BLOGGER HTML TEMPLATE AS OF 4/15/16 BEFORE REDIRECTION TO WORDPRESS New Amsterdam Psychedelic Law Blog: Power Trip: Psychiatry and the Unnameable

Wednesday, February 6, 2013

Power Trip: Psychiatry and the Unnameable

(c) Noah Potter 2013

  I researched and originally wrote this article as an undergraduate for an anthropology of mental health class in 1994. I tweaked it a few times since then but never tried to update it to keep the factual sections current with the times. The knowledgable reader will know that the field of psychedelic research has changed dramatically since I wrote it. I believe that the concepts in the paper are still relevant and I don't have my other posts ready so I'm posting the article. (Lawyers: I didn't feel like redoing the citation format so please disregard citation issues.) 

The Issue
To say a few words on psychoanalysis—I do not feel that psychoanalysis as it is organized today, as separate from psychiatry, will survive. The contributions of psychoanalysis which are considered constructive will have to be fused and merged with general clinical psychiatry. Psychoanalytic theories and practices...will also have to be related to brain function—not merely verbally, but through the consideration of neurophysiologic mechanisms.
Dr. Paul Hoch, Commissioner of the Department of Mental Hygiene, State of New York and a Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons, speaking at the Proceedings of the Fifty-First Annual Meeting of the American Psychopathological Association, New York City, February 1961
And if it was in my power I would make every psychiatrist mad under controlled conditions, I mean artificially mad under controlled conditions; and I would make all mental health workers, and hospital staffs—I would make them all mad under controlled conditions, so that they could understand what it was like.  
Christopher Mayhew, Member of Parliament and a vice president of the National Association for Mental Health, recounting a mescaline experience to the Quarterly Meeting of the Royal Medico-Psychological Association in London, February 1961 

Introduction

 In this paper I intend to discuss the relationship between psychiatry, a subcategory of medical science, and LSD, a psychoactive compound which is frequently treated as representative of a subcategory of drugs with comparable effects known by such terms as hallucinogens, psychotomimetics, and psychedelics. It is my contention that the varying labels for LSD signify a divergence of opinions over the nature of “madness” that has had substantial implications for the evolution of concepts of mental health and mental illness. The prohibition of LSD has ensured the supremacy of the model of madness as a disease. However, the topic of LSD is not merely an historical example of the power of medical specialists to set definitions which are beyond challenge by laymen, but is the key to analyzing an unresolved competition between prospective purveyors of order in society.   

Historical/Etymological Background

 The first question that arises in a discussion of this subject is terminology. There is a plethora of terms to describe this category of substances. Even the latest publications with the heaviest authority acknowledge difficulty in characterizing this subset of psychoactive compounds. A probe of the language also reveals some uncertainty over the proper characterization of their action. The current Textbook of Substance Abuse Treatment, published in 1994 by no less an authority than the American Psychiatric Press states in the second paragraph of the chapter entitled “Hallucinogens” that 
The label hallucinogens actually is inaccurate because true LSD-induced hallucinations are rare. What are commonly seen are illusory phenomena. An illusion is a perceptual distortion of an actual stimulus in the environment. To “see” someone’s face melting is an illusion; to “see” a melting face when no one is present is a hallucination. Consequently, some have called these drugs illusionogenic. Those who use the terms psychedelic or mind-manifesting for hallucinogens (a term coined in 1957 by Osmond) have been criticized as being “pro-drug” much as those who use the term hallucinogen have been accused of being “anti-drug” (Osmond 1957). The term psychotomimetic, meaning a producer of psychosis, also has been widely used.

  In the chapter addressing the historical background of LSD in the recently published LSD: Still With Us After All These Years, co-editor Leigh A. Henderson draws up an extensive list of alternative names for “the class of drugs called hallucinogens”: “psychotomimetic  (psychosis-mimicking), psychotogenic  (psychosis-causing), psycholytic (mind-loosening), psychodysleptic  (mind-disrupting), psychedelic (mind-revealing), phanerothyme (soul-revealing), mysticomimetic, emotionalgenic, mind-expanding, mind-expanding, consciousness-expanding, transcendental, illusiogenic, phantasticant, and deliriant,” (Leigh and Henderson, 1994: 37). A brief exploration of three of the more commonly used terms may open a discussion of the power dynamics implicit here. 

