The History of Psychedelic Therapy with the Dying
Stanislav Grof & Joan Halifax
Chapter 2 of The Human Encounter with Death
New York: E.P. Dutton 1977, ©Grof & Halifax
Our experience with persons dying of incurable diseases has been
closely associated with the development of psychedelic therapy, a comprehensive
program of brief psychotherapy utilizing mind-altering substances such as lysergic
acid diethylamide (LSD) and dipropyltryptamine (DPT). Although this treatment
is a direct outgrowth of modern pharmacological and clinical research, it has
close parallels in various contemporary non-Western cultures and its roots reach
back to prehistory and the shamanic rituals and healing ceremonies of many ancient
civilizations.
The first suggestion that psychedelic substances could be useful
in the therapy of individuals dying of incurable diseases came from pediatrician
Valentina Pavlovna Wasson. After many years of intensive ethnomycological studies,
she and her husband, Gordon Wasson, became interested in the use of psychedelic
mushrooms in pre-Columbian cultures and in contemporary Central America. They
made several field trips to Mexico to explore this issue, and finally in June
1955 they became the first Westerners to be admitted to a sacred ritual conducted
by the Mazatec curandera, or medicine woman, Maria Sabina. The Wassons
were deeply impressed by the powerful effect of the mushrooms that they ingested
in this ceremony. Roger Heim, the French mycologist whose aid the Wassons sought,
identified the mushrooms botanically as Psilocybe mexicana and its congeners;
he then sent samples to the laboratories of the Swiss pharmaceutical company,
Sandoz, for chemical analysis. In 1957 Valentina Pavlovna Wasson gave an interview
in This Week magazine about the history of this discovery and her own
experience after the ingestion of the Mexican sacred mushrooms. She expressed
the opinion that if the active agent could be isolated and a sufficient supply
assured, it might become a vital tool in the study of psychic processes. She
also stated that as the drug would become better known, medical uses would be
found for it, perhaps in the treatment of alcoholism, narcotic addiction, mental
disorders, and terminal diseases associated with severe pain. Several years
later a team of researchers working in Baltimore independently tested the validity
of her unusual vision. A group of psychiatrists and psychologists at the Maryland
Psychiatric Research Center who were not familiar with the article in This
Week conducted systematic studies of psychedelic therapy with LSD, a drug
closely related to psilocybin, for exactly the same indications that Valentina
Wasson predicted. We ourselves were surprised to discover the newspaper clipping
in Gordon Wasson's library during a 1974 visit to his home.
The next stimulus for the use of psychedelics with dying individuals
did not come from a physician or behavioral scientist but from the writer and
philosopher, Aldous Huxley. He was profoundly interested both in the phenomenon
of dying and in the religious and mystical experiences induced by psychedelic
drugs. With unusual sensitivity and insight he assisted his first wife, Maria,
when in 1955 she was dying of cancer. During her final hours he used a hypnotic
technique to bring her into touch with the memory of ecstatic experiences that
had occurred spontaneously on several occasions during her life. The explicit
goal was to facilitate her experience of dying by guiding her toward these mystical
states of consciousness as death was approaching. This deep personal experience
has its parallel in Huxley's novel Island, where the character Lakshmi
is dying under very similar circumstances. In a letter to Humphry Osmond, a
psychiatrist and pioneer in psychedelic research who introduced him to LSD and
mescaline, Huxley wrote:
My own experience with Maria convinced me that the living can
do a great deal to make the passage easier for the dying, to raise the most
purely physiological act of human existence to the level of consciousness and
perhaps even of spirituality.
To those who are familiar with the effects of hallucinogenic drugs
and with Huxley's personal history, there is no doubt that the "soma"
in Brave New World and the ''moksha medicine'' in Island are psychedelic
substances similar in their effects to LSD, mescaline, and psilocybin. In Huxley's
vision "moksha medicine'' gives inhabitants of the island mystical insights
that free them from the fear of death and enable them to live more fully. In another
letter to Humphry Osmond written as early as February 1958, Huxley was quite explicit
about his idea of seriously considering the use of LSD with dying individuals:
... yet another project--the administration of LSD to terminal
cancer cases, in the hope that it would make dying more spiritual, less strictly
physiological process.
According to his second wife, Laura, Aldous mentioned on several
occasions that ''the last rites should make one more conscious rather than less
conscious, more human rather than less human.'' In 1963, when he was himself dying
of cancer, Huxley demonstrated the seriousness of his vision. Several hours before
his death he asked Laura to give him 100 micrograms of LSD to facilitate his own
dying. This moving experience was later described in Laura Huxley's book, This
Timeless Moment.
