1955_abramson_1537_2.pdf

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_LSD
Noo71 (§102a)
M 500
properties
M 398 psychotherapy
M 398_2 psychoanalysis
_RAMSON,
i_ysergic
_
HoAo (New York City)
acid diethylamide (LSD-2_): III.
fear
of homosexuality,
As an adjunct
to psvchotherapy wit h elimina-
J. Psychol.39,127(
1955)o
In the author's
opinion
the unique action
of LSD has th_ following
favourable
characteristics
which may help the patient
and physician
to deal with analysis
of the
patient' s reactions_
a) Pharmacological
safety_
b) Effectiveness in small doses (20-40/_g) for therapeutic interviews;
C) The patient is conscious, cooperative and better able to integrate
material of _ychodyaami_
significance ;
d) The difficulties of the procedure of narcosynthesis are eliminated
with the patient undergoing an essentially elated disturbance in ego
function which is also accompanied by integration so that it may be
thought of as hebesynthesis_
e) The drug may be given_peatedly.
(A patient who was also a subject in
the first paper of this series _ABRAMSON et al., LSD 65] took
25-IO0/_g more than 50 times.)
f) There is no evidence of addiction;
g) The effects usually wear off within 12 hours_
h) PatientBusually like the experience of taking LSD in the dose range stated°
It is believed that the ambulant technique is perfectly safe if carried out
with the dosage recommended and with certain precautions. In view of the amount of
anxiety which may be mobilized in ambulant patients, a 2-week period of notice and
questioning precedes the LSD interview_
Preparation and management of the ambulant patient_ Emphasis placed on
therapeutic value of LSDo The unusual vegetative and psychic effects are related to
the patient at least two weeks before the LSD interview. The patient should be informed_
a) that there are no after-effects,
b) that someone should call for him four hours
after administration,
c) that he must remain at home tmtil the next morning 9 d) that
driving a car, using machinery or walking alone is prohibited_
e) a barbiturate
(1o5-3o0 g secobarbital) is given at bedtime,
f) the 4-hour interview is interrupted
at about 50-minute intervals for coffee and simple foods.
For short interview (1-2 hours), advantage should be taken of the data con-
rained in the paper by ABRAMSON et al. (LSD 65)° The peak reaction to 50/_g occurs
after l_ to 3 hours. This should be the period of choice. However_ the patients have
always been kept in the office under control for a minimum of 4 hours° No method,
except deep sedation, is known to stop the LSD reaction once it has begun° However,
sedation may even complicate the situation° One patient who received 50/eg at 8 pomo
showed marked signs of the LSD reaction at 1 a.m., even though 3 _Tains of secobarbital
had been given at midnight - the patient showed the effects of both drugs_ elation
(LSD) and an unusual lack of motor and sensory control (secobarbital)o
Case
report
A verbatim transcript of a 4-hour interview under 40_g LSD is reported.
A 40-year old married woman, who had come for psychoanalysis because of many psycho-
somatic and adaptive difficulties had made excellent progress, Cog. relationships with
he_ two children were markedly improved. Her ability to work had been restored and
nemrly all her psychosomatic complaints such as eczema, asthma_ hay fever and headache
been eliminated_ However, there were still some important problems connected with
her sex life within her marital
situation which required attention, even though
vaginal orgasm was frequently achieved with her husband. These sexual problems were
mobilized by a dream about two dogs preparing for the sex act. Analysis of the dream
was unsuccessful because the patient's anxiety overcame her usual interest in
ascertaining the nature of the symbolic meaning of the dream° On previous occasions,
she had utilized LSD to re-organize her defences so that in interviews lasting 4 hours
sufficient time permitted her both to reduce the defensive mechanisms and to re-construct
what was learned thereby to her psychic benefit.
In view of the satisfactory
experience
this patient
had previously
bad,in
interviews under LSD an attempt was made to determine which conscious
factors might be producing anxiety and the fear of analyzing the dog
interview the nature of the anxiety connected with the dog dream was
analyzed by the patient, and a fear of homosexuality in herself which
and had become intense was resolved_ The verbatim recording outlines
or unconscious
dream° In the
successfully
had been brewing
a good part of the
patient's psychosexual development which led to her confusing her childhood manner of
relieving anxiety through masturbatory
channels with later aspects of psychosexual
development which in the pre-analytic and analytic frame of reference led to the
patient's believing that she was a lesbian.
Other investigators have stated that LSD produces a disturbance of the person-
ality structure, this disturbance being analogous to a schizophrenic-like
state in
which ego depression occurs. ABRAMSON believes that this generalizations
although valid,
must be modified° The effect of LSD depends on dosage and the personality of the
individual° Although ego_depression occurs in the normal subject given 50/_g orally,
another process_ ego enhancement or re-inforcement,
goes on simultaneously°
The ability
of the individual under small doses of LSD to face preconscious or unconscious material
or to integrate this material into the dynamic forces of the ego structure is not part
of a loss of ego but rather that of a re-inforced ego which functions more effectively
under LSD, in the presence of the therapist°
A study of the psychoanalytic material of this patient after the LSD interview
revealed consistently that the LSD experience gave the patient much more confidence in
rewconstructing
and remevaluating data for a longer period than had previously been
possible without LSDo ABRAMSON prefers to consider the process of integration under
LSD as hebesynthesis, an elated state in which both ego depression and ego enhancement
may occur simultaneously9 with the ego enhancement leading to an increase in the
integrative function of the patient's ego°
COMMENTs
The previous papers in this series are by ABRAMSON et alo (LSD Noo65, LSD Noo66).
Several authors, eogo FREDERKING (LSD No.38), SANDISON et alo (LSD Noo48), BUSCH and
JOHNSON (LSD Noo4),have reported on the value of LSD as an aid in psychotherapy° This
paper is the first publication concerning the use of LSD in ambulant patients° The
special preparation recommended differs from the method employed by SANDISON et alo
(LSD_ IIIo Als Hilfsmittel
zu sein)
Protokoll
bei der Psychotherapieo
Beseitigung
der Furcht,
homosexuell
einer 4o-st_ndigen
psychotherapeutischen
Sitzung
mit einer
Patientin,
die 40 _ LSD oral erhalten hatteo Sie hatte in den bisherigen Sitzungen ausgezeichnete
Fo_sch_itte
gemacht, doch waren viele, mit ihrem Geschlechtsleben
zL_sammer_ngende
Probleme noch ungekl_rto Sie _usserten sich in einem Traum, dessen _nalyse jedoch
erfolglos blieb, weil die Angst der Patientin ihr sonst bezeu_es
Interesse an der
Ahkl_rung der symbolischen Bedeutung yon Trauminhalten
_iberwogo In der Aussprache
nach LSD-Verabfolgung
wurde der Charakter der mit dem Traum verbundenen AngstgefUthle
ezkannt und die Patientin von einer bereits sehr stark gewordenen Furcht_ homosexuell
z_ sein, befreito Die Erfahrungen unter LSD bewirkten_ dass die Patientin w_hrend
einer l_ngeren Zeit als sonst nach einer Sitzung grSsseres Vertrauen hatte in ihre
F_h_gkeit_ frt_here Erlebnisse zu rekonstruieren
und zu deuten, ale es nach Aussprachen
ohne LSD der Fall gswesen war° Der Autor beschreibt Einzelheiten der notwendigen Vor-
bereitung der Patienten bei ambulanter LSD_Anwendungo
ED 7298w
NKT/Dr°Bs/bh

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