  In the beginning was the hallucination.  Peter D. Slade and Richard P. Benthall in Sensory Deception, A Scientific Analysis of Hallucination trace the negative connotations of the perception of phenomena which are not materially present to within the pre-Reformation Church: “the scholastics argued for a sharp dividing line or discontinuity between normal perception and non-veridical perceptual experience. The important aspects of hallucinatory/imaginal experience for the scholastics, as reflected in the writings of St. Thomas Aquinas (AD 1225-1274), were source and content. For the scholastics, it was of crucial importance to decide on whether the reported experience was the work of the Devil, God, or other natural agencies or causes. "This initial move to qualify perceptual experience led to “the publication of Malleus maleficarum (The hammer of the witches)  in 1489.” The medieval authors “Kramer and Sprenger were charged with producing this work in order that Christendom could be defended against Satanic influences.”  

  It was actually the Inquisition, according to Slade and Benthall, “combined with the rediscovery of ancient Greek medicine in the guise of Galen and Hippocrates, which opened the way to the widespread acceptance of a medical, rather than religious, conception of madness.” These authors state that “enlightened and humane clerics” such as Teresa of Avila articulated “medical-type concepts and criteria” which caused the Church to “split into two camps, the hard-line inquisitors and the soft-line humanitarians.”  This split allowed physicians to build upon Galen’s conception of madness as a disturbance of bodily humours. Thus the word ‘hallucination,’  an anglicized version of the Latin allucinatio   (wandering of the mind, idle talk) was first introduced into English in the 1572 translation of a work by Lavater, in which the term was used to refer to a variety of strange noises, omens, and apparitions. (Slade and Benthall, 1988: 7). 

  In this portrayal, debate over the definition of madness is the catalyst that has revolutionary implications: the supplanting of ecclesiastical authorities by secular ones. Though it is really the subject of a different paper, the assertion made in Martin A. Lee and Bruce Shlain’s Acid Dreams: The Complete Social History of LSD that “[t]he witches of the Middle Ages concocted brews with various hallucinogenic compounds—belladonna, thorn apple, henbane and bufotenine (derived from the sweat gland of the toad Bufo marinus ) — and when the moon was full they flew off on their imaginary broomsticks to commune with spirits,” (Lee and Shlain, 1985: 66) bears mention. Dr. Thomas Szasz made the same assertion (Szasz, 1974: 62-63) ten years before Lee and Shlain in Ceremonial Chemistry, where he asserted that the drug control establishment is the descendant of the medieval Inquisition. This information was, however, buried deep in the historical record by the time that nineteenth-century European physicians set about investigating the plants of other continents that produced mental aberrations similar to those visible in madmen. 

Psychotomimesis

 The increased influx of psychoactive compounds to Europe beginning in the middle of the nineteenth century precipitated the rise of the psychotomimetic model. The agent of this rise was mescaline, the psychoactive element in the peyote cactus. An “important turning point” was reached when “in 1919 it was recognized that the molecular structure of mescaline was related to the structure of the adrenal hormone epinephrine.” This “structural resemblance of mescaline and epinephrine suggested a possible link between the drug and mental illness: Might the early, excited stage of schizophrenia be produced or at least triggered by an error in metabolism that produced a mescaline-like substance?” (Barron, Jarvik, and Bunnell, 1964: 32-33).  This possibility was made only more intriguing when the effects of LSD were discovered. 

