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ALTERED STATES OF CONSCIOUSNESS |
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Method From Schultz's clinical work a number of useful verbal formulas gradually evolved which, according to their more bodily or mental orientation, formed two basic series of mental exercises: the Standard Exercises and the Meditative Exercises. The six standard exercises are physiologically oriented. The verbal content of the standard formulas is focused on the neuromuscular system (heaviness) and the vasomotor system (warmth); on the heart, the respiratory mechanism, warmth in the abdominal area, and cooling of the forehead. The meditative exercises are composed of a series of seven exercises which focus primarily on certain mental functions and are reserved for trainees who master the standard exercises. Later, as more clinical and experimental data became available, a number of complementary exercises specifically designed for normalization of certain patho-functional deviations evolved. These were called special exercises. Psychophysiologically, autogenic training is based on three main principles: (a) reduction of exteroceptive and proprioceptive afferent stimulation; (b) mental repetition of psychophysiologically adapted verbal formulas; and (c) mental activity conceived as "passive concentration." A reduction of afferent stimuli requires observation of the following points: the exercise should take place in a quiet room with moderate temperature and reduced illumination; restricting clothes should be loosened or removed; the body must be relaxed, and the eyes closed, before the mental exercises are begun. Three distinctive postures have been found adequate: (a) the horizontal posture; (b) the reclined arm-chair posture; and (c) the simple sitting posture. All three training postures require careful [TC2 312] consideration of a number of points. When certain details are not observed, disagreeable side-effects or after-effects and ineffective performance of the exercises have been reported. The first exercise of the autogenic standard series aims at muscular relaxation. The functional theme of the verbal formula is heaviness. Right-handed persons should start out with passive concentration on "My right arm is heavy." Left-handed persons should begin with focusing on the left arm. During the very first exercises about 40 per cent of all trainees will experience a feeling of heaviness predominantly in the forearm. During subsequent periods of regular training, the whole arm becomes heavy and the feeling of heaviness will spread to other extremities. This spreading of a certain sensation (the heaviness, tingling, warmth) to other parts of the body is called the "generalization phenomenon." Along with the development of the generalization phenomenon, passive concentration on heaviness will be extended to the other arm or the homolateral leg. Usually the heaviness training continues until heaviness can be experienced more or less regularly in all extremities. This may be achieved within two to eight weeks. Clinical investigations of larger groups of trainees, however, indicate that about 10 per cent of the patients do not experience a sensation of heaviness. This fact is one of the reasons why patients should be told that the Heaviness Formula (and others) functions merely as a technical key to bring about many different functional changes in the brain and bodily system, and that a sensation of heaviness may or may not occur. Furthermore, it has been found helpful to tell a patient that many changes of bodily functions occur (see section on experimental data) which one cannot feel. It is also important for the patient to know that according to experimental observations, the exercises are effective as long as they are performed correctly, even if one does not feel anything at all. Apart from this it is necessary that the therapist is familiar with the therapeutic problems resulting from different forms of autogenic discharges which may start while the patient is in an autogenic state (Geissmann, Jus, & Luthe, 1961; Luthe, Jus, & Geissmann, 1962). Subsequently, passive concentration on warmth is added, starting, for example with "My right arm is warm." This formula aims at peripheral vasodilation. Depending on the generalization of the feeling of warmth in other limbs, the training progresses until all extremities become regularly heavy and warm. This training may take another period of from two to eight weeks. After having learned to establish the feeling of heaviness and warmth, the trainee continues with passive concentration on cardiac activity by using the formula "Heartbeat calm and regular." Then follows the respiratory mechanism with "It breathes me," and warmth in the abdominal region: [TC2 313] "My solar plexus is warm." The final exercise ofthe physiologically oriented standard exercises concerns the cranial region which should be cooler than the rest of the body. Here, one applies the formula "My forehead is cool." The time usually needed to establish these exercises effectively varies between four and ten months. The trainee's attitude, while repeating a formula in his mind, is conceived as "passsive concentration." Passive concentration may best be explained in comparison with what is usually called "active concentration." Concentration in the usual sense has been defined as "the fixation of attention," or "high degrees of intensity of attention," or "the centering of attention on certain parts of experience." This type of mental activity involves the person's concern, his interest, attention, and goal-directed investment of mental energy and effort during the performance of a task and in respect to the functional result. In contrast, passive concentration implies a casual attitude during the performance and with regard to the functional result. Any goal-directed effort, active interest, or apprehensiveness must be avoided. The trainee's casual and passive attitude toward the psychophysiologic effects of a given formula is regarded as one of the most important factors of the autogenic approach. Furthermore, the effectiveness of passive concentration on a given formula depends on two other factors namely (a) the mental contact with the part of the body indicated by the formula (for example, the right arm); and (b) keeping up a steady flow of a filmlike (verbal, acoustic or visual) representation of the autogenic formula in one's mind. Passive concentration on a formula should not last more than 30 to 60 seconds in the beginning. After several weeks the exercises may be extended to three or five minutes; after a few months up to 30 minutes and longer. The state of passive
concentration is terminated by applying a three-step procedure, namely (a)
flexing the arms energetically, then (b) breathing deeply, and (c) opening
the eyes. Usually three exercises are performed in sequence, with about a