Aldous Huxley's suggestion, although reinforced by his unique personal
example, for several years had no influence on medical researchers. The next contribution
to this area came from a rather unexpected source and was unrelated to Huxley's
thinking and efforts. In the early 1960s Eric Kast of the Chicago Medical School
studied the effects of various drugs on the experience of pain in the quest for
a good and reliable analgesic. He became interested in LSD as a possible candidate
for such a substance because of certain peculiarities of its effect on humans.
He learned that LSD tends to produce a marked distortion of the body image and
alterations of body boundaries; furthermore, it seemed to interfere with the ability
to concentrate and maintain selective attention on a particular physiological
sensation. Thus, in individuals who are under the influence of LSD, simple visual
impressions may take precedence over sensations of pain or concerns related to
survival. Both the effect of LSD on the body image and its interference with selective
focus on significant input seemed to be worth exploring in terms of their potential
for altering the perception of physical pain.
In a paper published in 1964 Kast and Collins described the results
of a study in which the hypothetical analgesic properties of LSD were compared
to those of two established and potent drugs, dihydromorphinone (Dilaudid) and
meperidine (Demerol). In a group of fifty individuals suffering from severe physical
pain were thirty-nine patients with various types and stages of cancer, ten patients
with gangrenes of feet or legs, and one with severe herpes zoster (shingles).
The outcome of the statistical analysis of this comparison indicated that the
analgesic effect of LSD proved to be superior to both Dilaudid and Demerol. In
addition to pain relief, Kast and Collins noticed that some of these individuals
showed a striking disregard for the gravity of their personal situations. They
frequently talked about their impending death with an emotional attitude that
would be considered atypical in our culture; yet it was quite obvious that this
new perspective was beneficial in view of the situation they were facing.
In a later study of 128 individuals with metastatic cancer, Kast
explored in more detail some of his earlier findings. This time he was interested
not only in the effects of LSD on pain but also on some additional parameters:
emotional changes, sleep patterns, and attitudes toward illness and death. In
view of the fact that there was no psycho therapeutic emphasis and the patients
were not even informed that they were being given LSD, the results were quite
remarkable. A precipitous drop in pain occurred in many individuals about two
to three hours after the administration of 100 micrograms of LSD and lasted an
average of twelve hours; pain intensity for the whole group (not necessarily for
every patient) was decreased for a period of three weeks. For about ten days after
the session, Kast observed improvement of sleep and a less concerned attitude
toward illness and death.
In 1966 Kast published another paper in which he paid more explicit
attention to the influence of LSD on the religious and philosophical experiences
and ideas of the patients. The group he studied consisted of eighty persons suffering
from terminal malignant disease, with estimated life expectancies of weeks or
months, each of whom had been fully informed of the diagnosis. In contrast to
earlier studies, the LSD sessions were terminated by an intramuscular injection
of 100 milligrams of chlorpromazine upon the appearance of fear, panic, unpleasant
imagery, or the desire to rest. The beneficial influence of a single administration
of 100 micrograms of LSD on physical pain, mood, and sleep patterns was similar
to the preceding studies. In addition, Kast described a variety of changes in
the patients that made their situation more tolerable. He noticed improved communication
both between the observer and the patients and among the patients themselves;
this enhanced their morale and self-respect and created a sense of cohesion and
community among them. Quite significant, also, was the occurrence of "happy,
oceanic feelings" lasting up to twelve days following the administration
of LSD. Kast stated explicitly that a certain change in philosophical and religious
attitudes in relationship to dying took place that were not reflected in his numerical
data and graphs.
In spite of what to an LSD therapist might at present appear as
shortcomings in Kast's studies, the historical value of his pioneering effort
is unquestionable. He not only discovered the analgesic value of LSD for some
patients with intractable pain, but he also brought forth the first experimental
evidence for Aldous Huxley's suggestion that the administration of LSD might ease
the encounter with death in persons suffering from cancer. Kast concluded the
last of his studies by stating that, according to his observations, LSD is capable
not only of improving the lot of dying individuals by making them more responsive
to their environment and family, but it also enhances their ability to appreciate
the nuances and subtleties of everyday life. It gives them aesthetic satisfaction
and "creates a new will to live and a zest for experience, which, against
a background of dismal darkness and preoccupying fear, produces an exciting and
promising outlook."