 A chemist named Albert Hofmann working in a Sandoz laboratory in Basel, Switzerland, synthesized lysergic acid diethylamide-25 in 1938 “while investigating the chemical and pharmacological properties of ergot, a rye fungus rich in medicinal alkaloids,” (Lee and Shlain, 1985: xvii). In 1943, Dr. Hofmann produced another batch, some of which he accidentally ingested. Realizing that this compound had psychoactive properties, he concocted another batch to ingest. “On April 19, three days after his initial psychedelic voyage, Dr. Albert Hofmann swallowed a mere 250 micrograms (a millionth of an ounce), thinking that such a minuscule amount would have negligible results. But he was in for a surprise,” (Lee and Shlain, 1985: xviii). In fact “LSD is one of the most powerful psychoactive drugs known. As little as 10 micrograms (ten millionths of a gram or .01 milligram) produces some mild euphoria, loosening of inhibitions, and empathetic feelings.” (Grinspoon and Bakalar, 1979: 11).

 It was this power, apparently, that eventually attracted the attention of the United States Central Intelligence Agency.

 According to Lee and Shlain, Major General William Donovan, the director of the Office of Strategic Services (OSS), the forerunner of the CIA, initiated an American psycho-pharmacological warfare program in 1942 when he “assembled a half-dozen prestigious American scientists and asked them to undertake a top-secret research program. Their mission was to develop a speech-inducing drug for use in intelligence interrogations,” (3). A variety of drugs were tested, including “a highly potent extract of cannabis,” (4) which proved fruitless. 

 After the war, the CIA and the military picked up where the OSS had left off in the secret search for a truth serum,” focusing on mescaline—ostensibly in response to Nazi experiments on inmates at the concentration camp Dachau (5-6).  Once the CIA became aware of the powerful effects which LSD could produce, it was prioritized as a subject of study. The CIA program testing LSD was codenamed first Operation BLUEBIRD, then Operation ARTICHOKE, and then Operation MK-ULTRA (9-10, 27). LSD was not especially useful as an interrogation agent, but “the Agency was not about to discard such a powerful and unusual substance simply because it did not live up to its original expectations,” (15). The authors allege that “when acid entered the scene, the entire program assumed a more aggressive posture. The CIA’s turned-on strategists came to believe that mind control techniques could be applied to a wide range of operations above and beyond the strict category of ‘special interrogation,’” (18). 

 According to Lee and Shlain, it was Dr. Paul Hoch who coined the term “psychotomimetic” model—they call it his “landmark thesis.” They ascribe to the Commissioner of Mental Hygiene of the State of New York and Professor of Clinical Psychiatry at Columbia University’s College of Physicians and Surgeons (Hoch and Zubin, 1962: 137) the following positions: 
Hoch reported that the symptoms produced by LSD, mescaline and related drugs were similar to those of schizophrenia: intensity of color perception, hallucinations, depersonalization, intense anxiety, paranoia, and in some cases catatonic manifestations. As Hoch put it, “LSD and the Mescaline disorganize the psychic integration of the individual.” He believed that the medical profession was fortunate to have access to these substances, for now it would be possible to reconstruct temporary or model psychoses in the laboratory. LSD was considered an excellent research tool in that the subject could provide a detailed description of his experience while he was under the influence of the drug.
 What is the relationship between psychotomimesis and the CIA? According to Lee and Shlain,  “the model psychosis dovetailed particularly well with the secret schemes of the CIA, which also viewed LSD in terms of its ability to blow minds and make people crazy,” (20-21). Lee and Shlain assert that a substantial amount of the research conducted with LSD in the United States was funded by the CIA. To what extent this is true is unclear. However, their depiction of widespread work with LSD following its appearance in the United States at the Boston Psychopathic Hospital in 1949 (Grinspoon and Bakalar, 62) is well-documented. LSD was everywhere in the 1950s. 

The reign of medicine

 The number of scientific reports on LSD alone rose from six in 1950 to 118 in 1956; thereafter it remained at about one hundred a year until research with human subjects was cut off almost completely in the mid-1960s (Hoffer and Osmond 1967, pg. 83). Throughout the fifties psychedelic drugs, mainly LSD and mescaline, were rather freely available to physicians and psychiatrists and the United States. They were regarded as promising therapeutic agents or as interesting tools for exploring the mind; the United States Army and the CIA also investigated them in ethically dubious and sometimes outrageous experiments in as incapacitating agents for chemical warfare.

