|Psychedelic-Assisted Psychotherapy for the Terminally Ill
A Thesis Submitted to the Faculty of the College of Arts and Sciences
In Candidacy for the Degree of
Master of Arts
May 18, 1997
INTRODUCTION: Helping to Make Death Meaningful: Addressing the Psychological Needs of the Dying
CHAPTER I: The Process of Dying
CHAPTER II: Current Treatment for the Terminally Ill
CHAPTER III: The Use of Psychedelics in Treating the Terminally Ill
CHAPTER IV: Proposed Model of Psychedelic-Assisted Psychotherapy with the Terminally Ill
CHAPTER V: Conclusion
|The writer wishes to express his gratitude and appreciation to Dr. Judy
Lam, chairman of his thesis committee, for her advice, criticism, and
The writer also wishes to thank Dr. Heidi Harlow, the other member of the
committee for her unconditional support.
The writer also wishes to thank Dr. Janice Kowalski for her timely
The writer also wishes to thank Rick Doblin and Sylvia Thyssen of MAPS.
They were able to respond to any questions and provide necessary
information to complete this task.
The writer also wishes to thank Karen Sewick for her unwavering assistance
in completing this paper.
Finally, this paper is dedicated to my Mother, Jean Sewick, whose
resiliency and courage in the face of cancer has inspired me to write
Helping to Make Death Meaningful: Addressing the Psychological Needs of
The subject of death and dying is usually avoided by medicine and
psychology. In medicine, death is seen as a sign of failure, while
psychological intervention is seldom offered to the dying. This paper
explores the Western concept of death, the stages of dying and the attempt
to make death meaningful. Current available treatments for the dying are
noted including hospice and palliative care.
In addition, this paper reviews the use of psychedelics in pre-industrial
societies. The development of psychedelics as medicine is also traced,
first as an analgesic, then as an adjunct to psychotherapy with the
terminally ill. As part of this review, current studies are cited and a
proposed model of psychedelic- assisted psychotherapy using D.P.T. is
evaluated. Finally, the future of psychedelic psychotherapy is discussed
in the context of Western society.
The Process of Dying
The traditional Western view of death is one of denial (Rando, 1984). This
denial is evident in the way death is referred to or labelled in Western
society. For example, expiring or passing on are typical of the type of
terms used to describe this phenomenon (Richards, 1975). Once the person
dies, the individual is often quickly removed to the funeral parlor, in
efforts to minimize the family's exposure to death. Furthermore, the
corpse is made to look as lifelike as possible, further perpetuating the
illusion of life and the denial of death. Thus, an attitude that death is
not a natural part of human existence is conveyed. Feifel (1977)
suggested that the denial of death is influenced by death being seen by
the American culture as the destroyer of the American vision of life,
liberty, and the pursuit of happiness.
The American culture's vision of life sees aging, terminal illness, and
death as the defeat of our attempts to master nature. The dying patient
is thus viewed as a loser in life's race (Grof & Halifax, 1977). Once the
patients die, their deaths can be scrutinized by the families for
mistakes along with any liability issues by the medical personnel
(McCue, 1995). This "medicalization" of death leads to the avoidance of
acknowledging the inevitability of death. The Western medicalization of
death causes physicians to ignore the emotional and spiritual side of the
patient and focus instead on the biological aspect (McCue, 1995).
Therefore, the struggle to delay death at any cost becomes more important
than the quality of the patient's remaining days (Grof & Halifax, 1977).
Alternatively, if the patient is terminally ill, a social death may
precede biological death in the form of psychological distancing from the
patient by family and medical personnel (Rando, 1984).
In contrast to Western society's denial of death, some primitive,
pre-industrial societies such as that found on the Fiji islands, accept
death as natural and inevitable (Rando, 1984). In these cultures, death
is not seen as the end of existence, instead death is regarded as a
transition or transfiguration. The dying individual is likely to have had
experiential training in altered states of consciousness through the use
of psychedelic or powerful non-drug methods. These altered states of
consciousness may include symbolic confrontations with death, giving one a
realization of life's impermanence and providing an insight into the
transcendent nature of consciousness (Grof, 1980).
Despite the Western history of death denial, the last two decades have
brought about changes in care and treatment of the dying. These changes
have been brought about by the Hospice movement, Kubler-Ross, and
thanatological research. First, the Hospice movement began in England due
to the efforts of Saunders. She founded St. Christopher's Hospice in 1948
with a donation from a dying patient (as cited in Fiefel, 1977). The
movement encourages the dying and their families to accept death, and
focuses on relieving pain and improving the quality of life and death
(Saunders, 1981). This focus allows the dying a chance to make death more
personal and spiritual. Second, Kubler-Ross brought a similar message to
Americaand created an interest in the experiences associated with death.
