An excerpt from Radical Adventure: An Inquiry into Psychedelic Psychotherapy
Content note: This article briefly mentions suicide. Reader discretion is advised.
I am afraid that in this renaissance of the use of psychedelics the whole enterprise is going to be medicalized. This, to me, means that big mistakes are going to be committed and opportunities squandered. For example, if you suggest to a patient that their psychotherapy could be enhanced with the use of a psychedelic, how will you ask for “informed consent” when neither you nor they know what they are consenting to? One of the other pseudoscientific questions that arises in psychedelic therapy is: How do you select your patients? What are the selection criteria? Well, as far as I have been able to ascertain, there aren’t any. Self-selection, I would say, is probably the best criterion. I have never suggested to anybody to do an LSD session. I only respond to people who say, “I’m going to do one.” Self-selection. Because anything else, any other criterion or restriction basically shows the therapist’s fear, his need to cover his own ass, to avoid being held responsible by the authorities.
I would say that some people instinctively just want to stay away from it, and I support them 100 percent. I would never want to talk anybody into it. I would never promote it. I would never say that it is a panacea. But equally strangely some people passionately seek it. Some people want the experience without knowing anything about it. The very first time I took LSD, I did not know what I was getting into. No matter how much you read about it, no matter what people tell you about it, the experience is a total surprise. So, in a way one has to be an adventurer.
There is one criterion that I sometimes watch out for. If you come to me and you say you want this kind of treatment, as we talk I may realize that in your life you are overloaded with responsibility, you carry the weight of your family, have lots of responsibilities, carry a big burden, and you are kind of the strong man in your family and among people that you work with. I might begin to sense that you are actually a bit suicidal. That is, you think you could lighten your load if you could only die. That this is the only way out for you; you do not have the wherewithal to say “No, I don’t want to do this anymore.” If you might want to exit by killing yourself, then it may not be a good idea for you to take LSD. The reason is that when you have gone deep into an altered state of consciousness, there is a moment where there is a kind of choice to make: Do I want to come back? And then it could occur to you, “Hey, this is an opportunity, I just go crazy here! I could be one of those people who go psychotic because of LSD, never come back, and then my family will have to take care of me, and doctors will take care of me, and I will have no responsibility.” So, if there is this sense, then I might say don’t do it. I do not want to give anybody this option of exiting from the responsibilities by going crazy because they took ayahuasca, LSD, or psilocybin. Alternatively, I would say that first you would have to be in therapy until you find your way out of being overburdened, until you are not tempted to use drugs to go AWOL.
I will tell two little stories that illustrate the dangers of pretending to know selection criteria. Under current prejudices, neither of the two patients in my stories would have been allowed LSD psychotherapy.
Mary was a roughly fifty-year-old woman, very depressed. She was in a mental hospital when there were still mental hospitals in Vancouver. And she was in a locked ward. She received several courses of electroconvulsive therapy, and she was on major antipsychotics. She had attempted suicide four times. Her psychologist at the hospital, who was a patient of mine, for some odd reason thought that Mary could benefit from seeing me. So, it was the psychologist who transported this woman to see me twice a week for fifty-minute sessions. For three long months, this woman came in, sat down, did not move a muscle, never looked at me, and just sat there silently. Three months, twice a week. “Who am I to say anything to her?” I thought at first. I welcomed her, and there we sat. After a while, I began to notice that I was thinking things that I probably wouldn’t be thinking if I had been alone, if I hadn’t been in her presence. Now, those thoughts, which I thought arose because I was with her, I started to verbalize. I even joked that she was my analyst because she was quiet, and I was speaking. She did not crack a smile. To cut a long story short, her first words to me were spoken after three months and totally surprised me because by then I expected that she would never speak. She said, “I’m afraid of you.” I said, “What could I possibly do that would be harmful to you?” She said, “You might take my freedom away from me.” I said, “How?” She said, “I’m afraid I won’t feel free to commit suicide if I continue this.” I did not think that was such a bad thing. So that is how it began.