 As psychotomimetic drugs they could provide a biological explanation for schizophrenia. If they were also “promising therapeutic agents,” though, the logical possibility that madness, which LSD modeled, might be beneficial could arise. This would make for a bit of a puzzle, since madness would then not necessarily be an affliction in need of treatment or of treatment-providers. This was the setting for the advent of the term “psychedelic.”  

 “Psychedelic” is attributed to Dr. Humphry Osmond, who is known for having tried LSD as a treatment for alcoholism at Weyburn Hospital in Saskatchewan, Canada. The term supposedly first appeared in a conversation with the novelist Aldous Huxley, who had written about his mescaline experience in the book The Doors of Perception.

 The terminology used to describe the LSD experience in the scientific literature did not sit well with Osmond. Words like hallucination and psychosis were loaded; they implied negative states of mind. The psychiatric jargon reflected a pathological orientation, whereas a truly objective science would not impose value judgments on chemicals that produced unusual or altered states of consciousness. 

(Lee and Shlain, 54)

 Psychedelic therapy describes a single, high dose treatment intended to act as a breakthrough (Grinspoon and Bakalar). This sort of treatment, prevalent in North America, was what Osmond administered to his alcoholic patients. The use of several moderate doses of LSD in conjunction with psychotherapy describes psycholytic therapy. The conference in London from which this paper’s opening quote was taken was entitled “Hallucinogenic Drugs and their Psychotherapeutic Use." G. W. Arendsen-Hein presented a paper on his recent psycholytic use of LSD in psychotherapeutic treatment of what he described as “criminal psychopaths, or severely disturbed neurotic criminals,” (Crocket, 1963: 102). 
After thorough preparation of the patient as to what he could expect of this treatment and the establishment of  a firm positive relationship with the therapist and the nurse...LSD was given once a week or once a fortnight, as the patient desired, during ten to twenty weeks, according to his clinical progress and the re-integration of previously repressed material...
...To share the intense emotional experiences of the LSD world with a trustworthy companion means a deeper human relationship than the patient has ever experienced before. Unleashed and being able to express his feelings more freely than under normal conditions, the regressed patient can enter into an affective contact, hitherto unknown to him, and the therapist has then an opportunity to provide some emotional compensation for the affective starvation that the patient has suffered from in the past...
(Crocket, 104)

(excerpts from Conclusions)
Especially I feel that we have to postpone the verdict of incurability on constitutional hereditary grounds until we have tried seriously to establish an affective contact and to penetrate deeper into the emotional life of the patient, and tried to understand the underlying motives of his behaviour patterns. 
With this concept in mind, forming the general attitude of the staff, and aided by the tolerant atmosphere of the therapeutic institution and LSD, we have seen functional changes in the personality coming about that would have been regarded as impossible according to our conventional concepts.
(Crocket, 106)

 Lee and Shlain depict Dr. Hoch at the first international conference on LSD therapy in 1959, defending his model by denying any therapeutic use of LSD.
Despite ample evidence to the contrary Dr. Hoch stubbornly insisted that LSD and mescaline were “essentially anxiety-producing drugs.” He asserted that they were “not especially useful” in a therapeutic context because they disorganize the psychic integration of a person. LSD experiments, according to the chairman, could not be compared with “results obtained in patients where tranquilizing drugs were used to reduce, instead of stir up the patient’s symptoms." Dr. Hoch was incredulous when other participants in the Macy conference reported that their patients found the LSD session beneficial and personally rewarding and were usually eager to take the drug again. “In my experience,” Hoch announced, “no patient asks for it again.” 

(Lee and Shlain 69)

Prime time

 Thomas Szasz makes for lively reading, as do most polemicists. In Ceremonial Chemistry, Szasz attacks the pharmacracy, his term for medicine as a “method of social control or political rule” (Szasz, 1974: 139). In particular, he is warmed to the task of inveighing against “the Medical Holy War on drug abuse,” (67) which he likens to the witch-hunting Inquisition. Writing in 1974, Szasz had just witnessed a tremendous increase in mobilization of the American public against illegal drugs—what was in fact the beginning of the current War on Drugs. (Three critical components of the drug prohibition - the National Institute of Drug Abuse, the Drug Enforcement Administration, and the 1970 Controlled Substances Act - were made their first appearances during Nixon’s presidency.)  Though his ire is directed at medical specialists, in the chapter entitled “Cures and Controls,” Szasz relents momentarily by allowing “the physician” momentarily into the position of injured party. 