one minute interval between each of them. The meditative exercises should not normally be started until after six to 12 months of standard training, and the trainee should be able to prolong [TC2 314] the autogenic state up to 40 minutes without experiencing any disagreeable side-effects or after-effects. The meditative series begins with passive concentration on phenomena of visual imagination, as, for example, the spontaneous experience of certain colors. Later, the trainee may focus on seeing all colors at will. When that is achieved, the meditative series continues with visual imagination of objects. This training phase may take several weeks before results are obtained. It is followed by imagining abstract concepts like "happiness" or "justice" in different sensual modalities (musical, chromatic, plastic). Still later, one may meditate on one's own feelings and, in contrast, try to evoke the image of another person. Finally, at the deepest level of meditation, an interogatory attitude may be assumed in expectation of answers from the unconscious. Autogenic training at the meditative level may be applied as what has been called "Nirvana Therapy" (Schultz,1932. Schultz & Luthe,1961) in clinically hopeless cases(for example, advanced cancer) or in monotonous and desperate situations as may occur under exceptional circumstances. The meditative exercises have also been found to be of particular value in depth-dimensional psychotherapy. In general, it has been observed that the effects of more physiologically oriented standard exercises are reinforced by the meditative training. However, the meditative exercises are not introduced to the average patient. The average clinical therapy centers on the standard formulas in combination with special exercises and intentional formulas specifically designed to meet the therapeutic requirements of relevant functional or organic disorders. Experimental Data From experimental data and clinical results we know that passive concentration on the standard formulas induces multidimensional changes of a mental and organismic nature. In principle, two categories of effects may be distinguished: immediate effects, occurring during passive concentration on the different formulas, and effects resulting from practice of autogenic exercises over periods of weeks and months. Information about the immediate effects during the exercises is still incomplete. However, the experimental data available indicate clearly that each of the standard formulas induces physiologic changes of certain autonomic functions which are coordinated by diencephalic mechanisms. During passive concentration on heaviness, Siebenthal (1952), Schultz, (1952), Wittstock (1956), and Eiff and Jorgens (1961) recorded a significant decrease of muscle potentials. Along the same lines Schultz found a significant reduction of the patellar response during passive concentration of heaviness [TC2 315] in both legs (1932). Determinations of motor chronaxie (musc. extensor digit. comm. dexter) by Schultz, Lewy, and Gaszmann (1932, 1961) indicated that the intensity of the stimulus has to be increased during the heaviness exercise because the excitatory threshold rises from its resting value. Changes in peripheral circulation during passive concentration on heaviness and warmth have been verified by a number of independent authors (Schultz, 1926,1932:Schultz & Luthe,1959; Binswanger,1929; Stovkis, Renes &Landmann,l961). The most extensive study was carried out at the University of Wurzburg by Polzien(1955,1959,1962,a,b.c). Polzien found the rise of skin temperature was more pronounced in distal parts of the extremities than in the more proximal areas. Simultaneously variable changes in the rectal temperature were recorded. Depending upon the subject, and the duration of passive concentration, the increase of skin temperature in the fingers varied between 0.2 and 3.5°C. These findings are in accordance with other results reported by Siebenthal (1952) and Muller-Hegemann (1956). Using special devices, both authors independently recorded an increase of weight in both arms during passive concentration on heaviness. The measured increase of weight has been ascribed partly to the relaxation of regional muscles and partly to an increase of blood flow in the arm (Schultz&Luthe,1959). More recently, Marchand (1956, 1961) demonstrated that the standard exercises and passive concentration on warmth in the liver area induce certain changes in the trainee's blood sugar level. During the first three standard exercises there is a slight increase of blood sugar. The fourth standard exercise (It breathes me) coincides with a slight drop in blood sugar, which is followed by another slight increase during passive concentration on "My solar plexus is warm" (fifth standard exercise). Subsequently passive concentration on warmth in the liver area is associated with a significant rise. The control values obtained after termination of the exercises indicate a sharp drop of blood sugar values, which, however, are slightly higher than the control values determined before starting the standard exercises. White cells counts during this investigation (24 subjects) indicated that the first four standard exercises are associated with a slight but progressive decrease in white cell values. This trend was reversed during the fifth standard exercise and during passive concentration on warmth in the liver area which was associated with a marked increase. The highest white cell values were obtained three minutes after termination of the exercises. Subsequent determinations corresponded to values obtained before starting the exercises (Marchand, 1956, 1961). Various electroencephalographic studies (Schultz &Luthe,1959;Geissmann, Jus&Luthe,1961; Luthe, Jus & Geissmann,1962; Franek & Thren,1948; Heimann & Spoerri,1953; Israel & Rohmer,1958; Israel, Geissmann & Noel,1960; [TC2 316] Jus & Jus, 1960; Geissmann & Noel, 1961, Jus & Jus, 1961; Luthe, 1962) during passive concentration on the standard formulas revealed that the different standard exercises and the autogenic state were associated with certain changes which are similar to, but not identical with, patterns occurring during sleep or hypnosis (Luthe, Jus, & Geissmann,1962; Luthe,1962). According to the observations reported by P. Geissmann and C. Noel (1961) no true psychogalvanic reactions appeared during the standard exercises in completely relaxed trainees; certain reactions which were observed in a number of subjects seemed to be due to difficulties related to the experimental arrangement. A systematic study of the
respiratory changes occurring during the standard exercises revealed a
significant decrease of the respiratory frequency which was associated
with a gradual and significant increase of the thoracic and abdominal
respiratory amplitude and a corresponding significant augmentation of the
inspiration/expiration ratio (Luthe, 1958; 1962; Luthe, in Stovkis, Ed.,
1960; Schultz & Luthe, 1959). Furthermore, it was observed that passive
concentration on heaviness in the limbs is associated with a significant
decrease of the respiratory volume and that the different standard
formulas may produce a number of qualitative changes of the trainee's
respiratory pattern. In asthmatic patients an almost instantaneous
normalization of a disturbed pattern of respiratory innervation has been