From her work with patients, Kubler-Ross noted that the dying appeared to
be more anxious about the dying process than what happens after death
(Kubler-Ross, 1975). However, these anxieties are typically treated as a
physical pain is treated, and the patient is sedated rather than
counseled. Based on interviews, Kubler-Ross was able to identify five
consecutive stages of the dying process through interviews with the
dying. The five stages are: denial and isolation, anger, bargaining,
depression, and acceptance (Kubler-Ross, 1969). Kubler-Ross' guidelines
on the stages of the dying process have provided professionals guidance
in their work with these patients. Effective psychotherapeutic
interventions have been developed to address patients' needs associated
with each stage.
Denial, the first response after receiving the report of impending death,
gives the patient time to collect himself. Denial is then replaced with
anger, the second response. In this stage, the anger may be projected onto
other people. The third stage, bargaining, reflects an attempt to postpone
death in exchange for some sacrifice by the patient. This stage may help
the patient resolve feelings of guilt (Kubler-Ross, 1969). Depression, the
fourth stage of this process, occurs when the feelings of numbness and
anger are replaced with a sense of great loss. Kubler-Ross (1969) has
distinguished between reactive depression and preparatory depression:
reactive depression occurs as a result of a past loss, preparatory
depression is taking into account impending losses. This preparatory
depression is necessary if the patient is to die in a stage of
acceptance. Kubler-Ross felt that only patients who have been able to
work through their distress and anxieties are able to achieve this last
stage. Finally, Noyes (1971), added to Saunders' and Kubler- Ross' work
with thanatological research of near death experiences. He identified
three, instead of five, successive stages of dying: resistance,
life-review, and transcendence. The resistance phase was characterized by
recognition of danger, fear of dying, struggle to live, and finally,
acceptance of death. Next came life-review, a condensed replay of one's
life. The final stage, transcendence, was characterized by a mystical
state of consciousness, analogous to Maslow's peak experience (Noyes,
1972). A peak or mystical experience occurs when personal boundaries are
dissolved and one feels a sense of becoming one with other people,
nature, the entire universe, and God (Grof, 1990). Other published
reports of near-death experiences and mystical, psychedelic states of
consciousness resembling death, provided an additional impetus for change
by making death experientially possible (Ring, 1988). Noyes (1972) noted
that persons who have experienced these states naturally or artificially
have expressed what happens to them in terms of death and rebirth. This
death-rebirth experience provides Western culture with an analogy to the
symbolic, transformational death of pre- industrial cultures, and thus a
way to accept death by experiencing it symbolically.
Western society's denial of death began to change with the publication of
books and studies on dying by Saunders, Kubler-Ross, and Noyes. This
information helped shift the Western view of death away from denial
towards acceptance. The next chapter examines the treatments used with
the terminally ill.
Current Treatment for the Terminally Ill
More than 80 percent of the people in the United States die in
institutions, thus making the medicalization of death inevitable (McCue,
1995). This chapter describes the current treatment for the terminally ill
as a result of this trend. Physicians tend to be disease-oriented in their
approach with the terminally ill (Heinemann, as cited in Goldberg,
Malitz, and Kutscher, 1973). Psychotherapists tend to focus on helping
the patient cope with the disease (Weisman & Sobel, 1979). This
separation of care leads to the patient being over or under medicated
(Munley, 1983). Klerman suggested that the prescription of psychotropic
drugs was determined by the physician's desire to avoid the patient (as
cited in Goldberg, et al.). This disease-oriented approach leads to
pharmacologic intervention for the pain (Foley, 1985), anxiety, and
depression (Breitbart, 1989) associated with terminal illnesses,
Pharmacologic interventions for pain relief include non-narcotic and
narcotic drugs (Foley, 1985). Foley listed non-narcotic analgesics (e.g.
aspirin and acetaminophen) for mild to moderate pain, and narcotic
analgesics (e.g. codeine and morphine) for acute pain. Shapiro (as cited
in Goldberg, et al. 1973), suggested the use of minor tranquilizers (e.g.
meprobromate) for anxiety, and antidepressants (e.g. tricyclics and
monoamine oxidase inhibitors) for depression. Psychotherapeutic
interventions for coping with a medical disease tend to deal with
immediate problems. For example, cognitive-behavioral therapy,
hypnotherapy, and relaxation/imaging techniques may be introduced to help
ease the pain (Breitbart, 1989).
