Archives of General Psychiatry, 1962; 6 (203-213)
Since the hallucinogenic properties of D-lysergic acid diethylamide (LSD-25) were accidentally discovered by Hoffman in 1943 there has been wide experimentation with the drug designed to test its properties both as a psychotomimetic and as a therapeutic agent. It has been considered by some investigators as having great value in revealing the nature of the schizophrenic state and thereby advancing the understanding that leads to progress in therapy. However, other investigators, while acknowledging the undoubted psychic effects of the drug, insist that the LSD experience cannot be equated with naturally occurring psychosis. It is not the first psychopharmaceutical agent to be used as an adjunct to psychotherapy; most of its predecessors were greeted with equal enthusiasm by some because of their action in unlocking the gates of repression and thus leading to disinhibition and catharsis. In fact, according to Hoch, careful studies of a large number of patients who were under the influence of different drugs did not reveal any marked specificity as to the use of those different agents. He describes mescaline and LSD as essentially anxiety-producing drugs which, because of their magnification of the patient’s symptomatology and the accompanying increase in anxiety and fear of loss of ego integration, may lead to the release of repressed material. These same qualities may be responsible for the precipitation of overt psychosis in borderline cases.
However, the facilitation of psychotherapy with these agents is by no means uniform. Variations in response to them by different patients may be due to metabolic as well as psychological and social factors, and the attitude of the psychotherapist who employs these adjuvants has been recognized as subtly or not so subtly influencing the results obtained. While the therapeutic value of LSD in the treatment of psychoneurotic patients has been accepted with greater or less enthusiasm by various investigators, its value in the treatment of the psychoses has been considered much more questionable. In fact, by 1954, there seemed to be fairly general agreement that it provided little opportunity for genuine progress in the treatment of schizophrenics. This group of patients was found to be markedly resistant to the drug and relatively higher doses than for normal or neurotic subjects were necessary to produce any effects. Nevertheless, some striking temporary changes were observed in the behavior of schizophrenics who had been given LSD.
In a study of 18 schizophrenic patients, Busch and Johnson 4 reported that excitation was the outstanding effect of LSD administration. This group moved and talked more than usual and showed greater interest and emotion.
Hoch, Cattell, and Pennes observed psychic changes including hallucination, perceptual disturbances, and unreality feelings in a group of 21 schizophrenics. There was also evidence of anxiety, euphoria, and depression.
Pennes reported of LSD and mescaline, “The characteristic effects of both these drugs consisted of an exacerbation of pre-existent symptoms.” In a group of 25 schizophrenic subjects he found that responses to LSD could be classified as intensifications in 16 (64%), diphasic (mixtures of intensification and normalization) in 6 (24%), and absent in 3 (12%). Normalization features in the 6 diphasic reactors included definite relaxation, decreased anxiety and tension, decreased concern over phobias and compulsions, subjective euphoric state with lifting of depression, and improved affective display and general contact.
At the Second International Congress of Psychiatry in Zurich in 1957, Hoch, Pennes, and Cattell (fn 7) raised the question, “What is the reaction of psychotic subjects to drugs which have strong psychological effects or induce psychotic states in normal individuals?” Their answer was, “The majority of schizophrenics displayed intensification of their pre-existing symptomatology on administration of mescaline or LSD 25… The reactions of schizophrenic patients to mescaline and LSD 25 are usually marked with severe anxiety and other emotional patterns, while disorganization of thought and behavior patterns may be profound.”
It has been the opinion of some investigators, however, that this disorganization of behavior patterns in schizophrenics might be followed by a reorganization that could be a step toward normalization. Quite recently, Bierer and Browne stated that “We thought this so-called ‘disorganization of the psychic integration’ must be a temporary removal of the ego-defenses and possibly could be used therapeutically.” They decided to combine LSD or LSD plus methamphetamine hydrochloride (Methedrine) with group psychotherapy. Their report on results of treatment of 75 patients, of whom 30 had the diagnosis of schizophrenia or advanced schizoid states, indicated that “burnt out” schizophrenics are among those on whom LSD appears to have no effect. They also state, “Further work is necessary, but it is clear that to include 50% of schizophrenics in a group markedly reduces the chances of success.”









