The Brain
The Use Of Psychedelics In Dutch Psychiatry
by Stephen Snelders
October 1995
Part I Of II
Introduction:
It is an irony of Fate that in the technological advanced society in which we live, many researchers have started to study the achievements of cultures that used to be seen as 'primitive'.
The study of the use of psychedelic substances (substances which produce changes in thought, mood and perception akin to dreams, religious exaltation, involuntary memory or psychoses) in these cultures is one of the most important examples of this development.
After centuries of neglect and outright suppression of this use - a period so long, that historians and archaeologists can hardly trace its manifestations in the past - Fate decreed that the rediscovery of psychedelics should find its first advance guard among members of the medical profession, a profession which is one of the main foundations of our technological society.
The first culmination point of this rediscovery came after the discovery of LSD-25 in the 1950s and 1960s. The research done in this period offered great promises, especially (but not exclusively) in the fields of psychotherapy and biological psychiatry, promises that were unfulfilled because of the limitations which governments put on the experiments.
The problems and themes that arose out of this research have, however, lost nothing of their importance. So, since we are witnessing in our days a revival of this kind of research, and since there is some historical distance with the 50s and 60s, it's about time to take a fresh look at those decades using the tools of historical research.
Here I would like to discuss one of the themes which I have encountered in my study of the reception of the use of psychedelics in Dutch psychiatry in this period.
The theme which I want to discuss is that of continuity and discontinuity. In studies on the history of psychedelic research there is a tendency to stress the new elements and insights that the research with LSD and other psychedelics gave from the fifties onwards. This is logical if we look from the point of view of the overwhelming psychedelic experience itself.
But I think that one of the key factors in the positive view on psychedelic research in the fifties is the existence of continuity with earlier tendencies in psychiatric research. The rediscovery of the use of psychedelic substances was made possible because it seemed to provide answers and research strategies to problems which arose out of earlier lines of research. Any introduction of new elements in society, however revolutionary it may seem, has to have some connection to existing elements.
If not, then there is no way to connect the old and the new. So first I want to trace some elements of continuity between the psychedelic research in Dutch psychiatry and earlier developments. I will do this by presenting these elements in the work of four key figures in this research.
The limitations put on this research in 1966 is evidence of the existence of elements of discontinuity, elements which at that time could not be incorporated in Dutch society or its scientific community. I shall try to find out where the roots of this discontinuity are to be located.
It is not my aim here to sketch the complete history of the use of psychedelics in Dutch psychiatry. That would not be possible in the context of this article. Besides, I must warn that my research is by no means completed. So my discussion of my theme is based on preliminary research.
By posing the problem of continuity and discontinuity, I hope to contribute to a history of the (non-)acceptance of psychedelics in society which escapes from a purely positive or a purely negative point of view.
The history of psychiatry or the sciences in general is the last decades transcending black-or-white views, in which every development is seen in the context of the rise of a theory or school which is seen as the holder of truth. But whether or not there is such a thing as absolute truth (something which I'm not inclined to think), this is no way to ascertain the reasons why certain people acted in a certain way.
To study this we must see them in their own time, with their own possibilities, belief systems and limitations. By this way we can study (to use a popular term) the 'paradigm shifts' which seem to rule the development of all sciences. And what's more, I think that only by this way we can contribute to a discussion on the use of psychedelics in society, which aims not at a confrontation between views, but at finding the ways in which a more general consensus on the subject can be achieved.
H. M. van Praag and Biological Psychiatry
My first example for the continuity mentioned before comes from the rise of biological psychiatry in the 1950s. The key figure in biological psychiatry has been Herman van Praag.
Van Praag became in 1962 doctor of medicine. His thesis investigated the possible role of Monoamine Oxidase Inhibitors (MAO's), which inhibit the working of certain neurotransmitters like dopamine, noradrenalin and serotonin in the central nervous system, in the treatment of depressions.
He came to the conclusion that two drugs used since 1958 as antidepressive medicines, Marsilid and Marsplan, could be (but where not always) effective against so-called 'vital' depressions.