In 1995, a study identifying patient preferences for end of life care was
completed. The Study to Understand Prognoses and Preferences for Outcomes
and Risks of Treatments (SUPPORT) examined the care and treatment of
9,105 terminally ill patients. This was a two phase study: Phase I was
observational, Phase II was an intervention to correct deficiencies noted
in Phase I. Based on the results from the first phase, a specially
trained nurse was assigned to each terminally ill patient to facilitate
communication between physician, patient, hospital personnel and family.
Information regarding patient and family preferences, understanding of
outcomes, and advance care planning was available on an as needed basis
to all involved. No improvement in care was seen in Phase II of this
study (Support Principal Investigators, 1995). Pain was also reported as
moderate to severe for half of the patients who were able to communicate
in their last few days. Apparently, increased attention to the
physiological components of dying did not improve the quality of death.
It can be inferred that the treatment of the physiological dimension of
dying as a disease-related event and the psychological aspect as a pain
reduction method leaves out the personal and spiritual dimension of dying
(McCue, 1995). Kubler-Ross equates the peaceful, spiritual part of death
to feeling a sense of history - that one is part of what has come before
and part of what is yet to come (Kubler-Ross, 1975).
Prior to the Western industrial revolution, religion provided this sense
of history in the form of a spiritual reality. Affirmation of this
spiritual reality stressed the subjective inner experience, rather than
the manipulation of the external world. Religion went from being an
endogenous experience to an exogenous experience along with the
accumulation of wealth, admiration of science and control of nature
The focus on prolonging life without nurturing personal growth does not
make dying less painful, as the SUPPORT study clearly shows. Richards
(1975) noted that physical pain is lessened when areas of psychological
pain are confronted and resolved. Kubler-Ross (1975) advised that by
transcending one's individual existence and becoming at one with yourself
and others, death can be a growing experience. The pharmacologic and
psychotherapeutic treatments just described primarily treat the
physiological and psychological effects of disease. Hospice and palliative
care treatments, however, can include these interventions but focus on
the patient rather than the disease (National Hospice Organization [NHO],
Hospice care refers to care provided to the terminally ill with a life
expectancy of six months or less, and began in the U.S. in 1974 (Rhymes,
1996). The National Hospice Organization describes hospice as a concept of
humane, compassionate, and palliative care which can be implemented in a
variety of settings (NHO, 1996).
Palliative care regards dying as a normal process and neither hastens nor
postpones death. It focuses on symptom relief and integrates
psychological and spiritual aspects into patient care. Palliative care
also offers a support system for the patient and family (World Health
Organization [WHO], 1990).
Palliative and hospice care is necessary for the humane care of dying
patients, but is poorly integrated into routine medical settings (Rhymes,
1996). There is a need for a brief therapeutic method that is consistent
with the philosophy of palliative care and can integrate well in various
settings. Chapter 3 traces the development of a brief, psychedelic-
assisted method of treating the terminally ill consistent with palliative
The Use of Psychedelics in Treating the Terminally Ill
Ancient or pre-industrial cultures have used hallucinogenic plants for
healing, religious rites, and for death-rebirth experiences (Schultes &
Hoffman, 1979). This symbolic death was offered as a core experience of
shamanic initiation and rites of passage, resulting in spiritual opening
and insight into the transcendent nature of human consciousness (Grof,
1980). Hallucinogenic plants have been used in death-rebirth experiences
for thousands of years by shamans who either ingest the plants
themselves, or supervise its use by a client (Grinspoon & Bakalar, 1983).
In contemporary times, these hallucinogenic plants have been synthesized,
and psychoactive ingredients isolated and evaluated by Western scientists
and psychiatrists. The hallucinogenic plants which have been synthesized
include: rye fungus (from which lysergic acid diethylamide, LSD, is
derived), the psilocybin mushroom (psilocybin), and the peyote cactus
(mescaline) (Weil, 1983). Since their discovery, the synthetic versions
of hallucinogens have been used for their psychotomimetic properties,
including the production of states of temporary psychosis (Osmond, 1957).
Mental health professionals have been able to familiarize themselves with
temporary psychotic states through didactic LSD experiences. In addition,
the pharmacology of these substances was also thought to provide the
chemical explanation for endogenous psychosis, as the chemical structure
of these substances has been found to be closely related to the chemical
structure of neurotransmitters found in the human brain (Restak, 1994).