[T]he citizen as potential sick person is deprived of the right to self-medication...the opportunity and right to select the expert of his choice...and by the right to treatment with certain drugs which, although available in other countries, may be forbidden in the United States, even through prescription by accredited physicians. [T]he physician...is ultimately victimized, mainly as a result of the enforcement of precisely those drug controls whose ostensible aim was only the protection of the layman from ‘using the wrong medicine.’ This seemingly altruistic motive and practical goal conceals the drive for domination—of patient by physician, of some physicians by others, of physician by politician, in an unending spiral of regulations and tyrannizations.
(Szasz, 148)

  Szasz has inserted a small but important variant into his “Therapeutic State” of medical power which is smocked in compassion but prescribes coercion: there are checks and balances even on social control. 

 On January 18, 1968, the New York Times carried a page of excerpts from President Lyndon Johnson’s State of the Union Address of the day before, in which the Chief Executive announced that he would “propose a drug control act to provide stricter penalties for those who traffic in LSD and other dangerous drugs with our people,” (New York Times, 1/18/68: A16). Johnson did not neglect LSD in his anti-crime proposal to Congress, reported February 8: “I propose that the Congress immediately enact legislation to make the illegal manufacture, sale or distribution of LSD and other dangerous drugs a felony and the illegal possession of these drugs a misdemeanor,” (New York Times, 2/8/1968: A20). 

 What had happened? LSD had gotten out of the laboratories, the institutions, the controlled environments, and into the public consciousness. In line with Hoch’s concept of an LSD experience as being inherently negative, the official portrayal came to be that of an exclusively dangerous drug—a spreading plague of madness—as the authority to make definitions was removed from researchers and given to the police. 

  In 1962, tensions between Dr. Timothy Leary, a Psychology Professor, and other faculty members of Harvard University over his studies of psilocybin (a psychoactive compound found in some mushrooms) and LSD began to appear in the Boston press. After he and his colleague Ralph Metzner were fired in the following spring, Leary began to appear in the national press extolling the virtues of LSD. Hallucinogens had already passed from his scene at Harvard to New York through Beat poets and musicians.  Contemporaneously, Ken Kesey, a graduate student at Stanford University who had been a paid subject in psychotomimetic testing, became the node of a “psychedelic” scene on the West Coast. Reports of LSD began to percolate through the information veins of America. 

 Until 1962-1963, LSD, mescaline, and psilocybin were easy to obtain for clinical and experimental research; and until 1966 there were no state or federal criminal penalties for unauthorized possession, manufacture, and sale,” (Grinspoon and Bakalar, 75). The rate of LSD use skyrocketed. “[A]fter 1966, when Sandoz Pharmaceuticals took its LSD off the market in response to the new laws and the public atmosphere,” underground chemists began making it (Grinspoon and Bakalar, 75). By that time a subculture had bloomed around the experience of psychedelics. “The hippie movement constituted the mass following of the psychedelic ideology. It began to gather force around 1965 and reached its height between 1967 and 1969...there is no doubt that the initiating element, the sacrament, the symbolic center, the source of group identity in hippie lives was the psychedelic drug trip,” (Grinspoon and Bakalar, 70-71). 

 This story was not part of anybody’s international conference on hallucinogens. The medical authorities (presumably the very ones Szasz derides) responded with alarm at the way LSD and assorted drugs were manifesting outside clinical environments. This reaction was not without cause. Records from the time indicate that outside of such controlled spaces the potential adverse reactions might overwhelm the drug-taker. In 1965, LSD still required a graphic explanation in the press. The New York Times reprinted the contents of a New England Journal of Medicine report of an increase “in the number of patients admitted to the Bellevue Psychiatric Hospital because of bad reactions to LSD, a drug that produces powerful hallucinations and is being used experimentally in the treatment of mental illness...Its effects on the mind and perception were discovered in 1943. In addition to vivid, colorful hallucinations, these include many bizarre effects such as terror or other distortions of mood and perceptual disorders in which a patient may not, for example, be able to distinguish his own body and the chair he sits in.” This article emphasizes that the drug requires special knowledge or expertise in that ‘a large number of anxiety-ridden people have begun to experiment with acid in the hope of achieving help.’ The theme of the report was that there is little prospect for such help when the drug is taken by any but the most carefully chosen patients and is administered under any but the most carefully supervised conditions. 