These were characterized by symptoms such as unmotivated depressions, retardation of thoughts and actions, reduced receptiveness to psychic feelings, disturbances in conception of time, somatic disorders, and a fluctuation in intensity of complaints during the day (Van Praag 1962).
With this thesis (which looked ahead to much research that is currently taking place, e.g. on Prozac) Van Praag became one of the figure heads in the movement of biological psychiatry, which looked for biochemical factors in the causation of psychic diseases.
Van Praag himself stressed that the flourishing of this kind of research since the second half of the fifties was triggered by the research with LSD. He referred especially to the hypothesis which Woolley and Shaw published in 1954.
Starting from a comparison of psychedelic and schizophrenic states of consciousness (a comparison which Van Praag himself thought superficial) they wrote that 'naturally occurring psychic states such as schizophrenia might well be pictured as resulting from a deficiency of serotonin in the brain, brought about not by drugs, but by failure of the metabolic processes which normally synthesize or destroy them' (Van Praag 1962:26).
A hypothesis which soon turned out to be too simple, but which gave rise to an avalanche of comparable research.
Van Praag himself experimented from 1958 to 1962 with LSD. As chef de clinique of the psychiatric department of hospitals in Rotterdam and Groningen from 1963 to 1968, and as lector and from 1970 professor in psychiatry at the State University Groningen, he continued to further biological psychiatry and to advocate scientific research in the effects of psychedelics (or 'psychodysleptics', as he preferred to call them).
The research in psychodysleptics was according to him not only interesting for the psychopathologist, because 'model psychoses' could be created by their use, but also for the neurobiochemist and the neurophysiologist. The questions about the influence of psychodysleptics on brain metabolism, on the working of neurons and neurotransmitters, could give insight in the relation between material processes in the brain, and psychopathological syndromes (Van Praag 1966).
The openness with which scientists welcomed the research of biological psychiatry was not something that was new in the fifties. At the end of the 19th century there had been a theory in vogue that psychotic disturbances are caused by self-poisoning by the metabolism of abnormal products.
Another Dutchman, Herman de Jong, had from 1921 on done research with different psychopharmacological substances, that produced catatonic states in animals: starting with bulbocapnine, the psychotoxic principle from Corydalis cava (which was used in the Middle Ages against certain forms of madness), he went on to study the effects of mescaline and other chemical substances, but also of electrical and neuro-surgical methods.
All these methods and procedures could, so concluded De Jong, probably together with psychogenic factors, end in catatonic states (De Jong 1945).
Besides the work of a pioneer like De Jong, the climate in the 1950s seemed to be ripe for the study of the role of biochemicals in the functioning of the human brain. A sign of this was the inaugural speech with which Joh.
Booij accepted the professorate of psychiatry at the Free University in Amsterdam, in 1955. Psychiatry was in crisis. Different doctors did not agree about diagnosis. Treatment methods of endogenous psychoses, schizophrenia and manic depressive psychoses, like sleep-, insulin-, electroshock- and electrocoma-therapy, had not lived up to the expectations.
Statistical research in the effects of psychotherapy showed that remissions after treatment did not occur more often than spontaneous remissions. It was according to Booij, time to center interest on the neurobiochemic processes, which lay at the foundation of psychic disturbances. In this context Booij saw hope in the study of the effects of LSD.
In his view LSD caused psychotic images, and that could give a clue to the biochemical processes involved in psychoses (Booij 1955). Another professor of psychiatry, J. H. Gaarenstroom from the State University Groningen, held at this time similar hopes (Gaarenstroom 1956).
I certainly don't want to give the impression that this was the general or uncontested viewpoint in Dutch psychiatry. Later on, I will return to the position of Van Praag in the discussion around the limitations on psychedelic research. But it is clear that the research in the biochemical effects of psychedelics was connected to larger developments.
For the historian, there are clear signs of continuity. The same is true for the use of LSD in psychotherapy. To see the continuity at work in this sphere, I will give examples from the work of the three psychiatrists who did pioneer work in the development of the therapeutic use of psychedelics: J. Bastiaans, G. W. Arendsen Hein en C. H. van Rhijn.
