible for
a serious researcher to get a license for scientific investigation of their effects.
As a result of this, professionals are in a very paradoxical situation: they are
expected to give expert help in an area in which they are not allowed to conduct
research and generate new scientific information. The widespread use of psychedelics
and relatively high incidence of drug-related problems are in sharp contrast to
the lack of understanding of the phenomena involved; this is true for the general
public as well as the majority of mental health professionals.
This situation has very serious practical consequences. Various
emergencies associated with psychedelic drug use are handled in a way that is
at best ineffective, but more likely counter-productive and harmful. Crisis intervention
in psychedelic sessions and treatment of the long-term adverse effects of unsupervised
self-experimentation are issues of such medical and social relevance that they
deserve special attention. Much of the information that is essential for understanding
the problems involved and for an effective approach to this area has been presented
in various sections of this book. However, because of the importance of the problem
I will briefly review the most pertinent data here and apply them to the area
in question.
THE NATURE AND DYNAMICS OF PSYCHEDELIC CRISES
Understanding the dynamics of psychedelic experiences is absolutely
necessary for effective crisis intervention. A difficult LSD experience, unless
it results from a gross abuse of the individual, represents an exteriorization
of a potentially pathogenic matrix in the subject's unconscious. If properly handled,
a psychedelic crisis has great positive potential and can result in a profound
personality transformation. Conversely, an insensitive and ignorant approach can
cause psychological damage and lead to chronic psychotic states and years of psychiatric
hospitalization.
Before discussing the difficult experiences that occur in psychedelic
sessions, their causes, and the principles of crisis intervention, we will summarize
our previous discussions about the nature and basic dynamics of the LSD process.
LSD does not produce a drug-specific state with certain stereotypical characteristics;
it can best be described as a catalyst or amplifier of mental processes that mediates
access to hidden recesses of the human mind. As such, it activates deep repositories
of unconscious material and brings their content to the surface, making it available
for direct experience.
A person taking the drug will not experience an "LSD state"
but a fantastic journey into his or her own mind. All the phenomena encountered
during this journey—images, emotions, thoughts and psychosomatic processes—should
thus be seen as manifestations of latent capacities in the experient's psyche
rather than symptoms of "toxic psychosis." In the LSD state the sensitivity
to external factors and circumstances is intensified to a great degree. These
extrapharmacological influences involve all the factors usually referred to as
' set and setting': the subject's understanding of the effects of the drug and
purpose of ingestion, their general approach to the experience, and the physical
and interpersonal elements of the situation. A difficult LSD experience thus reflects
either a pathogenic constellation in the experient's unconscious, traumatic circumstances,
or a combination of the two.
Ideal conditions for an LSD session involve a simple, safe and beautiful
physical environment and an interpersonal situation that is supportive, reassuring
and nourishing. Under these circumstances, when disturbing external stimuli are
absent, negative LSD experiences can be seen as psychological work on the traumatic
areas of one's unconscious. It is essential for the good outcome of an LSD session
to keep it internalized and fully experience and express everything that is emerging.
Psychedelic sessions in which the subject does not stay with the process tend
to create a dysbalance in the basic dynamics of the unconscious. The defense system
is weakened by the effect of the drug, but the unconscious material that has been
released is not adequately worked through and integrated. Such sessions are conducive
to prolonged reactions or to subsequent "flashbacks."
The only way to facilitate the completion and integration of an
LSD session in which the experiential gestalt remains unfinished is to continue
the uncovering work, with or without psychedelics. It is important to emphasize
that the effect of LSD is essentially self-limited; the overwhelming majority
of difficult psychedelic experiences reach a resolution quite spontaneously. Actually,
those states that are most dramatic and stormy tend to have the best outcome.
The use of tranquilizers in the middle of a psychedelic session is a grave error
and may be harmful. It tends to prevent the natural resolution of the difficult
emotional or psychosomatic gestalt and to "freeze" the experience in
a negative phase. The only constructive approach is to provide basic protection
to the subject, and support and facilitate the process; the least one can do is
to not interfere with it.