observed frequently (Schultz & Luthe, 1959). Electrocardiographic changes during autogenic standard therapy were reported by various authors (Schultz & Luthe,1959; Luthe in Stokvis, Ed.,1960; Jus&Jus, 1960; Geissmann & Noel, 1962; Polzien, 1962b; Schultz &Luthe, 1961). The relevant observations may be summarized as follows: during passive concentration on heaviness (and warmth) the heart rate usually decreases. In relatively few cases an increase of the heart rate has been observed. [TC2 317] This paradoxic reaction is regarded as resulting from autogenic discharges (Luthe, 1961; 1962; Luthe, Jus, & Geissmann, 1962). During the Third World Congress of Psychiatry in Montreal (1961), Polzien reported that 28 out of a group of 35 patients with confirmed ST depressions showed an elevation of the ST-curve and an increase of the T-wave by .05mV or more during the first standard exercise. In five cases the ECG remained unchanged and two patients reacted with further deterioration. In a control group of 20 patients with normal curves, an elevation of the ST-curve or the T-wave by .O5mV or more was observed in 10 trainees. It is of particular interest that a correlation between the heart rate and the ST and T-wave changes did not exist. This finding is in contrast to the physiologic correlation which normally exists between the heart rate and the elevation of the "ST segment-T wave phase." In other words, it is not possible to explain the elevation of the "ST segment-T wave phase" as observed during autogenic training, by the simultaneously occurring changes (decrease, increase) of the trainee's heart rate (Polzien, 1962b). More recent investigations carried out at the University of Wurzburg have verified the normalizing effect of the standard exercises on certain hyperthyroid conditions(Polzien,1962a). 0ther experimental studies dealing with the effect of autogenic training on bodily work and subsequent recuperation have been carried out at the University of Leipzig (Hiller, Muller-Hegemann, & Wendt, 1961; 1962). Briefly, the experimental data indicate that passive concentration on physiologically oriented formulas influences autonomic functions which are coordinated by diencephalic mechanisms. Both clinical results and experimental data indicate that autogenic training operates in a highly differentiated field of bodily self-regulation and that with the help of autogenic principles it is possible to use one's brain to influence certain bodily and mental functions effectively. It is evident that this type of psychophysiologic manipulation requires proper training, adequate medical background knowledge, critical application, and systematic control of the effects of the treatment (Luthe, 1961). Furthermore, I hope it is quite clear that autogenic training is neither a simple relaxation technique nor a self-persuasive approach as applied by Coue.* *Dr. Luthe stated in a letter accompanying this article, that `'Passive concentration on autogenic standard formulas (or any others) is a very potent 'interference' with 'normal' functions. Even the trial of the First Standard Formula should be thoroughly discouraged unless a careful medical and psychodynamic evaluation has been carried out before, and unless the trainee is under supervision by a physician who himself has adequate practical experience with the method. Undesirable and regrettable consequences may result in case autogenic techniques are applied without careful adaptation to each individual case."—Editor. [TC2 318] The long-range effects resulting from regular practice of the standard exercises are manifold and depend largely on the psychophysiologic constellation of the individual and the nature of the patient's condition. Briefly, one could say that a gradual process of multidimensional optimalization develops. This process is reflected in psychodynamic changes which can be verified by physiologic measurements and projective tests. In line with reports on gradual changes in the patient's behavior (Schultz & Luthe,1959; Luthe, in Stovkis,Ed.,1960; Luthe, in Speer, Ed.,1958; 1962d), I have observed a characteristic pattern of projective changes, for example, in the Drawing-Completion test: Progressive differentiation of the projective responsiveness, increase of output, more shading, elaboration of details, stronger pressure of lines, increase of dynamic features, better integration and composition of the drawings, less rigidity, fewer inhibitions, faster performance, and better adaptation to the different stimuli. Corresponding changes have been observed in the Draw-A-Person test (Luthe, in Speer, Ed., 1958). Our observation that a patient's progressive improvement jumps ahead after four to eight months of regular practice of the standard exercises is reflected objectively by the patient's performance in the control tests which I administer at regular intervals during autogenic standard therapy. With respect to these clinical observations it is of particular interest that the EEG also reveals significant differences between trainees who have practiced autogenic exercises for two to four months and others who have practiced the standard exercises for much longer periods (Geissmann, Jus, & Luthe, 1961; Luthe, Jus, & Geissmann, 1962). Subjects practicing two to four months show an EEG pattern similar to the EEG pattern seen in states of "predrowsiness," for example, bursts of anterior theta waves with a tendency to spatial generalization in anterior posterior direction in association with a preserved alpha activity. In contrast, subjects with longer training periods (6 to 36 months) pass very rapidly from the pattern of a normal state to a pattern characterized by (a) a flattening of the baseline pattern with theta oscillations; (b) the alpha main frequency shows an increase of rapidity (1 unit/sec.); and (c) brief paroxysmal bursts of thetawaves in temporal-posterior derivations (Geissmann, Jus, & Luthe, 1961; Luthe, Jus, & Geissmann, 1962; Franek & Thren, 1948; Heimann & Spoerri,1953; Israel & Rohmer, in Aboulker, Chertok, & Sapir, Eds., 1958; Israel, Geissmann, & Noel, 1960; Jus & Jus, 1960; Geissmann & Noel, 1961;Jus&Jus, 1961; Luthe, 1962e; Schultz & Luthe, 1961; Luthe, 1962b). These electroencephalographic differences between short-period and long-period trainees seem to indicate that the regular practice of the standard exercises over longer periods of time brings about certain functional changes in the trainee's brain. [TC2 319] Clinical and experimental observations gathered over the past 35 years have indicated that the physiologic changes occurring during autogenic exercises are of a highly complex and differentiated nature, involving autonomic functions which are coordinated by diencephalic mechanisms. The physiologic changes which occur during the standard exercises coupled with the fact that the regular practice of autogenic training over longer periods of time has a normalizing influence on a great variety of bodily and mental disorders led to the conclusion that autogenic training exerts a therapeutic action on certain mechanisms which are of pathofunctional relevance for many different types of bodily and mental disorders. In