 An editorial in the Journal makes clear the concern on the part of the elements of the medical profession: 
The editorial said the drug’s true value in research and treatment of patients still largely remains to be proven. It cautioned that further work with LSD and similar drugs ‘certainly should be undertaken only in controlled setting by scientists capable of impartial, critical judgment.’
(New York Times, 12/2/1965, 43)

 In October 1968, the New York Times ran a story with a very different tone entitled “Bill Signed to Curb Mind-Drug Peddling,” (New York Times, 10/26/1968: 26). It opened with a flourish: “President Johnson today signed a stiff measure designed to outlaw traffic in LSD and other mind-bending drugs.” After this trippy plug for acid, the article continues: “Mr. Johnson said in a statement: ‘It is measures like this—and not talk about crime—that strengthen the hand of our police and give our family protection.’ ” Apparently President Johnson was not listening to the head of the National Institute of Mental Health, Dr. Stanley Yolles.

 A month after Johnson’s anti-crime proposal to Congress, the Times ran almost a full-page spread on the testimony of Dr. Yolles, the director of the National Institute of Mental Health (NIMH), on the issue of drug abuse before the Senate Subcommittee on Juvenile Delinquency. The spread consisted of a summary of his testimony, excerpted remarks, and a personal profile of the doctor. The summary begins citing Dr. Yolles’ statement that “ ‘alienation,’ which he called a major underlying cause of drug abuse, was wider, deeper, and more diffuse than it has been at any other period in American history.”  
He said the problem—which he defined as “rebellion without a cause, rejection without a program and a refusal of what is without a vision of what should be”—deserved urgent attention. “If this is not done, there are serious dangers that large proportions of current and future generations will reach adulthood embittered towards the larger society, unequipped to take on parental, vocational, and other citizen roles, and involved in some form of socially deviant behavior,” he said.
 Ostensibly Dr. Yolles was in front of the Senate to testify about LSD and marijuana. He testified that LSD seemed use seemed to be declining, admissions to psychiatric hospitals for “bad trips” from LSD were reported lessening, marijuana use seemed to be increasing, no conclusive evidence was available concerning links between LSD and birth defects, scare tactics in drug education “are not only ineffectual, but are even detrimental to conveying needed information about the hazards of drug abuse,” and he proposed that “if we are ever to solve the problem of drug abuse, it is critical for us to focus on and try to solve the root causes of alienation.” 

 The last three paragraphs of the summary of Dr. Yolles' testimony read as follows:
He said that while he supported the Administration’s proposal to stiffen penalties for manufacture and sale of LSD and other dangerous drugs, he had personal reservations “as a physician” about penalties for possession of these and other drugs. 
Like the other health and medical experts who testified, Dr. Yolles was reluctant to speak publicly about differences of opinion with law enforcement officials on the philosophy of curbing drug abuse.
Generally, health officials have favored educational approaches over strong punitive measures for those who possess drugs for their own personal use. They have been critical of what they call “propaganda” and “scare tactics” of some law enforcement agencies, preferring straight, factual information.
Johnson signed the law controlling “mind-bending drugs” seven months later.

Overthrow

 The doctors lost control that year. They became subservient to the newly ascending police forces.
“In 1968 the Drug Abuse Amendments were modified to make possession of LSD a misdemeanor and sale a felony. Responsibility for enforcing the law was shifted from the FDA [Food and Drug Administration] to the newly formed Bureau of Narcotics and Dangerous Drugs (BNDD). Two years later psychedelic drugs were placed in the Schedule I category—a classification for drugs abuse that have no medical value,” (Lee and Shlain, 93).  The occasion of this “scheduling” was the Controlled Substances Act of 1970. The FDA was in the Department of Health, Education, and Welfare at the time (now the Department of Health and Human Services, or DHHS), the location of the federal health agencies. The BNDD was the name by which the Federal Bureau of Narcotics would be known as it moved out of the Treasury Department and into the Department of Justice, location of the federal domestic police agencies.