After this brief introduction, we can return to the problem of complications
during unsupervised psychedelic experimentation. Although the basic principles
discovered during clinical research with LSD are directly applicable to crisis
intervention, it is important to emphasize the basic differences between the two
situations. The LSD administered in clinical and laboratory research is pharmaceutically
pure and its quality can be accurately gauged; most black market samples do not
meet these criteria. Only a small fraction of a "street acid" specimen
is relatively pure LSD; the black market preparations frequently contain various
impurities or admixtures of other drugs. In some of the street samples that have
been analyzed in laboratories, researchers have detected amphetamines, STP, PCP,
strychnine, benactyzine, and even traces of urine. There have been instances where
alleged LSD samples contained some combination of the above substances and no
LSD whatsoever. The poor quality of many of the street specimens is certainly
responsible for some of the adverse reactions that occur in the context of unsupervised
self-experimentation. In addition, uncertainty about quality and dosage and the
resulting fears can have a negative influence on the ability of the subject to
tolerate unpleasant experiences, which are then readily interpreted as signs of
toxicity or overdose rather than manifestations of the users' unconscious.
However, the quality of drug and the uncertainty about it seem to
be responsible for a relatively small fraction of the adverse reactions to LSD.
There is no doubt that extrapharmacological elements, such as the personality
of the subject and the set and setting, are by far the most important factors.
In order to understand the frequency and seriousness of psychedelic
crises that occur in the context of unsupervised self-experimentation, it is important
to take into consideration the circumstances under which many people tend to take
LSD. Some of them are given the drug without any prior information about it, without
adequate preparation, and sometimes even without forewarning. The general understanding
of the effects of LSD is poor, even among experienced users. Many of them take
LSD for entertainment and have no provisions in their conceptual framework for
painful, frightening and disorganizing experiences. Unsupervised experimentation
frequently takes place in complex and confusing physical and interpersonal settings
that can contribute many important traumatic elements. The hectic atmosphere of
large cities, busy highways in the rush hour, crowded rock concerts or discos,
and noisy social gatherings are certainly not settings conducive to productive
self-exploration and safe confrontation with the difficult aspects of one's unconscious.
Personal support and a relationship of trust are absolutely crucial
for a safe and successful LSD session, and these are seldom available under these
circumstances. Not infrequently the person under the influence of LSD is surrounded
by total strangers. In some other instances good friends may be present, but they
are themselves under the influence of the drug or are unable to tolerate and handle
intense and dramatic emotional experiences. When a group of people take LSD together,
the painful experiences of one person can create a negative atmosphere which contaminates
the sessions of others. There have even been episodes in which persons who took
LSD or were given the drug were, for a variety of reasons, exposed to deliberate
psychological abuse. It is easy to understand that such toxic circumstances are
highly conducive to adverse reactions.
PROFESSIONAL CRISIS INTERVENTION AND THE SELF-HELP APPROACHES
The present intervention offered by professionals in psychedelic
crises is based on the medical model and usually creates more problems than it
solves. The steps typically taken under these circumstances reflect a serious
lack of understanding of the nature of the psychedelic experience, and are conducive
to long-term complications. This is further complicated by the numerous demands
on the time of a mental health practitioner and a lack of adequate facilities
for handling casualties from the psychedelic scene. The tranquilizers that are
routinely administered under these circumstances tend to prevent effective resolution
of the underlying conflict and thus contribute to the incidence of chronic emotional
and psychosomatic difficulties after the session. Instant transfer of the individual
to a psychiatric facility in the middle of the LSD experience is not only unnecessary,
but represents a dangerous and harmful practice. It disregards the fact that the
LSD state is self-limiting; in most instances, a dramatic negative experience
if properly handled will result in a beneficial resolution and the subject will
not need any further treatment. The "emergency transfer" to a psychiatric
facility, particularly if it involves an ambulance, creates an atmosphere of danger
and urgency that contributes considerable additional trauma for a person who is
already extremely sensitized by the psychedelic state and the painful emotional
crisis. The same is true of the admission procedure in the psychiatric facility
and the atmosphere of the locked ward which is the final destination of many psychedelic
casualties.
Exposure to the routines of the psychiatric machinery while under
the influence of LSD can cause a life-long trauma. The fact that psychiatric diagnosis
and hospitalization may often represent a serious social stigma is another important
factor to consider before proceeding with an unnecessary transfer and admission.