summarizing my experimental and clinical findings I hypothesized (Schultz, 1959; Luthe, in Stovkis, Ed., 1960; Luthe, Jus, & Geissmann, 1962) that the therapeutic key factor lies in a self-induced (autogenic) modification of cortico-diencephalic interrelations, which enables natural forces to regain their otherwise restricted capacity for self-regulatory normalization. The hypothesis implies that the function of the entire neurohumoral axis (cortex, thalamus, reticular system, hypothalamus, hypophysis, adrenals) is directly involved and that the therapeutic mechanism is not unilateraly restricted to either bodily or mental functions. Implications of LSD and Experimental Mysticism Pahnke, Walter N. & William A. Richard [TC2 399-428] [TC2 416] Implications for Theology. On the basis of the research findings discussed above, it now appears possible to select almost any normal, healthy person and, combining a sufficient dose of a psychedelic substance with a supportive set and setting, enable that person to experience various altered forms of consciousness. The mystical experience seems the most difficult to facilitate, perhaps because of the as yet undetermined roles of personality variables; but nonetheless, these phenomena are now sufficiently reproducible to allow mysticism to be studied scientifically under laboratory conditions. Thus at long last, research into mysticism need no longer be limited to the scholarly scrutiny of various devotional or metaphysical documents left behind by such historic personages as Shankara, Plotinus, Meister Eckhart, William Blake, and Teresa of Avila. Persons can be studied extensively both before and after the experience of mystical consciousness in controlled settings. As noted above, experimental subjects who have experienced this form of consciousness have made powerful claims of increased personality-integration, of greater sensitivity to the authentic problems of other persons, of a responsible independence of social pressures, of both sensing deeper purposes in life and losing anxieties about death, guilt, and meaninglessness, and so forth. If research continues, there is no reason why such claims cannot be studied empirically and then either accepted as valid or dismissed as instances of emotional exaggeration and wishful thinking. To some theologians, the awareness that it appears possible to experience mystical consciousness (samadhi in advaitan Hinduism, satori in Zen Buddhism, the beatific vision in Christianity) with the help of a drug on a free Saturday afternoon at first appears ironic and even profane. Such experience is the goal of life for most followers of the Hindu, Buddhist, and Taoist religions. In Christianity, Judaism, and Islam, it has generally been viewed as a gift bestowed by God upon certain saints and prophets who have lived [TC2 417] lives of exceptional stature. It is understandable that throughout Christian history, certain leaders have responded defensively whenever such biochemical aids to mystical consciousness have been encountered. Padre Nicolas de Leon, a Spanish missionary in Mexico who found that the Aztecs were using peyote (the natural source of mescaline), for example, included the following questions in the confessional that priests were instructed to employ in their examinations of penitent Indians: Art thou a sooth-sayer? Dost thou foretell events by reading omens, interpreting dreams, or by tracing circles and figures on water?... Dost thou suck the blood of others? Dost thou wander about at night calling upon demons to help thee'? Hast thou drunk peyote or given it to others to drink . . ? (LaBarre, 1964) More recently, a very able professor of comparative religions at Oxford, R.C. Zachner, has responded to the psychedelic drugs in a similarly irrational and defensive manner. Zachner even submitted himself to "artificial interference with consciousness" at one time for the purpose of proving that "this state . . . has nothing at all to do with what Christians . . . mean by the Beatific Vision. (Zaehner, 1954)" As might be expected, Zaehner did not experience mystical consciousness in this session, but had a rather shallow aesthetic experience, typical of subjects with considerable anxiety and resistance. Unfortunately the publication of his experience did not prove the existence of the Thomistic gulf between the natural and the supernatural as he had hoped, but rather reflected the mental set of a dedicated Roman Catholic convert (Zachner, 1961, pp. 212-226). Perhaps one of the reasons mysticism has come to be considered otherworldly in the sense of being an escape from social responsibilities lies not in the nature of mystical consciousness itself, but rather in the poor methods that have been used by men to gain such experience. The medieval monk in his darkened cell and the hermit in the deep recesses of his cave, for example, used not psychedelic substances, but the tools of sensory deprivation, sleep deprivation, meditative disciplines, and fasting to elicit biochemical changes and unlock the door to unconscious levels of mind. The Hindu yogin uses similar methods in addition to autohypnosis and breath control, the latter increasing the amount of carbon dioxide in the blood and triggering unconscious levels of mind (see Meduna, 1950). Altered forms of consciousness often occur unexpectedly and spontaneously when one is undergoing great mental stress and is exhausted physically. It would appear logical to suggest that whenever altered forms of consciousness occur, whether they are anticipated or come as a complete surprise, underlying biochemical activity may be involved. Thus the Hindu yogin practicing breath control or the Christian monk spending long hours in solitary prayer may be seen to be influencing body chemistry in the same direction as the [TC2 418] modern man who ingests a psychedelic drug. In all seriousness, one may ask if the yogin or monk has much time for social action when perhaps a major portion of his life is spent in withdrawal from the world. Furthermore, such ascetic practices are poor means of unlocking the unconscious and may be similar to the ingestion of extremely small doses of the psychedelics. One thus enters aesthetic realms of experience more often than mystical consciousness itself. It is granted that other nonmystical forms of experience that may be considered "religious" are also known to occur, with and without the assistance of drugs. There is reason to think that otherworldliness may be a result, not of going too deep into the unconscious mind, but rather of not going deep enough. [I don’t agree] It seems significant that persons who have experienced mystical consciousness generally feel thrown back into the very heart of life in this world and feel also that they have been given the inner strength to cope with suffering and struggle in society. It would seem better for a person to have a drug-facilitated experience of mystical consciousness, enjoy the enriched life that may follow, and serve other persons during the greater part of his life than to live a life that may be inauthentic and withdrawn until old age, when such an experience may occur