Jan Bastiaans
Jan Bastiaans, who became the most well-known Dutch psychiatrist who used psychedelics in his psychiatric practice, stands firmly in the tradition of Freudian psychoanalysis, and in that of psychosomatic medicine. From 1954 till 1961, he was president of the Psychoanalytic Institute in Amsterdam, a major bastion of psychoanalysis in the Netherlands.
Before this time, from 1946 till 1954, he had been a collaborator of Groen, then head of the second department of internal medicine at the University of Amsterdam. Groen was influenced by American ideas on psychosomatic medicine, in particular the hypothesis of psychosomatic specificity.
According to this hypothesis, specific psychic problems can lead to specific physical diseases among those people, who are vulnerable because of the structure of their personality.
In 1949 Groen founded the Psychosomatic Working Party, in which Bastiaans took part as psychiatrist. It was his job to make a psychiatric examination of each patient and to deliver a psychiatric report and a biography which included youth, school years, relations with parents, and satisfaction in marriage and work (Dehue 1990:124-126).
Groen and Bastiaans both became convinced advocates of the theory of psychosomatic specificity, even though there were (and still are) many researchers who reject this theory. Bastiaans started to apply the theory on the many victims of the Second World War: the survivors of the war who had been through extremely painful situations in the Nazi and Japanese prisons and concentration camps, many of whom had become as a consequence extremely traumatized.
These were people for whom there were hardly any facilities for adequate treatment, nor more than a few psychiatrists who were competent to treat them. In his doctoral thesis from 1957, entitled The psychosomatic consequences of oppression and resistance, Bastiaans enumerated the psychosomatic syndromes which he had found in war victims.
These syndromes seemed to be an aspect of delayed reactions to traumatizing stress, especially found under 'highly self-controlled personalities who had expended considerable will-power and energy on trying to control, suppress or repress the painful traumatic consequences of the war' (Bastiaans a:112).
But this confronted him with the definition of a psychotrauma. A somatic injury could be easily defined, but what was the essence of a psychotrauma? He came to the conclusion that 'A psychotrauma may be described as a mental injury marked by the fact that a human being is fixated in a state of affect lameness, in a state of powerlessness usually associated with intense suppression and repression of anxiety, grief and anger.
This state of partial mental isolation makes it impossible for the victim to cope in a healthy manner with the traumatizing stress situation.' (Bastiaans b:3) Whether this would develop in a post-traumatic stress disorder was dependent on the inbuilt capacity of the traumatized person for adaptation, and on the severity of the stress situation. If the person couldn't cope, part of his past became undigested and he couldn't free himself.
He became fixated in a state of powerlessness. This affected his relation with the world at large, resulting in loss of mental freedom and a state of mental isolation. 'Here the individual consciously or unconsciously locks himself into mental invulnerability-structures of a psychotic, psychoneurotic or psychosomatic nature. In psychopathology the reflection of this type of isolation is found in the concepts of autism, narcissism, character neuroses, depersonalization or psychosomatic character formation.
The patient so affected becomes isolated from the world of his inner emotions by an excessive use of self restraint (Bastiaans c:1-2). As a result of actual traumatizing stress, former traumatic experiences (e.g. from childhood) can be activated and a very complex link between early and later traumatizing experiences established.
How to treat these people? To start with, use was made of the techniques of hypnoanalysis, narcoanalysis and psychoanalytic treatment. Narcoanalysis, using barbiturates to put patients in a kind of dream-sleep and to elicit their memories, was a highly acceptable method for exploring the human psyche in the years after the war.
Bastiaans used Sodium Pentothal in combination with psychoanalysis and psychodrama. The patients were required to relisten systematically and regularly to the tape-recordings which were made of their expressions in their drug-induced sleep.
Although Bastiaans later claimed that in the right climate of safety and security, 'an average number of eight sessions is usually sufficient to free the patient', he came to the conclusion that in the most rigid cases, there weren't sufficient results (Bastiaans b:5).