Moreover, if the LSD process does not reach a satisfactory resolution, contemporary
psychiatric care applies continued medication with tranquilizers instead of the
uncovering therapy that is the preferred treatment under these circumstances.
The basic points of the above discussion can be illustrated with
the following example:
When I was working in the Psychiatric Research Institute
in Prague, Czechoslovakia, I was asked as consultant to see two employees of
the pharmaceutical laboratories that were involved in the production of LSD.
They had both suffered delayed adverse effects of an accidental intoxication
with LSD, while synthesizing the drug. One of them, a man in his forties who
was heading the department, showed symptoms of deep depression with occasional
bouts of anxiety, a sense of meaninglessness of existence, and doubts about
his sanity. He dated these symptoms to the time of his intoxication with LSD
and subsequent brief hospitalization in a psychiatric facility. His assistant,
a woman in her twenties who had experienced accidental intoxication with LSD
several months after he did, complained about bizarre sensations in her scalp;
she was convinced that she was rapidly losing her hair, although there were
no objective signs to support this.
During the diagnostic interviews with them I tried to reconstruct
the circumstances of their LSD experiences and the dynamics of the problems
they presented. The story that I heard, although unbelievable of LSD therapists
or people familiar with the nature of psychedelic states, is unfortunately a
typical example of crisis intervention based on the conventional medical and
psychiatric models. The pharmaceutical laboratories that were involved in the
production of LSD were situated approximately two hundred miles from Prague,
where most of the clinical and laboratory research with psychedelics was happening
at that time. When the management received the order to start the synthesis
of Czechoslovakian LSD, it was felt that, because of the nature of the substance,
the staff should be informed about its effects and instructed about the necessary
measures in case of accidental intoxication. The director invited from the nearby
state mental hospital a psychiatrist who had no personal or professional experience
of LSD and prepared himself by reading a few papers on the-model psychosis"
approach to schizophrenia. During the seminar with the staff, this superficially
informed psychiatrist managed to paint an apocalyptic picture of LSD. He told
them that this colorless, odorless and tasteless substance could insidiously
enter their system, as had happened to Dr. Albert Hofmann, and induce a state
of schizophrenia. He suggested that they should keep a supply of Thorazine in
their first-aid kit and in case of accidental intoxication bring the tranquilized
victim without delay to the psychiatric hospital.
As a result of these instructions, both laboratory workers received
Thorazine shortly after they had started to feel the effects of the drug, and
were rushed in an ambulance to the locked ward of the state mental hospital.
There they spent the rest of the intoxication period and a few following days
in the company of psychotic patients. While under the influence of the LSD-Thorazine
combination, the department chief witnessed several grand mal seizures and had
a long discussion with a patient who was showing him his wounds after a suicide
attempt. The fact that he was put by mental health experts in the company of
severely disturbed patients contributed considerably to his fear that he might
himself be developing a similar condition. Analysis of his LSD state, which
was only incompletely truncated by the Thorazine medication, showed that he
was experiencing elements of BPM II,*
and the confinement in the locked ward and his adventures there represented
a powerful reinforcement of his desperate state.
The experience of his research assistant was more superficial;
her reaction to the atmosphere of the locked ward was to pull herself together
and maintain control at any cost. Retrospective analysis of her experience showed
that she was approaching a traumatic childhood memory, but because of the external
circumstances she suppressed it and prevented it from surfacing. Her feeling
of losing her hair turned out to be a symptom related to this deep psychological
regression; the infantile body image corresponding to the age when she experienced
the traumatic event involved hairlessness as a natural condition.
During their visit to the Psychiatric Research Institute in Prague
these two pharmaceutical workers were able not only to work on their symptoms,
but also to change their image of LSD and the negative feelings associated with
it. We explained to them the nature of the LSD state and discussed with them
our therapeutic program and the principles of conducting sessions. Before they
left they had ample opportunity to discuss the effects of LSD with patients
undergoing psycholytic treatment who had experienced their sessions under substantially
different circumstances. I assured them that there was no reason for alarm if
someone was intoxicated by LSD; as a matter of fact, we were producing situations
like that routinely in our program. They were advised to have a special, quiet
room where the intoxicated individual could spend the rest of the day listening
to music in the company of a good friend.