by means of ascetic practices. Some persons concerned with religion are disturbed by drug-facilitated mystical experiences because of the apparent ease of production, implying that they are "unearned" and therefore "undeserved". Perhaps the Puritanical and Calvinistic element of our Western culture, especially in the United States where most of the controversy about psychedelic drugs has centered, may be a factor in this uneasiness. Although a drug-facilitated experience might seem unearned when compared with the rigorous discipline that many mystics describe as necessary, the available evidence suggests that careful preparation and expectation play an important part, not only in determining the type of experience attained, but in determining the extent of later fruits for life. By no means is positive mystical experience with the psychedelic drugs automatic. It would seem that this specific "drug effect" is a delicate combination of psychological set and setting in which drug itself is only the trigger or facilitating agent. Rather than a psychedelic experience being an easy way to achieve growth, many subjects report that the subjective sense of work done during the drug session entails as much suffering and exhaustion as would be encountered in several years of living. But perhaps the hardest work comes after the experience when insights must be integrated. Unless such an experience is integrated into the on-going life of a person, only a memory remains rather than the growth of an unfolding process of renewal that may be awakened by the mystical experience. If the person has a religious framework and discipline within which to work, the integrative process is encouraged and stimulated. In this respect, Huston [TC2 419] Smith's (1964, p. 165) distinction between "religious experiences" and "religious lives" is especially noteworthy. Many persons may not need the drug-facilitated mystical experience, but there are others who would never become aware of the undeveloped potentials within themselves or become inspired to work in this direction without such experience. "Gratuitous grace" is an appropriate theological term in this connection, for the psychedelic mystical experience can lead to a profound sense of inspiration, reverential awe and humility, perhaps correlated with the feeling that the experience is essentially a gift from a transcendent source, a gift that can never be earned or deserved by any man. In a paper of this scope, it is impossible to deal adequately with any of the theological questions raised by this field of research. Suffice it to say that there is an increasing need for contemporary theologians to include mystical consciousness in their rational reflections. Among experimental subjects who have known this dimension of experience, some have reported an enrichment of their understanding of Christianity, claiming that dead dogmas have suddenly come alive; others with less theological sophistication have despaired at the seeming indifference of dogma-centered churches to mystical experience and have turned towards the religions of the East. Tillich has perceptively noted that "The alliance of psychoanalysis and Zen Buddhism in some members of the upper classes of Western society (those within the Protestant tradition) is a symptom of dissatisfaction with a Protestantism in which the mystical element is lost" (Tillich,1963, p.243). Perhaps basically, theologians need to acknowledge the reality of other worlds, other dimensions of Being, to which man has access through the mystery of mind, but which no man would claim as his own personal property any more than the tourist who once visited Paris would claim that Paris was part of himself. Besides the works of Tillich, the recent impassioned attempt of Karl Jaspers (1962, 1963) to relate his Existenzphilosophie to Christian theology could prove valuable to theologians concerned with this creative area of thought. In general, mysticism and inner experience have been stressed much more by Eastern than by Western religions. Perhaps Western culture is as far off balance in the opposite direction with its manipulation of the external world as exemplified by the emphasis on material wealth, control of nature, and admiration of science. As mentioned above, mysticism has been accused of fostering escapism from the problems of society, indifference to social conditions, and disinterest in social change. While the possibility of such excesses must be considered, the beneficial potential of mystical experience in stimulating the ability to feel and experience deeply and genuinely with the full harmony of both emotion and intellect has been indicated in the course of psychedelic research. [TC2 420] Further, the experience of mystical consciousness may enable Western scholars better to understand the so-called elusive "Eastern mind". In the approaching era of unprecedented cultural interaction, this possibility could be of profound significance. Not only the religious systems of Hinduism, Buddhism, and Taoism, but also Eastern political traditions and even Eastern forms of architecture may be seen to have largely originated in various forms of altered consciousness. After such experience, contemplation may take on new meaning for the Western man who finds little time to ponder the meaning of his own existence and the philosophical presuppositions upon which his religious, political, scientific, and ethical convictions rest. It is also possible that psychedelic drug experiences carefully employed in a religious setting (as in the experiment described above) could illumine our understanding of the dynamics and significance of worship. Increased understanding of the psychological mechanisms involved might lead to more meaningful worship experiences for those who have had neither spontaneous nor drug-facilitated experiences. Light might be shed upon doctrines of the Holy Spirit and the efficacy of sacraments, for example, thus enriching worship through psychological understanding. Such considerations raise the question of the place of emotion as opposed to cognition in religious worship. An even more basic question inquires into the validity of mystical consciousness in terms of religious truth. Reactions to such questions and possibilities will vary with theological positions and presuppositions, but the field under discussion invites thoughtful examination by those persons concerned with the lack of meaning reported by many contemporary church members in conjunction with religious worship. The ethical implications relevant to this field of inquiry also merit careful examination. Any research that uses human volunteers must examine its motives and methods to make certain that human beings are not being manipulated like objects for purposes that they neither understand nor share. But in research with powerful mental chemicals that may influence the most cherished human functions and values, the ethical problem is even more acute. Historically, mystical experience has filled man with wondrous awe and has been able to change his style of life and values; but it must not be assumed that increased control of such powerful