 After Dr. Yolles’ testimony, but before January of 1969, a workshop organized by the Pharmacology Section of the Psychopharmacology Research Branch of the NIMH was held at the University of California, Irvine. The topic was psychotomimetic drugs.  In the Preface to the Proceedings, Dr. Daniel Efron, the Chief of the NIMH Pharmacology Branch, mentions also the terms hallucinogenic and psychotogenic as possible labels. He then contrasts the “restricted” and “orderly”   “use of these psychotomimetic substances in ancient times” with the “abuse” and “disorderly manner” of use in the “new era” : “The newer times also brought with them the so-called experimenting with drugs by people who do not possess enough knowledge in this area and, what is worse, enough maturity to judge these ‘experiments,’ ” (Efron, 1969:5). Later, Dr. Morris Lipton of the University of North Carolina stated in his presentation on “The Relevance of Chemically-Induced Psychoses” that there was no definitive information one way or another on a biological root to schizophrenia or therapeutic uses of psychotomimetics. (237-239). 

 In the “general discussion” at the end of the conference, Dr. Lipton brought up “the pending legislation which may permit the Narcotics Bureau of the Department of Justice to control the distribution of psychotomimetics employed for research.”  This was “alarming” because “the utility of these compounds for the acquisition of new information about the brain and its functioning have hardly been tapped. Even their utility for therapy is far from clear.” Dr. Lipton suggested “we should individually and collectively through our organizations attempt to recommend a reasonable set of regulations, and these, it seems to me, should be under the control of the National Institutes of Health,” (330). Dr. Daniel Freedman of the Department of Psychiatry at the University of Chicago School of Medicine directed the issue to one Dr. Milton Joffe of the Abuse and Liabilities Branch of the Department of Justice. Dr. Joffe repeatedly assured the conference that everything was cool: there was no plan to “take over” “all research and education,” and that the impending “omnibus bill” would protect LSD and marijuana in a “research category.” Dr. Joffe eventually was addressed by three doctors in total, the second of whom was Dr. Freedman, and the third of whom, Dr. Victor Laties of the Department of Radiation Biology and Biophysics at the University of Rochester, asked specifically about language specifying that the Department of Justice would have discretion to license researchers wishing to do research with Schedule I compounds.

 Dr. Joffe made a few attempts to assure the conference that he, a doctor, was with them, not with his law enforcement superiors at the Department of Justice, and that he was as concerned as they were. His reassurances were empty. Clinical research with hallucinogens died a precipitous death until the 1990s (largely due to the activism of the Multidisciplinary Association for Psychedelic Studies). The Schedule I classification means that a substance is so dangerous that "there is a lack of accepted safety for use of the drug or other substance under medical supervision," (CSA 981)—in other words, hallucinogens are so dangerous that they can never be administered safely. The preceding text should make clear that that view was imposed on the researchers from outside, and that the research did not die of natural causes. 

 The statement by Jerome Jaffee, Nixon’s one-time chief of drug control policy, that in each case of proposed therapeutic uses of LSD, “use has been abandoned either because controlled studies have failed to demonstrate the value of LSD or because the precautions required to minimize adverse psychological reactions dampened enthusiasm and rendered its therapeutic use impractical,” (Gilman and Goodman,  1985: 565) is untruth tending—in its ignorance of history by one who was present there—towards conscious falsehood. 

Implications

  After the advent of LSD in the early 1950s, hallucinogens were the most promising new development in psychiatry. They seemed to verify the long-entertained suspicion that all varieties of mental life correspond to chemical substrates. However, the emergence of the psychedelic model undermined the model of mental illness as a disease, in that psychedelic and psycholytic therapies promised to help reveal the roots of mental illness buried in the memories of the afflicted. Implicit in the word “mind-revealing” is the faith that there is a mind to be revealed at all, a mind which is inconveniently unquantifiable – perhaps intangible.