Several months later, I received a call from the department chief.
He told me that they had had another "accident"; a nineteen-year-old
laboratory assistant had experienced a professional intoxication. She spent
the day in a comfortable room adjacent to her laboratory in the company of her
friend and "had the time of her life." She found her experience very
pleasant, interesting and beneficial.
The avoidance techniques developed by the self-help movement, although
less harmful than the approach based on the medical and psychiatric model, are
also counterproductive. Attempts to engage the subject in superficial conversations
("talking them down"), to distract them by showing them flowers and
beautiful pictures, or taking them for a walk does not solve the underlying problem.
This can be seen at best as playing for time—keeping the individual occupied
with distracting maneuvers until the crisis subsides or diminishes with the waning
of the pharmacological effect of the drug. These approaches are based on the erroneous
assumption that the drug has created the problem. Once we realize that we are
dealing with the dynamics of the unconscious, not a pharmacological state, the
short-sightedness of this approach becomes obvious. The danger in using techniques
that encourage avoidance lies in the failure to confront and resolve the unconscious
material that underlies the emotional and psychosomatic crisis. LSD sessions in
which the emerging gestalt is not completed are conducive to prolonged reactions,
negative emotional and physical aftereffects, and "flashbacks".
COMPREHENSIVE CRISIS INTERVENTION IN PSYCHEDELIC EMERGENCIES
Having discussed the factors that contribute to the development
of emergencies in unsupervised LSD sessions and described the harmful practices
that characterize most professional and lay interventions, I would like to outline
what I consider the optimal approach to psychedelic crises, based on the understanding
of their dynamics. What constitutes an emergency in an LSD session is highly relative
and depends on a variety of factors. It reflects an interplay between the subject's
own feelings about the experience, the opinions and tolerance of the people present,
and the judgment of the professional called upon to offer help. This last is a
factor of critical importance; it depends upon the therapist's degree of understanding
of the processes involved, his or her clinical experience with unusual states
of consciousness, and his or her freedom from anxiety. In psychedelic crisis intervention,
as in psychiatric practice in general, drastic measures frequently reflect the
helpers' own feelings of threat and insecurity, not only vis à vis possible
external danger, but also in relation to their own unconscious. The experience
from LSD therapy and the new experiential psychotherapies clearly indicates that
exposure to another person's deep emotional material tends to shatter psychological
defenses and to activate corresponding areas in the unconscious of the persons
assisting and witnessing the process, unless they have confronted and worked through
these levels in themselves. Since traditional psychotherapies are limited to work
on biographical material, even a professional with full training in analysis is
inadequately prepared to deal with powerful experiences of a perinatal and transpersonal
nature. The prevailing tendency to put all such experiences into the category
of schizophrenia and suppress them in every way reflects not only a lack of understanding,
but also a convenient self-defense against the helpers' own unconscious material.
As the sophistication and clinical experience of LSD therapists
has increased, it has become more and more evident that negative episodes in psychedelic
sessions should not be seen as unpredictable accidents, but intrinsic and lawful
aspects of the therapeutic work with traumatic unconscious material. From this
point of view the colloquial term "bummer" or "bad trip" does
not make sense. To an experienced LSD therapist an unsuccessful psychedelic session
is not one in which the subject experiences panic anxiety, self-destructive tendencies,
abysmal guilt, loss of control, or difficult physical sensations. If properly
handled, a painful and difficult LSD session can bring about an important therapeutic
breakthrough. It can facilitate resolution of problems that have plagued the subject
in subtle ways for many years and contaminated his or her everyday life. An unsuccessful
session, however, is one in which difficult feelings begin to emerge, the subject
does not fully surrender to the process and the gestalt remains unresolved. From
this point of view, all psychedelic experiences in which the process is thwarted
by the administration of tranquilizers and external distractions such as transfer
to a psychiatric hospital are not failures because of the nature of the psychological
process involved, but because the crisis management has interfered with a positive
resolution.