phenomena will automatically result in wise and constructive uses. Potential abuses are equally possible. The degree to which brainwashing techniques could be enhanced by the psychedelics is at present unknown. As persons in the deeper states of altered consciousness are so hypersensitive to the fine nuances of interpersonal communication, especially in terms of love and honesty, deception and manipulation may be minimized. In this sense, the drugs may be seen to have a "built-in control." Yet there are many varieties of psychedelic [TC2 421] experience that do not entail such Buberic communication and may certainly be prone to suggestive influences, either for good or evil. Implications for Psychiatry. Turning from the religious implications of these drugs to their possible applications in psychiatry, we find that in the more than twenty years during which LSD has been investigated under medically controlled conditions, two major methods of therapeutic application have evolved. The first, called psycholytic therapy and predominant in Europe, involves a small-dose technique (e.g., 25 to 100 mcg. of LSD) in weekly or bi-weekly sessions order to facilitate the release of unconscious material and aid psychotherapy or group therapy. Sandison and Spencer (Sandison, Spencer, & Whitlaw, 1954) in England and Leuner (1962) in Germany have pioneered in this method. Leuner in particular uses a psychoanalytic approach in working through the material during the drug sessions themselves as well as during the time between subsequent sessions. Mascher (1967) recently reviewed the research presented in forty-two scientific papers that describe the method and results of psycholytic therapy in sixteen-hundred patients during the past fifteen years. LSD sessions are considered superior to Amytal interviews, for example, insofar as the patient remains alertly conscious during the experience and has much less amnesia afterwards. The second method, called psychedelic therapy and used mainly in the United States and Canada, involves a much smaller number of sessions, or even a single session, but at a higher dosage in order to produce an experience with such an overwhelming impact that the patient's view of the world and himself may be radically changed in a healthful and therapeutic manner. The primary aim is to achieve a breakthrough to a "psychedelic peak" that has the characteristics described above in the definition of mystical consciousness. Relatively high dosage is a necessary, but not a sufficient, condition for eliciting a psychedelic peak. Through careful preparation, a trustful bond of rapport with the therapist must be established as in any effective therapy. Special skill on the part of an experienced psychedelic therapist must be used for guiding the patient during the actual drug session. Careful planning of both the emotional atmosphere and the physical environment is important. Stimuli such as classical music (symphonic and choral) with long, flowing phrases, beautiful flowers, and reproductions of great works of art have proved helpful. After the drug session, the therapist must accept the crucial task of helping the patient integrate what he has learned during this intense, existential experience. Frequently this entails the direct confrontation of problematic situations in the patient's everyday world. Descriptions of this method have been written [TC2 422] by Chwelos and co-workers (Chwelos, Blewett, Smith, & Hoffer, 1959), MacLean and co-workers (MacLean, MacDonald, Byrne & Hubbard,1961), and Sherwood and co-workers (Sherwood, Stolaroff, & Harman, 1962). Also instructive is Unger's excellent review article (1963) and his description of the English language literature (1964b). If the claims of therapeutic help from such experiences are substantiated in the controlled, clinical trials now being conducted, the need for, and relevance of, interdisciplinary discussion in this area between psychiatry and religion is accentuated. At the Spring Grove State Hospital in Baltimore, two projects that have been supported by the National Institute of Mental Health are in progress. There the effects of psychedelic therapy are being investigated on two groups of hospitalized patients: chronic alcoholics and severe psychoneurotics. Although the final results must be judged by the statistical evaluation of long-term follow-up studies in comparison with control groups, the early reports are encouraging (Kurland, Unger, & Shaffer, 1967; Savage, 1966). Mystical consciousness is being experienced by these patients, many of whom were not previously interested in either religion or mysticism. A project in Massachusetts began to investigate the possible effectiveness of psychedelic therapy in the rehabilitation of prisoners, but unfortunately was interrupted and remains incomplete and inconclusive (Leary, Metzner, Presnell, Weil, Schwitzgebel, & Kinne, 1965; Leary, & Clark, 1963). It is probable that such a procedure would have the highest chance of success if it were co-ordinated with a treatment program that included job placement. At the Federal Narcotics Hospital in Lexington, Kentucky, drug addicts have been treated with a combination of LSD and hypnosis—so-called hypnodelic therapy. This technique is now also being applied to chronic alcoholics in a study at the Mendota State Hospital in Madison, Wisconsin (Levine & Ludwig, 1967; Ludwig, 1966). When LSD was compared with narcotics as a pain-relieving agent for terminal cancer patients at the Cook County Hospital in Chicago (Kast, 1964), a marked analgesic effect was noted; but of greater significance, it appears possible that psychedelic therapy can provide an opportunity for the dying patient to view his life and death in a new perspective (Cohen, 1965). Useful possibilities of working with such experiences by those who care for and minister to the dying open up an area for investigation that has all too often been a depressing embarrassment to physicians in spite of the triumphs of modern medicine and surgery. Because of the unique effects of mystical consciousness upon attitudes and interpersonal relationships, not only the patient, but also his family may be able to approach and view death in a new way. Old barriers and defenses can crumble within the patient, making possible meaningful dialogue with family members and [TC2 423] friends concerning issues and feelings of mutual importance. This as yet relatively unexplored area of psychedelic research needs much more attention and careful study. Again the obvious religious implications highlight the intersection of psychiatry and religion. Even if the therapeutic effectiveness of psychedelic therapy is eventually demonstrated empirically in carefully controlled clinical research, a further problem still remains. As yet there is no adequate theory to explain why the experience of mystical consciousness should facilitate therapy. Some of the researchers have claimed that "the root of the therapeutic effectiveness of the LSD experience is its potential for producing self-acceptance" (Chwelos et al., 1959, p. 589). This view has definite parallels with aspects of Paul Tillich's thought. The