We engaged in regular, unassisted psychotherapy for about three years, during which time she weaned herself off all psychiatric medication. What we came to was that she lived in a 24/7 soap opera. From the time she was born, she wanted to be the good child of her parents, be the good student at school, and then the good wife to her husband. Then she said she didn’t want any children, but her husband insisted, so she had to be the good mother to her children. She was very keenly aware that no one was interested in her. Everybody was interested in the mother, in the daughter, in the wife. I had to make very sure that I didn’t expect her to be a good patient. It would have been one more weight on her shoulders. Clearly, her attempts at suicide were to escape the 24/7 soap opera. I mean, imagine yourself having to perform 24/7, and there is no way out, no way to get offstage, except, she thought, by offing yourself. I could understand. The only alternative I could offer her was that maybe there is a way to be authentic and not have to play anything or anybody without having to kill yourself. I wasn’t sure, but at least it seemed to me worth trying before she really annihilated herself. And then she had the bright idea that she was going to take LSD. I thought she was either brave or foolhardy, but I was willing to accompany her into the unknown. First session, absolutely nothing happened. She got even gloomier than before. A month later, she said, “I’m doing it again.” I said OK. It works, she cried. She had a horrendous experience of abandonment. She saw me walking away from her. She said, “All I see is your back, and you’re leaving.” Now, that opened something up. That opened up a trauma that she hadn’t talked about before. She was three years old, in Germany, where her family was stationed, when they got the order to go back to Canada, and her parents suddenly thought, “We haven’t even seen Europe.” So, she was three years old, and they put her with a German nanny. In her words, they “parked me like luggage.” The older children and the parents went off for a six-week tour of Europe. Of course, the German woman who looked after her didn’t want any crying, didn’t want any tears, so, from that moment on, she felt she was a piece of shit because gold you take with you, shit you leave behind. She got the message. She thought I, too, would leave her sooner or later. It was a very dark, sad, traumatic LSD session. A month later, I thought she was going to kill herself for sure. It was clear between us that suicide prevention was not my job, and it was clear even between her husband and me that if he wanted to protect her, he would have to keep a twenty-four-hour vigil. I could not do that. She informed me that she was doing a third and last LSD trip before ending her life and—guess what?—she came out of that episode smiling and laughing. In terms of Stan Grof’s four stages of birth—bliss inside, no exit, bloody battle, bliss outside—she came out in bliss outside, and she conceived a way of being where she did not have to play any roles, and she was not too frightened that her husband wouldn’t have anything to do with her, her children wouldn’t have anything to do with her. Because that was her fear, that unless she performed the roles, no one would tolerate her. In Laing’s terms, used in The Divided Self, she found her way from object-for-the-other to subject-of-desire. Now, this was more than ten years ago, and she is still perfectly well. She is living a very creative and happy life. She performs occasional grandmother functions, which she used to dread but now embraces because she is in control of it. She does not play the grandmother; she is the grandmother. Once a year, she sends me a little note: “Love you and hate you!” She need not have been diagnosed with a complex form of mental illness, and then treated with electric shocks and poisonous medication. She needed me to listen to her with a love that recognized her total being, and accepted it, with no strings attached. Then she could escape from the prison of having to be good and obedient. LSD simply helped with the regression necessary to find and reconnect with her long-abandoned authentic self.
The second story illustrating the uselessness of selection criteria is about Lana, a woman I worked with for at least four years. She was diagnosed with multiple personality disorder. She was a fifty-five-year-old woman who would suddenly, in front of my eyes and ears, turn into a seven-year-old boy.
I thought she was pulling my leg. Around that time, I was going around saying and teaching that multiple personality disorder was iatrogenic. Patients just performed that to entertain their therapist. But it was apparently not so. So, I wanted to look up the literature on what to do with somebody who is so split. And then I resisted the urge, and I thought she is going to teach me. Her multiple personality disorder is not like anyone else’s. That’s how we proceeded. The little boy taught me everything. The little boy knew everything. He was the repository of all the memories of torture and sexual abuse that she went through in her childhood. She knew nothing about the boy. She remembered nothing of the abuse. Occasionally, she would come in as the woman. She would say hello, the boy would come out, and at the end of the session, she would come out and write the check and sign it and ask, “What did we do?” But, of course, when I offered to tape-record the session, she would have none of it. It took a while, but magically, the two personas integrated.
Physiologically she manifested some very interesting phenomena. She wore glasses with a very strong prescription. When the boy came out, the boy took the glasses off, and he had perfect vision. She was allergic to peanut butter. The boy could polish off half a jar of peanut butter and show no symptoms. If she had a cold and took aspirin, he would call me up and say she was overmedicating him. After he disappeared, blended into her, because she was slowly able to receive all the information that he was the repository of, she had to change her glasses; her new prescription was half as strong as the original.
After that, for about five years, she was fine and lived her life and worked. And then she phoned me up and said she was going to do some LSD. I thought, what if the boy comes out again? But that was my worry, not hers. I mentioned it to her, but she said, “Well, then we’ll deal with him.” Her reason was that she thought that her life was a little bit gray, not enough color in it. She felt that some creativity in her could be loosened up, that there was still some stultifying fear. Again, to cut a long story short, she had a very deep LSD session. At one point she was crying, and there was snot and tears all over her face, and I, without thinking, wiped her nose with my handkerchief. She later identified that moment as life-changing. She said nobody had ever done that for her. This allowed her to feel the grief of never having been cared for, of never having been loved. It is the smallest things that can make the biggest difference, and these actions cannot be programmed. They somehow have to be allowed to happen. There is no protocol, there is no schema, there is no book of how to conduct a protocol of a debriefing or an integration. Being able to talk with others who have had similar experiences, to be in a community, is highly desirable, but it isn’t a community that has ideas about what should happen. It has to be a community that is open to surprises and who will let me be and not speak of what I do not want to speak of and not put pressure on me that I have to integrate. I don’t have to do anything. To embark on psychedelic therapy is to head into the unknown in each other’s company, with no promises, no particular goal. Psychedelic psychotherapy, at its best, can heal both therapist and patient. Within a therapeutic relationship, the experience during an altered state of consciousness becomes integrated in the patient’s life in the process. I think it is very important to think of taking psychedelics within therapy. I wouldn’t just do a psychedelic trip with a stranger; I would first have the relationship, then the psychedelic. Integration would be continuing the relationship after the experience. How do you integrate climbing a mountain with your therapist? Continuing the therapy and continuing the relationship. There is a relationship before climbing the mountain, there is the climbing the mountain, and then you talk about how I was in trouble and you helped me, or I was in trouble and you didn’t help me, or I thought you were going to do this, and you did something else and I had an experience. This is where it is absolutely important that somebody who just wants to have a psychedelic experience without therapy is barking up the wrong tree. It might turn out to be harmful. Integration is the relationship itself. It is the relationship between the therapist and the patient that heals, not the method, not the protocol, not the psychedelic; it is the relationship.