Although LSD can induce difficult experiences even under the best
circumstances, it would be a mistake to attribute all "bad trips" to
the drug itself. The psychedelic state is determined by a variety of non-drug
factors; the incidence of serious complications depends critically on the personality
of the subject, and the elements of set and setting. This can be illustrated by
comparing the incidence of complications during the early supervised experimentation
with LSD, and the psychedelic scene of the sixties. In 1960, Sidney Cohen published
a paper entitled, LSD: Side Effects and Complications. J. Nerv. Ment. Dis.
130:30, 1960. It was based on reports from forty-four professionals who had
administered LSD and mescaline to about five thousand persons over twenty-five
thousand times; the number of sessions per person ranging between one and eighty.
In the group of normal volunteers, the incidence of attempted suicides after the
session was less than one in a thousand cases, and that of prolonged reactions
lasting over forty-eight hours was 0.8 per thousand. The numbers were somewhat
higher when psychiatric patients were used as subjects; in every thousand patients
there were 1.2 suicide attempts, 0.4 completed suicides and 1.8 prolonged reactions
lasting over forty-eight hours. In comparison with other methods of psychiatric
therapy, therefore, LSD appeared to be unusually safe, particularly when contrasted
with other procedures used routinely in psychiatric treatment at that time, such
as electroshocks, insulin comas, and psychosurgery. These statistics contrast
sharply with the incidence of adverse reactions and complications associated with
unsupervised experimentation. During my visit to the Haight-Ashbury clinic in
San Francisco in the late sixties, I was told by its director David Smith that
they were treating an average of fifteen "bad trips" a day. Although
this does not necessarily mean that all these clients had long-lasting adverse
effects from their psychedelic experiences, it illustrates the issue in question.
The experience and sophistication of psychiatrists and psychologists
in relation to psychedelics was certainly not great during the early years and
the settings were far from ideal. However, the sessions reported in Dr. Cohen's
paper were conducted in protected environments, under reasonable supervision and
by responsible individuals. In addition, those who had difficult experiences were
in a place that was equipped to provide help in case of need and they did not
have to be subjected to the absurd ordeal of transfer to a psychiatric facility.
The psychedelic crisis is caused by a complicated interplay of internal
and external factors. The therapist has to distinguish which of the two sets of
influences is more important and proceed accordingly. The first and most important
step in handling a psychedelic crisis is to create a simple, safe and supportive
physical and interpersonal environment for the subject. In cases where external
factors seem to have played a crucial role, it is important to remove the individual
from the traumatic situation or change it by active intervention. If the crisis
occurred in a public locale, he or she should to be taken to a quiet, secluded
place. If the incident happens during a party in a private residence, it is important
to simplify the situation by moving to a separate room or asking the guests to
leave. A few close friends who appear sensitive and mature may be asked to assist
in the process. They can provide group support or help the subject to actively
work through the underlying problem during the termination period of the session.
The techniques of group involvement in psychedelic sessions have been discussed
earlier in this book (p. 145).
After creating a safe environment the next important task is to
establish good contact with the subject. A relationship of trust is probably the
most significant prerequisite for the positive outcome of a psychedelic session
in general and for successful handling of a crisis in particular. A person asked
to intervene in a crisis triggered by LSD is at a great disadvantage as compared
to an LSD therapist facing a similar situation in the course of psychedelic treatment,
because the therapeutic session is preceded by a drug-free preparation period
during which there is enough time to establish good contact and a relationship
of trust. If a difficult situation arises in the course of an LSD series, the
client can also draw on his or her memories of previous sessions where painful
experiences had been successfully worked through and integrated with the help
of the therapist.
In contrast, the professional dealing with a crisis outside of the
therapeutic context walks into the emergency situation as a stranger, usually
without any previous contact with the subject and other persons involved. Trust
and cooperation have to be established in a very short time and often under dramatic
circumstances. Freedom from anxiety, an ability to remain centered, deep empathy,
and intimate knowledge of the dynamics of psychedelic states are the only means
of generating trust under these circumstances.
