The Trials of Psychedelic Therapy by Matthew Oram
The history of psychedelia in the United States during the mid-twentieth century is dominated by three narratives: the medical, cultural and military/clandestine. In many respects, all three are deeply interwoven. For example, the CIA secretly funded medical research and reportedly carried out cultural experiments with LSD, and some researchers like Dr Timothy Leary left the lab and joined the growing counterculture of the late 1960s. Historically speaking, therefore, lines of distinction can be difficult to draw.
Out of this milieu has grown a popular belief that medical research was left behind due to the widespread cultural appropriation of LSD that ensued after the research heyday of the 1950s. Yet studies into the psychotherapeutic value of the substance continued well into the 1970s, albeit in a much reduced form. In The Trials of Psychedelic Therapy: LSD Psychotherapy in America (2018), the historian Matthew Oram skilfully teases out the medical narrative in order to explore the hitherto ignored impact of new regulatory models.
The book begins by examining the ‘free experiment’ period of the 1950s, which was characterized by numerous small scale LSD studies and the development of several methodologies and treatment models: the psychotomimetic, psycholytic and psychedelic. It was a largely unregulated pharmaceutical landscape that was populated by preclinical researchers employing both biological and psychological approaches, which is reflected in the aforementioned models. As a result, there was little co-ordinated developmental research.
LSD studies were conducted against the backdrop of a psychopharmacology revolution in which efficacious new psychiatric drugs were also being discovered. Simultaneously, calls for better regulation grew, fueled by the disastrous thalidomide scandal. This resulted in the Drug Efficacy Amendment of 1962, which aimed at establishing better regulations for pre-market clinical drug research. Although not the principle cause of the amendment, LSD was classified as an experimental drug and thus fell under its auspices.
The amendment established a role for the Food Drug Administration (FDA) as a gatekeeping authority that stipulated how efficacy was interpreted, and this proved particularly problematic for LSD psychotherapy researchers. Underlying this was the introduction of the randomized double-blind placebo-controlled trial as the gold standard for research design, which became a central interpretive lens for evaluating efficacy. As Oram notes, ‘its focus on isolating drug effects from psychological influences reflected a “magic bullet” concept of drug efficacy’ (Oram 2018: 80). LSD was not akin to an antibiotic, but a treatment adjunct.
LSD psychotherapy researchers argued that the methodology was ‘neither appropriate nor possible,’ citing the problem of applying a statistical method to questions of the psyche, and the problems of finding a placebo that could mimic LSD’s symptoms but not its potential therapeutic qualities. Underlying this was the problem of there not being a universally-accepted cause of mental illness, thus no one particular biological/psychological point at which to aim any magic bullet. The amendment unintentionally turned psychopharmacology into a predominantly biological form of treatment.
As a result of these changes, psycholytic therapy, predicated on a series of small dose LSD sessions conducted alongside psychotherapy, quickly disappeared from the research landscape. The 1960s approach to LSD was in part shaped by this regulatory change.
Over the 1960s the field of LSD psychotherapy research transformed rather than died: from a large but loose collection of small, varied studies into a smaller number of major clinical trials working toward a common goal (Oram 2018: 78).
The psychedelic model fared slightly better. A large, single dose of LSD, buttressed by therapy, was developed as a method of treating alcoholism. Humphry Osmond and colleagues first developed it in Canada, and it reached a ‘mature form’ at the Palo Alto Medical Research Foundation through the work of Charles Savage, James Terrill, and Donald Jackson, who first presented their research in 1960.
A better development process in psychedelic therapy, coupled with clear outcome goals, underscored a process more suited to the new regulations. Fewer but larger studies emerged as a result. Oram’s work historicizing the Spring Grove LSD research program, at Spring Grove State Hospital in Maryland, is particularly illustrative, and wonderfully executed. Established by psychiatrist Albert Kurland and psychologist Sanford Unger, they brought in Savage as director of medical research, and later Stanislav Grof and Walter Pahnke among others. Promising early results were hampered by methodological failings, however, and these and other studies failed to fully realize LSD’s potential for treating alcoholism by the early 1970s.
The late sixties also marked the height of LSD hysteria in the press, alongside its appropriation by protest and counterculture groups. Although these things did not directly hamper research, they did contribute to a more toxic public environment. The Drug Abuse Control Amendments 1965 began the process of LSD being understood as a drug of abuse. Its manufacturer Sandoz withdrew its research sponsorship the following year, which had a detrimental effect on the number of studies conducted. Although the FDA did continue to support research that fulfilled criteria, the Controlled Substances Act (1970) deemed LSD to have no medical value which created further regulatory impediments.
Ultimately, Oram concludes, ‘although the increased regulation may have had some impact, the decline of LSD research in the 1970s can be more convincingly explained through the outcome of the clinical trials of the late 1960s’ (Oram 2018: 188). This is of course a double edged moment as the regulatory criteria itself hampered the variety of methodological approaches, particularly in the psychological sciences. It remains an important point though that study design in tandem with regulation, and a lack of commercial interest, combined to create an increasingly difficult research atmosphere.
The Trials of Psychedelic Therapy is a brilliantly researched book that does an excellent job of elucidating the medical narrative of LSD. It is important food for thought in an age when research with psychedelic substances is once again hitting the headlines with promises of their therapeutic value. It remains to be seen, however, whether LSD itself will ever lead this field again, as psilocybin and MDMA in particular have taken centre stage. Either way, this book is essential reading for anyone who wishes to understand the history of LSD therapy.