Besides, people did not always remember actually saying the things they heard on tape. He began to look for other methods. This was stimulated by the conclusions of a research program on prognosis and effect of psychoanalysis and psychotherapy, which was conducted by the psychologist Johan Barendregt under supervision of Bastiaans as director of the Psycho-Analytic Institute.
Barendregt concluded that there was no difference in the changes in neurotic patients after some years, whether or whether not they had gone through psychotherapy. It seemed that traditional psychoanalysis needed between 800 to 1000 treatment sessions to help patients with severe character neuroses (Bastiaans c:2-3; Dehue 1990:129-138).
In 1961, Bastiaans started to use psychedelics, or as he called them, hallucinogenic drugs, to help these people: mainly LSD, but also psilocybin. From 1963 until 1985 he was professor of psychiatry at the State University of Leiden. Many patients were helped in the Jelgersmakliniek in Oegstgeest, where he worked until 1988.
After some experience, he came to the conclusion that for three categories of patient treatment with LSD was advisable: psychosomatic patients with an intensive rigidity of their defence and coping mechanisms; patients with survivor- or concentration camp syndromes, and patients who after many years of psychoanalysis did not achieve the prognosticated positive results.
A concentration camp or KZ-syndrome was actually not a syndrome, but a process of four phases that contained different conventional syndromes: a shock phase with the feeling of extreme powerlessness; an alarm phase, with alarming emotions and fear which had the function of preparing the drive for solutions; an adaptatian phase, with flight-or-fight mechanisms, and an exhaustion phase. The need for security drove patients with a KZ-syndrome to a psychological position of master or slave in relation to other people.
Patients who were what he called 'inhibited fighters', with intensive life experiences, but psychically traumatized, were usually the best candidates. They often suffered from alexithymia, and were unable to talk about their emotions. Under LSD, in a safe and secure environment and under the right guidance of the therapist, this would change completely.
Bastiaans claimed that his most positive results were achieved with survivors from jails and concentration camps, and with people whose childhood could be compared with some kind of private concentration camp. Seldom were more than seven sessions necessary; in one case there were 28 sessions.
The therapist spent on average some 50 hours on sessions and interviews. So, according to Bastiaans, the psychotherapeutic process was facilitated by a combination of psychoanalysis with the use of hallucinogens (i.e., psycholytic therapy). But this was not a revolutionary new departure, but a logical follow-up of the earlier used forms of narco-analysis.
This doesn't mean that Bastiaans' methods were uncontested in the psychiatric world. On the contrary, he later complained bitterly that he was accused by analysts of giving up the gold of psychoanalysis for the silver of LSD-psychotherapy. These people, he wrote, did not understand that an LSD session is more than an abreaction procedure.
Under LSD, the patient is confronted with his own resistances and defense mechanisms in an unescapable manner, whereas the repression or denial of experiences in traditional psychoanalysis is a common phenomenon. What's more, the therapist himself is confronted with the need to be as open and honest as possible.
The patient under influence of LSD sees clearly the therapists' intentions. At the same time, the therapist is confronted with his own alexythimia in presenting his knowledge of the LSD-experience to his own colleagues, not to say to laymen.
Bastiaans concluded that 'It does appear as if medieval fears for insanity or for the confrontation with psychotics are evoked again, leaving one with the impression that society has a need for eliminating as swiftly as possible that which seems to pose a threat to its own existence.' (Bastiaans c:16)
So although I'm stressing here the continuity of Bastiaans' work with earlier developments in psychotherapy, we're already faced with the problem of discontinuity which would raise its head in the 1960s and which resulted in the legal restrictions on the use of psychedelics in 1966.
I will return to this theme later. For the moment I content myself with giving the explanation of Bastiaans for the ultimate negative reaction of his professional colleagues, which had the result that after his retirement his work was not continued at Leiden University and at his clinique in Oegstgeest: 'Some [psychiatrists] have an intuitive feeling that the confrontation with the world of psychotics may be too much for them to bear, many others fear the misinterpretation of their efforts by their own scientific community' (Bastiaans c:16).
continued on page II
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