It is essential to convey a sense of safety and security by emphasizing
the self-limiting nature of the LSD experience. No matter how critical the condition
appears to be, in most instances it will be resolved spontaneously five to eight
hours after the ingestion of the drug. This time limit should be clearly communicated
to the subject and other people present; until that time there is absolutely no
reason to panic or worry, however dramatic the emotional and psychosomatic manifestations
might be. It is also of great advantage to keep the subject in a reclining position,
but this should be attained without using physical force and open restraint. With
a little experience, one can develop a technique with which it is possible to
effectively restrain the individual using a context of support and cooperation
rather than conflict.
When adequate contact has been established, a positive framework
should be offered for the difficult LSD experience. It is essential to present
it as an opportunity to face and work through certain traumatic aspects of one's
unconscious rather than as an unfortunate and tragic accident. A person assisting
in a psychedelic crisis should make consistent attempts to internalize the experience
of the LSD subject and encourage him or her to face the critical issues involved.
The LSD subject should be encouraged to keep his or her eyes closed and confront
the experience, whatever it is. The therapist should repeatedly communicate to
the subject that the quickest way out of this difficult state is through surrendering
to the emotional and physical pain, experiencing it fully and finding appropriate
channels to express it. This process of surrendering can be greatly facilitated
by music. If a good high-fidelity stereo set is available, and the subject is
open to it, music should be introduced into the situation as soon as possible.
When good rapport has been established, it is possible to offer
active assistance using comforting physical contact, elements of playful struggle,
and pressure on or massage of the parts of the body where the energy appears to
be blocked. This should not be done if the trust bond is precarious or absent;
it is absolutely contraindicated if the subject is paranoid and includes the people
present among his or her persecutors. In some instances simply being with the
client and playing for time might be the only solution. Under such circumstances,
it is essential to use any possible means and existing resources to keep the LSD
subject from hurting himself or others and causing serious material damage. While
following this basic rule, occasional attempts should be made to establish rapport
and gain the individual's cooperation.
If the gestalt of the experience remains unfinished when the effect
of the drug is subsiding, psychological and physical activity should be used to
facilitate integration. Ideally, the subject should complete the session feeling
comfortable and relaxed, without any residual emotional or psychosomatic symptoms.
The two techniques that have proven useful in this context—the abreactive
approach and the cleansing hyperventilation—have been discussed earlier in
this book (pp. 144-5, 147-8). After the subject reaches a psychologically and
physically comfortable state, it is important to create a safe and nourishing
atmosphere for the rest of the day and night. Ideally, a person who has been through
a psychedelic crisis should not be left alone for at least twenty-four hours after
the ingestion of the drug. After this time the therapist should see the client
again, reevaluate the situation and, depending on his or her condition, choose
the future strategy. In most instances no further provisions are necessary if
the crisis was properly handled. It is useful to discuss the LSD experience in
detail and facilitate its integration into the client's everyday life. If significant
emotional and psychosomatic complaints have appeared as a result of the LSD experience,
arrangements should be made for follow-up uncovering therapy and body work. An
individualized selection of meditation techniques, Gestalt practice, neo-Reichian
approaches, guided imagery with music, controlled breathing, polarity massage
or rolfing should be offered to the client.
Where the clinical condition remains precarious despite all the
uncovering work, this treatment may have to be continued on an in-patient basis.
If all the above approaches prove ineffective, integration can be facilitated
by chemical means. Ideally, a supervised psychedelic session should be scheduled
after adequate preparation. This approach might seem paradoxical to the average
mental health professional, since it involves administration of the same drug
or category of drugs that apparently brought the client trouble in the first place.
Yet judicious use of psychedelics under these circumstances is the preferred treatment.
Clinical experiences have shown that it is extremely difficult to restore defenses
by the use of covering techniques such as tranquilizers, once the unconscious
has been opened by a powerful psychedelic substance. It is much easier to continue
the uncovering strategy and facilitate completion of the unfinished gestalt.
Psilocybin, methylene-dioxy-amphetamine (MDA), tetrahydrocannabinol
(THC), and dipropyltryptamine (DPT) are viable alternatives to LSD. They have
the same general effects and are less contaminated by bad publicity. MDA and THC
seem to be particularly useful in this context, because of their gentle effect
and selective affinity to positive governing systems in the unconscious. Effective
psychological work with these substances involves less emotional and psychosomatic
pain than when LSD is used.