renewed sense of self-esteem noted in some patients after such experience may be due to a realignment of ego defenses and boundaries. Alcoholics who have experienced psychedelic mystical consciousness are surprised to discover that they have some internal, intrinsic worth as members of the human race and seem to gain a new self-concept involving goodness and love. In trying to account for the phenomena associated with mystical consciousness, the concept of regression has been proposed (Prince & Savage, 1965). Such aspects of mystical consciousness as "unity" and "deeply felt positive mood" are certainly suggestive of the prenatal life of a foetus. Theories that dismiss mystical consciousness as "mere regression" or "an oceanic feeling of primary process," however, fail to wrestle with the noetic aspects of "objectivity and reality" and "transcendence of space and time." The mind appears to gain the ability of operating on many levels at once, while grasping interrelations of psychic functioning. The concept of time does not merely lose meaning, but, more impressively, is seen in a new perspective. Subjects assert that they felt "outside of" time, beyond both past and future, as though they were viewing the totality of history from a transcendent vantage point. The feeling of profundity and truth that insights acquire under the influence of psychedelic drugs may be a delusion: but this quality seems to provide the motivation for the patient to affect behavior change, especially if the insight gained holds true for the particular person when examined and tested later when the rational mind is again in full command. Because the life experience and learning acquired over the years are retained while in this altered state of consciousness, perhaps the term "regression in the service of the ego" is more appropriate. Implications for Society As is unfortunately true with many potentially beneficial but powerful discoveries, such as fire or atomic energy, misuse and abuse are possible if the discoveries are improperly handled. The psychedelic drugs are no [TC2 424] exception, as the growing black market ominously testifies. There are an increasing number of people who are obtaining these drugs illegally and ingesting them without psychiatric screening, preparation, supervision or follow-up therapy. Such practices will inevitably lead to psychiatric casualties as have already been reported in the medical literature (Frosch, Robbins, Stern, 1965). When certain borderline or pre-psychotic persons take psychedelic drugs without capable psychiatric supervision, there is a risk of prolonged psychosis, irresponsible behavior, or suicide. Even persons who are in good physical and mental health can become quite emotionally shaken when they discover that their usual sense of control is suspended. Fighting to overcome the drug effect can lead to intense fear and a psychotic reaction. [The same holds true for all mystical experiences, is thus not specifically drug-related] Most of the cases coming to psychiatric attention are acute panic reactions that are usually reversible with proper drug treatment and temporary hospitalization. There are also some persons who seem to experience a spontaneous recurrence of the LSD effect months after having last taken the drug. Usually these persons are under stress when the symptoms recur. Although much more rare, the cases of prolonged psychosis following LSD and lasting more than a week are more alarming. A direct, causal relation to LSD cannot always be determined, however, because an examination of the case histories usually reveals severely disturbed persons who probably were in severe psychological trouble prior to taking the drug. Not all persons who seek psychiatric help after LSD, however, are in acute distress or in need of hospitalization. There are also a growing number of persons who mistakenly thought they were in good mental health, but discovered during their drug experience that many repressed problems came to the surface. This realization may encourage such persons to work out their problems, whereas previously they may have denied their reality or sought some form of escape. Paradoxically enough these are people who probably should have been in psychiatric treatment before, but only now are motivated to do so. In the long run, with proper help, many of them may be guided towards better mental adjustment, but at best this is a risk-filled method of self-diagnosis. In any discussion of the dangers of psychedelic drugs, it is essential to consider the incidence rates of harmful effects. Cohen has collected the only statistics of this nature published to date and found that, in a survey of 5,000 persons who had taken psychedelic drugs a total of 25,000 times, there was a suicide rate of one per 2500 persons among psychiatric patients undergoing treatment, and no attempted or completed suicides among experimental subjects. Psychotic reactions lasting longer than forty-eight hours had an incidence of one per 555 among patients and one per 1200 among experimental subjects (Cohen, 1960). [TC2 425] In commenting on Cohen's statistics, Levine and Ludwig (1964) have emphasized the relative safety of LSD when compared with other methods of psychiatric treatment. Since Cohen's survey was published in 1960, much more has been learned about treatment procedures with LSD-type drugs and the art of avoiding psychotic reactions. With this increased knowledge, coupled with improved therapist training, the use of LSD should become even safer. It must be emphasized, however, that Cohen gathered his data from a survey of doctors engaged in clinical research with these drugs. These statistics and comments, therefore, refer only to the properly controlled, medical use of LSD. The current increase in dangerous after-effects is almost entirely caused by the indiscriminate use of LSD among untrained persons. Such use takes place outside legitimate research auspices without medical supervision. These very real dangers must not be allowed to obscure the potentials of a powerful therapeutic tool. To offer an analogy, little benefit would be expected to come from an x-ray machine if an untrained person were allowed to shoot x-rays in all directions indiscriminately. In fact, unless the intensity and frequency of the x-rays were carefully controlled, much harm could result in the form of radiation sickness and permanent damage. Although neither physiological addiction nor tissue damage has been reported in the case of LSD, psychological dependence might be expected if the experience were continually repeated. The intense subjective pleasure and enjoyment, at least of aesthetic forms of experience, could lead to escapism and withdrawal from the world. An experience capable of changing motivation and values might cut the nerve of achievement. Wide spread apathy toward productive work and accomplishment could cripple a society. It is unfortunate that, at present, public opinion concerning these drugs is being molded primarily on the basis of the response of the beatnik dimension of society, a dimension that contains many persons already in poor states of mental