The encouraging results of Kast's studies inspired Sidney Cohen,
a prominent Los Angeles psychiatrist, friend of Aldous Huxley, and one of the
pioneers in LSD research, to start a program of psychedelic therapy for individuals
dying of cancer. Unfortunately the results of his study and the details of his
treatment procedure have never been published. In a 1965 article Cohen expressed
his feelings about the potential of psychedelic therapy for the dying, based on
his pilot experiments with a small group of patients. He stated that his own work
confirmed Kast's findings about the beneficial effect of LSD on severe physical
pain and suggested that LSD may one day provide a technique for altering the experience
of dying. Cohen saw clearly the importance of this research endeavor: "Death
must become a more human experience. To preserve the dignity of death and prevent
the living from abandoning or distancing themselves from the dying is one of the
great dilemmas of modern medicine."
Cohen's co-worker, Gary Fisher, later published a paper in which
he discussed the personal and interpersonal problems of the dying. In this context
he emphasized the significance of transcendental experiences--whether spontaneous,
resulting from various spiritual practices, or induced by psychedelic drugs. As
a result of such experiences the individual ceases to be concerned about his or
her own physical demise and begins to see it as a natural phenomenon of the cycling
of the life force. This acceptance drastically alters a person's life-style; the
individual no longer reacts with panic, fear, pain, and dependency to the changes
that are occurring. Rather, the patient is willing and eager to share this new
knowledge with close family members and friends. Fisher discussed the use of LSD
therapy within the framework of a research project where this drug was compared
with an experimental analgesic and only one hour was allowed for preparing patients
for the session. In spite of this limitation, he observed what he described as
dramatic results in terms of pain reduction, psychological aftereffects, and adjustment
of the patients to their impending deaths.
Another series of observations that was later integrated into the
concept of psychedelic therapy for the dying originated in the Psychiatric Research
Institute in Prague, Czechoslovakia. A research team of this institute headed
by Stanislav Grof (coauthor of this book) conducted experiments in the early 1960s
with psychiatric patients, exploring the potential of LSD for personality diagnostics
and psychotherapy. These efforts finally resulted in treatment that involved intense
psychological work and a series of therapeutic sessions with LSD. Although this
approach was initially based in theory and practice on psychoanalysis, in the
course of years it underwent substantial modifications and became an independent
therapeutic procedure combining work on psychodynamic issues with a definite emphasis
on transpersonal and transcendental experiences.
In the exploratory phase of this work, all psychiatric patients
from various diagnostic categories undergoing serial LSD sessions sooner or later
transcended the psychoanalytic framework and spontaneously moved into experiential
realms that have been described through millennia as occurring in various schools
of the mystical tradition, temple mysteries, and rites of passage in many ancient
and pretechnological cultures of the world. The most common as well as the most
important of these phenomena were experiences of death and rebirth, followed by
feelings of cosmic unity. This profound encounter with one's own impermanence
and mortality was very complex and had biological, emotional, intellectual, philosophical,
and metaphysical dimensions. Experiences of this kind seemed to have had very
beneficial consequences for these psychiatric patients; some very dramatic improvements
of various psychopathological conditions were observed immediately following the
death-rebirth phenomenon and, in particular, the experiences of oneness with the
universe. This suggested the existence of a powerful therapeutic mechanism as
yet unknown to Western psychiatry and psychology that appeared far superior to
those used in conventional psychotherapy.
Many individuals who had the experience of death and rebirth sometimes
accompanied by feelings of cosmic unity independently reported that their attitudes
toward dying and their concepts of death underwent dramatic changes. Fear of their
own physiological demise diminished, they became open to the possibility of consciousness
existing after clinical death, and tended to view the process of dying as an adventure
in consciousness rather than the ultimate biological disaster. Those of us conducting
this research kept witnessing, to our great surprise, a process that bore a striking
similarity to mystical initiation and involved experiential sequences that resembled
those described in the Tibetan or Egyptian Book of the Dead.
The claims of changes in attitudes toward death were so frequent
that it seemed important to test their practical relevance. It was obvious that
a deep change of consciousness of that sort could be very beneficial for dying
individuals, particularly those with chronic, incurable diseases. The first author
(S.G.) then had an opportunity to work with several persons diagnosed with cancer.
These pilot observations indicated that the alleviation of the fear of death earlier
reported as a result of LSD therapy in psychiatric patients (most of whom were
young and physically healthy) can occur also in those for whom the issue of death
is of immediate relevance. At this point the Prague group began seriously discussing
the possibility of working systematically with dying people, and Grof designed
a research program using serial LSD sessions with individuals dying of cancer.
These plans were interrupted by a fellowship granted to him by the Foundation's
Fund for Research in Psychiatry in New Haven, Connecticut, that took him to the
United States.