  The disease model of madness treats it as a disease to be cured. Dr. Hoch’s insistence that LSD could not be a positive experience exemplifies the authority of the medical specialist to make proclamations about the mental patient’s experience. To the observer on the outside, the symptoms “thought, mood, and perceptual disorders” (Galanter and Kleber, 1994:141)—are clearly recognizable. But what do they signify? To the medical specialist they look like madness, and madness is a disorder, a disease to be cured. If they mimic schizophrenia, then they signify nothing.  Biology gives physicians jurisdiction here. 
 
  From the perspective of Mr. Mayhew, the Member of Parliament who wanted to make all psychiatrists mad, these drugs afforded a valuable learning experience for psychiatrists: they could feel what being mad is like. The psychotomimetic model ascribes all agency to the drug itself. In this model, doctors, who dictate the treatment modality, deny any effects of their own agency on the “psychosis.” Similarly, the biological disease model of madness rests on the assumption that the “disease” is produced wholly by the patient.  In contrast, if the symptoms of a hallucinogenic experience caused in “normal” people after ingestion of psychoactive compounds can vary, then potentially the experiences of the mad can vary as well. According to one definition, “iatrogenic,” meaning “caused by the mannerisms or treatment of a physician, is specified as “imaginary illness of the patient brought about by the physician,” (New Webster’s Dictionary, 1985: 473).  If the agency of the physician has iatrogenic effects in patients undergoing “psychomimesis,” that premise implies that some of the negative symptoms of mental illness generally might likewise be generated by the treatment regimen. In that case the outcome of hallucination could be revelation or psychosis, depending on the influence of outside agencies.    

  In examining these two different attitudes visible in psychiatry in the 1950s and early 1960s, which seems closer in spirit to our current conception of mental health? We live in a society in which the allegedly “mind-revealing” agents have been banned, while elimination of symptoms is considered “treatment” of mental illness. When psychedelia was banned, the opening doorway into the mind of the patient was slammed shut and locked, and psychiatry continued unimpeded in the business of labeling disorders. Is it not possible to see psychiatry today as being the result of the choice of a model of brain-adjusting over a model of mind-manifesting?

  This paper posits a feedback relationship between mental health and drug control policy, such that each one shapes the other. In essence, the drug control field is a deformity in the mental health field, an evolutionary offshoot subject to peculiar rules (such as the predominant presence of policemen and the national security state apparatus). The question now is how to re-integrate the two.

  The essential subconscious obstacle to an evolution in drug control is the premise that the psychedelic substances cannot have therapeutic applications, since the mental state generated or facilitated by psychedelics can only be pathological; the alternative conclusion poses too great a threat to the dominant model of normative consciousness. In simplest terms, because psychedelic substances, and to some extent, other psychoactive substances, induce states of abnormal perception and/or mood, they induce what appears to be pathology; in other words, they are ‘poisons’ and it is inconceivable to the current colloquial conception of mental health that a ‘poison’ – i.e. that which induces a ‘disease’ state of impaired rationality - could also be a medicine. The proposition that there could be a therapeutic use of psychedelics therefore threatens a fundamental dichotomy – the dichotomy between ‘sane’ and ‘insane.’ It may be that this ‘threat’ underlies, to some extent, opposition to reform of drug control policy in general.

  The relationship between mental health and drug control is clear as a historical matter – the drug control field clearly evolved out of the mental health discipline. Drug control therefore is most properly a matter of mental health norms. It may be that only by recognizing that the roots of the ‘drug’ issue lie in a mental illness stigma will it be possible to address the source of the fear and evolve to a new model of mental health. In accord with the foregoing, the matter of drug policy reform is then not an independent enterprise but depends upon a simultaneous evolution in the societal understanding of the nature of the mind.

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1 Comments:

At March 15, 2013 at 4:45 AM , Blogger kurt black said...

Very interesting paper and I enjoyed reading it. It is however a dangerous drug and is illegal. ss disability medford

 

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