health. Such persons are accused of numerous forms of irresponsible behavior, and also the sin of quietism—of claiming inspiration, but producing few concrete works of social, literary, or artistic promise. There are relatively few experimental studies that provide information concerning the possible continuing benefits of psychedelic drug experiences in normal, mentally healthy persons who have already established a responsible and creative position in society. In fact, these people cannot legally take the drugs unless they happen to live near one of the few qualified research projects. Increased legitimate opportunities for both average and gifted people to take these drugs under adequate supervision will be needed before the possible beneficial effects for individual persons and society can be assessed. [TC2 426] Practically speaking, the reality of the black market must be confronted. LSD can take the form of a clear, odorless, tasteless liquid. It can be quite easily and inexpensively manufactured in a home laboratory by any good organic chemist. Two hundred millionths of a gram constitutes a powerful dose that is no larger than a drop of water. At present there is a 1000% to 3000% mark-up from manufacturer to consumer. So it is that attempts to control the black market by police force face serious obstacles and almost certainly will prove futile. There is, in fact, a growing demand for these drugs, not only among the rebellious element of society, but also among our future leaders who are now attending universities. Many of the sensationalistic articles in the popular press that have presented somewhat slanted accounts of the bizarre and lurid effects of these drugs rather than their potential usefulness have only attracted more interest and curiosity from the very people who should not take the drugs, and have tended to decrease support for responsible investigation. If the recent estimate is correct that one million doses of LSD will be consumed in the United States in 1966 (Rosenfeld & Farrell, 1966), the usage will probably grow at an even faster rate because each person who has a positive experience will introduce at least one or two of his friends to the drug. Positive experiences are much more common than negative ones, and it is a human fallacy to believe that a bad reaction "won't happen to me". How then can we deal constructively with the problems posed by the black market? It would seem that not suppression, but informed education and an expanded program of research with an interdisciplinary approach is urgently needed. Education needs a basis of empirically derived facts on which to draw. To gather such facts, concerning both dangers and possible benefits, increased, responsible research in all realms of application is needed before research is stopped because of the growing public hysteria in the face of the black market. We propose carefully controlled studies in which drug dosage, setting, personality variables, experimenter expectation, experimental procedure, and follow-up can be regulated. Only then can answers be found to questions concerning the personality characteristics or disturbances that contra-indicate the use of the drugs, the optimal treatment procedures to insure the most beneficial effect, and the best screening procedures to identify persons most likely to be harmed or those who should be singled out for special handling. Patients with various symptoms and relatively normal subjects both need to be intensely studied in such experiments. Because persons who take the drugs on their own are most interested in aesthetic and mystical experiences, research needs to be focused on the possible benefit or harm resulting from such experiences. Another [TC2 427] variable needing elucidation [is] the effect of frequency of ingestion. It is conceivable that benefit might result from an experience once or twice a year, whereas weekly exposures might cause chronic deleterious changes in personality. Because these drugs are without a doubt the most powerful psychoactive agents known to man, their use needs to be supervised by persons who have received specialized training. In view of the wide range of potential applications, an interdisciplinary approach to their use is essential. A training and research center for psychedelic therapists [how incredibly optimistic, utopian, when seen now] will probably need to be established. The staff of such a center should include psychiatrists, clinical psychologists, and professional religious personnel. The results of increased knowledge from such research on the drugs may provide an answer to the problem of the black market. If legitimate medical uses and methods are confirmed and the dangers and benefits are determined accurately, socially sanctioned centers for persons desiring this form of human experience can be establised. Most persons would then probably prefer the safety of medical supervision to the risk of blackmarket usage. Admittedly, this kind of solution may lie a long way in the future and will depend upon the results of careful yet imaginative and daring research. But this may be the only way to deal effectively with this problem. What would be the effect of relatively broad use of the psychedelics in some future decade? Would people become more creative than ever before? If the garbage collector experienced mystical consciousness, would he collect garbage more passionately than ever before, or would he escape to the forest or the university? Could these drugs enrich society or do they threaten to destroy it? If the latter should prove to be the case, are there ways in which this threat can be lessened? These are questions whose crucial answers are at present unknown. Not only are they unknown, but research aimed at finding answers to them is severely limited in the United States. Religion has long been accused by sociologists of being a prime illustration of the phenomenon of the "cultural lag." Bruno was burned at the stake for his adherence to the Copernican view of the universe. For the same heretical belief, Galileo was condemned and forced to recant, even though the truth of the panoramas he had seen through his telescope were indelibly fixed upon his mind. Similarly, Darwin was condemned for his heretical theory of evolution. Yet, in retrospect, Christian theology, including biblical interpretation, has been greatly enriched by the convictions of these men. New glimpses into the nature of reality always seem first to evoke defensive reactions of fear and, only later, reactions of wonder and praise. [TC2 428] With these drugs, science stands on an awesome threshold. Some religious leaders would undoubtedly consider it improper for man to tread upon the holy ground of the unconscious, protesting against the exploration of "inner space" as they have campaigned against the exploration of outer space. But man's apparent destiny to seek an ever greater comprehension of the nature of reality cannot be thwarted or suppressed. The importance of research proceeding in harmony with the highest known ethical principles, however, is clear. Those who undertake such research carry a heavy responsibility. |