After his arrival in Baltimore in March 1967, he joined the team
in the Research Unit of Spring Grove State Hospital, which later became the core
of the Clinical Sciences Department of the newly built Maryland Psychiatric Research
Center. Here he found, to his surprise, that some time prior to his arrival this
group had been interested in exploring the potential of LSD psychotherapy for
alleviating the emotional and physical suffering of cancer patients. The sequence
of events that spurred the interest of the research team in this problem area,
briefly described, is this: Since 1963 a group of psychiatrists, psychologists,
and social workers at Spring Grove had been exploring the effects of a brief course
of LSD-assisted psychotherapy on the drinking behavior, psychological condition,
and social adjustment of alcoholics. In a parallel study the therapeutic potential
of this new treatment was tested in a group of neurotic patients. During the assessment,
based on clinical interviews as well as psychological testing, the symptoms particularly
responsive to psychedelic therapy appeared to be depression and anxiety.
In 1965, when the studies with alcoholics and neurotics were well
under way, the Spring Grove research team first focused its attention on the needs
of dying cancer patients in an unforeseen and tragic manner. A professional member
of the research team, Gloria, a woman in her early forties, developed a carcinoma
of the breast. She had undergone a radical mastectomy; subsequent surgery had
revealed inoperable metastases of the liver. Although still ambulatory, she was
in severe physical and emotional distress. She was fully aware of her condition
and her prognosis and shared her feelings of despair with staff members. On the
basis of the relief of depression and anxiety frequently observed in psychiatric
patients following LSD-assisted psychotherapy, Sidney Wolf, a psychologist and
member of the therapeutic team, suggested that the psychedelic treatment procedure
might prove helpful to his colleague. It seemed possible that her depression and
anxiety, although reactive in nature and well substantiated by a painful life
situation, might respond favorably to LSD therapy, as was the case in other conditions
of a psychogenic nature.
After discussions with her husband, her physician, and with the
approval of all concerned, a course of psychedelic therapy was initiated, with
Sidney Wolf in the role of "sitter.'' In the treatment plan at Spring Grove
the primary objective was to facilitate the occurrence of a psychedelic peak experience
in the context of brief but intensive psychotherapy. The preparation for the session
lasted somewhat over a week; the focus was on the issue of personal identity and
on current interpersonal relationships. When most of the important areas involved
were satisfactorily clarified, a 200-microgram LSD session was conducted under
conditions quite similar to those used for psychiatric patients. The outcome of
this pioneering experiment was quite remarkable: After careful preparation and
several subsequent drug-free interviews a single LSD experience seemed to have
changed the quality of Gloria's remaining days. Shortly after the LSD session
she went on vacation with her husband and children. Upon her return, two weeks
after the session, she completed the following retrospective report:
''The day prior to LSD, I was fearful and anxious. I would at that
point have gratefully withdrawn. By the end of the preparatory session practically
all anxiety was gone; the instructions were understood and the procedure clear.
The night was spent quietly at home; close friends visited and we looked at photograph
albums and remembered happy family times. Sleep was deep and peaceful. I awakened
refreshed, and with practically no fear. I felt ready and eager. The morning was
lovely, cool and with a freshness in the air. I arrived at the LSD building with
the therapist. Members of the department were around to wish me well. It was a
good feeling.
''In the treatment room was a beautiful happiness rosebud, deep
red and dewy, but disappointingly not as fragrant as other varieties. A bowl of
fruit, moist, succulent, also reposed on the table. I was immediately given the
first dose and sat looking at pictures from my family album. Gradually, my movements
became fuzzy and I felt awkward. I was made to recline with earphones and eyeshades.
At some point the second LSD dose was given to me. This phase was generally associated
with impatience. I had been given instructions lest there be pain, fear, or other
difficulties. I was ready to try out my ability to face the unknown ahead of me
and to triumph over my obstacles. I was ready, but except for the physical sensations
of awkwardness and some drowsiness nothing was happening.
''At about this time, it seems, I fused with the music and was transported
on it. So completely was I one with the sound that when the particular melody
or record stopped, however momentarily, I was alive to the pause, eagerly awaiting
the next lap of the journey. A delightful game was being played. What was coming
next? Would it be powerful, tender, dancing, or somber? I felt at these times
as though I were being teased, but so nicely, so gently. I wanted to laugh in
sheer appreciation of these responses, regardless of where I had just been, how
sad or awed. And as soon as the music began, I was off again. Nor do I remember
all the explorations.
"Mainly I remember two experiences. I was alone in a timeless
world with no boundaries. There was no atmosphere; there was no color, no imagery,
but there may have been light. Suddenly I recognized that I was a moment in time,
created by those before me and in turn the creator of others. This was my moment,
and my major function had been completed. By being born, I had given meaning to
my parents' existence.
"Again in the void, alone without the time-space boundaries.