Since the above psychedelics are not readily available, and obtaining
permission to use them involves tedious administrative procedures, a session with
Ritaline (100-200 milligrams) or Ketalar (100-150 milligrams) might be a more
feasible approach. Tranquilizers should not be used in any condition related to
the use of psychedelic drugs until all the above uncovering approaches have been
tried and have failed.
Powerful non-drug approaches could also be used in lieu of tranquilizers
in all those cases where a poorly resolved LSD experience results in a long-term
psychotic condition and psychiatric hospitalization lasting months or years. If
these do not bring about sufficient clinical improvement, psychedelic therapy,
using the substances mentioned above, is the next logical choice. Ketalar, a drug
that is legally available and has been used in a medical context for general anesthesia
could prove promising in these otherwise desperate cases.
I would like to conclude this discussion of psychedelic crisis intervention
with a description of the most dramatic situation of this kind I have encountered
in my professional career.
In my third year in Big Sur, California, I was awakened
at 4:30 one morning by a telephone call. It was the night guard from the nearby
Esalen Institute asking for help. A young couple called Peter and Laura, who
were traveling down the coast, had parked their VW camper on coastal route 1
in the vicinity of the Esalen Institute and had decided to take LSD together.
They rolled out the bed in their car and shortly after midnight both of them
ingested the drug. Laura-s experience was relatively smooth, but Peter progressively
developed an acute psychotic state. He became paranoid and violent, and after
a period of verbal aggression he started throwing things around and demolishing
the car. At this point Laura panicked, locked him in the car and sought help
at Esalen. She appeared at the guard shack completely naked, holding the car
keys in her hand. The night guard knew about my previous work with psychedelics
and decided to give me a call; he also woke up Rick Tarnas, a resident psychologist
who had done his dissertation on psychedelic drugs.
While the guard was taking care of Laura, who calmed down and
had a pleasant, uncomplicated LSD experience, Rick and I walked to the camper.
As we approached the car we heard loud noises and shouting; when we came closer
we noticed that several of the windows were broken. We unlocked the car, opened
the door and started talking to Peter. We introduced ourselves and told him
that we had had considerable experience with psychedelic states and had come
to help him. I tentatively stuck my head inside the door and looked into the
camper; a half-gallon bottle missed me by about four inches and landed on the
dashboard. I repeated this several times, and two more objects came flying in
my direction. When we felt that Peter had nothing more to throw, we quickly
moved into the camper and lay down on the roll-out bed on either side of him.
We continued talking to Peter, reassuring him that everything
would be all right in an hour or two; knowing that he and his girlfriend had
taken LSD after midnight, we could give him this definite time limit. It became
obvious that he was in a paranoid state and saw us as hostile FBI agents who
had come to fetch him. We held his arms in a comforting and reassuring way,
changing this into a firm grip whenever he made an attempt to escape, but avoiding
real physical antagonism and struggle. All the while, we kept talking about
having had difficult experiences ourselves, and finding them retrospectively
useful. His condition oscillated for about an hour between mistrust with anxiety-laden
aggressive impulses, and episodes of relief when it was possible to connect
with him.
As time went by and the LSD state became less intense, Peter slowly
developed trust. He was more and more willing to keep his eyes closed and face
the experience, and we were even able to start working carefully on the blocked
parts of his body, encouraging full emotional expression. By seven o'clock all
negative elements completely disappeared from Peter's LSD experience. He felt
cleansed and reborn, and was thoroughly enjoying the new day. His previous hostility
turned into deep gratitude and he kept repeating how much he appreciated our
intervention.
At about half-past-seven Laura appeared at the camper and joined
us; she was herself in very good condition, but was naturally concerned about
Peter. Rick and I helped dispel the negative aftermath of the dramatic events
of the night and facilitated their reunion. We advised them strongly against
driving that day. They spent a leisurely day by the Pacific Ocean and the next
day continued their journey south. They were both in good spirits, although
somewhat worried about the bill for the repair of their damaged camper.
Editor's Footnote
*Dr. Grof's theory of Basic Perinatal Matrices
is explained both in LSD Psychotherapy and Beyond the Brain (back)