Life reduced itself over and over again to the least common denominator. I cannot
remember the logic of the experience, but I became poignantly aware that the core
of life is love. At this moment I felt that I was reaching out to the world--to
all people--but especially to those closest to me. I wept long for the wasted
years, the search for identity in false places, the neglected opportunities, the
emotional energy lost in basically meaningless pursuits.
"Many times, after respites, I went back, but always to variations
on the same themes. The music carried and sustained me. Occasionally, during rests,
I was aware of the smell of peaches. The rose was nothing to the fruit. The fruit
was nectar and ambrosia (life); the rose was only a beautiful flower. When I finally
was given a nectarine it was the epitome of subtle, succulent flavor.
"As I began to emerge, I was taken to a fresh windswept world.
Members of the department welcomed me and I felt not only joy for myself, but
for having been able to use the experience these people who cared for me wanted
me to have. I felt very close to a large group of people. Later, as members of
my family came, there was a closeness that seemed new. That night, at home, my
parents came, too. All noticed a change in me. I was radiant, and I seemed at
peace, they said. I felt that way too. What has changed for me? I am living now,
and being. I can take it as it comes. Some of my physical symptoms are gone. The
excessive fatigue, some of the pains. I still get irritated occasionally and yell.
I am still me, but more at peace. My family senses this and we are closer. All
who know me well say that this has been a good experience."
Five weeks after the date of the session, Gloria suddenly developed
ascites (accumulation of serous fluid in the abdominal cavity) and had to be rehospitalized;
she died quietly three days later.
The result of Sidney Wolf's endeavor was so encouraging that the
Spring Grove staff decided to explore further the potential of psychedelic therapy
for alleviating the suffering of those dying of cancer. A group of open-minded
surgeons at Baltimore's Sinai Hospital expressed interest in this procedure, offered
their cooperation, and agreed to refer patients for LSD therapy. Three more persons
were treated at this time by Sanford Unger, a psychologist who had played an important
role in launching the Spring Grove studies of alcoholics and neurotics.
The next important step in this direction was made in late 1967,
when Walter N. Pahnke joined the Spring Grove team. He was instrumental in changing
the initial interest of the staff into a systematic pilot exploration and eventually
a research project. Pahnke's background made him ideally suited for this type
of work. He was a graduate of Harvard Medical School, and in addition had a doctoral
degree in comparative religion and a degree in divinity.
It is hard to imagine a more useful way to combine medicine, psychology,
and religion than psychedelic therapy with dying individuals. With unusual energy,
enthusiasm, and devotion, Pahnke assumed the role of principal investigator in
the cancer study. After pilot experimentation he was able to obtain financial
support from the Mary Reynolds Babcock Foundation. He started a research program
exploring the value of psychedelic therapy utilizing LSD. Later he initiated a
similar project in which a short-acting psychedelic, dipropyltryptamine (DPT),
was used in lieu of LSD.
Walter Pahnke's life and work were drastically terminated in a tragic
accident on July 10, 1971. While vacationing in his summer cabin in Maine, he
did not return from one of his scuba-diving expeditions. His body and diving equipment
were never recovered and the nature of the accident has remained a mystery. Walter's
demise was a great loss for the Spring Grove team, from the personal as well as
professional point of view. After Walter's death the first author (S.G.) assumed
medical responsibility for the cancer study as his primary research activity and
interest. His objective was not only to complete the research projects and accumulate
enough data but also to formulate a theoretical framework that would account for
some of the dramatic changes occurring as a result of LSD therapy. It seemed important
at this point to carefully analyze the data from LSD sessions of normal volunteers,
psychiatric patients, and dying individuals, and to formulate a comprehensive
theory of LSD therapy based on a new model of the unconscious.
A new dimension was added to these endeavors when in 1972, Joan
Halifax, the second author, joined the team as co-therapist and anthropological
consultant. We could now combine our backgrounds in experimental psychiatry and
medical anthropology and view the data from a broad cross-cultural perspective.
It was in this process of interdisciplinary cross-fertilization, when we were
working as a therapeutic dyad, sharing observations and exchanging data, that
the ideas expressed in this book started to crystallize into their present form.
Note:
Although the Spring Grove psychedelic research continued on until
the mid-1970's, it, too, finally came to an end for various reasons. Lack of
new funding by the government, discouragement of the workers involved in not
obtaining permission to carry out desired projects, continuing bad publicity
resulting from clandestine use of psychedelics, and other factors could be cited.
And so, by the late 1970's essentially all psychedelic research in North America
had ceased, and what remained of European research was a mere ghost of the promising
work of the 1950's and 1960's.
-Peter Webster