This also explains why moods and emotions are impacted by psychedelics.
The term "psychedelic" is interchangeable with "hallucinogen" throughout
Grinspoon & Bakalar (1983) described hallucinogens as non-addicting
psychopharmacological agents that produce changes in thought, mood, and
perception. These changes are similar to those experienced in dreams,
religious exaltation, flashes of vivid involuntary memory and acute
psychosis. The emotional effects of psychedelics are more profound than
the perceptual ones. Everything in the field of consciousness assumes
importance and feelings become magnified. Forgotten incidents from the
past are sometimes retrieved and relived. Loss of self by ego dissolution
is not uncommon, sometimes in the form of a death-rebirth. In some cases,
the experience culminates in a peak, mystical experience that is
boundless, timeless, and ineffable. The nature of the psychedelic
experience is dependent on individual set and social setting (Grinspoon &
Strassman (as cited in Pletscher & Ladewig, 1994) has suggested that the
most useful classification of hallucinogens is in the context of their
time course, notably onset, peak effect, and duration of action. In
general, short-acting hallucinogens have an onset between 15 to 30
minutes, peak effects between 30-90 minutes, and duration between one and
three hours. Dipropyltryptamine(DPT) and Methylenedioxymethylamphetamine
(MDMA) are examples of this category. In contrast, intermediate-acting
hallucinogens have an onset of 30-60 minutes, peak effects at 2-3 hours,
and duration of 4-6 hours. An example of such an hallucinogen is
psilocybin. Finally, long-acting hallucinogens have an onset of 30-90
minutes, peak effects occur within 3-5 hours, with a duration of 8-12
hours. LSD and mescaline are examples of this category.
Early research with psychedelics focused primarily on LSD, the most potent
of the hallucinogens. Bush and Johnson (1950) administered LSD to eight
cases of psychoneuroses to induce a chemical shock, similar to
Electroconvulsive Therapy. They concluded that LSD offered an expedient
way to gain access to the chronically withdrawn patient, and could be used
as an adjunct to psychotherapy. In 1953, Sandison opened the first LSD
clinic at a small mental hospital in England. He and his colleagues
published their preliminary findings in 1954. Thirty six mentally ill
patients with diagnoses ranging from obsessive reactions to schizoid
personality were given small doses of LSD, starting at 25 mcg. and
increasing dosages incrementally until there was a reaction. Fourteen
patients recovered and three showed moderate improvement. Sandison and his
group concluded LSD to be more effective when used as an adjunct to
psychotherapy (Sandison, Spencer, & Whitelaw, 1954). They felt that LSD
therapy works best with obsessional and anxiety groups. In a subsequent
study from the clinic, Sandison and Whitelaw (1957) examined 94
psychiatric patients treated with LSD, including 30 of the orginal 36.
They reported that 65% were considered to be recovered or improved.
Sandison and Whitelaw concluded that LSD treatment shortened the time
necessary for a full psychological analysis. After nearly a decade of
research, LSD and other hallucinogens came to be used more as adjuncts to
psychotherapy than as psychotomimetics. Osmond (1957) successfully
treated chronic alcoholics with LSD and coined the term psychedelic, or
mind-manifesting to describe this change in therapeutic use. The term
"psychedelic therapy" was then used to describe Osmond's method of
administration of high doses of LSD (300 mcg. or more) sometimes in
conjunction with other hallucinogens at one, or if necessary, two or
three sessions of therapy. The theory underlying this approach is that
providing a single, overwhelming and profound experience can result in a
personal change that will continue in the following months and years
(Sherwood, Stolaroff & Harman, 1962).
Sandison coined the term psycholytic therapy to designate the
administration of moderate doses (75-300 mcg.) of LSD at one to two week
intervals, for an average of 40 sessions. This treatment method represents
an extension and modification of psychoanalytically oriented
psychotherapy Traumatic experiences from childhood are relived, with
emphasis on emotional abreaction and integration resulting in valuable
insights (Grof, 1980).
Sherwood, et al., (1962) detail their procedure and results of
psychedelic psychotherapy on 25 patients at an outpatient clinic. An
autobiographical review in the context of the patient's life philosophy
and hierarchy of values preceded the psychedelic session by a period of a
few weeks or months depending on the individual patient's needs.
Experiential training in altered states of consciousness also preceded
the psychedelic session by the inhalation of a 30% carbon dioxide -70%
oxygen mixture. This rendered a didactic experience by providing
ventilation and abreaction. An LSD dosage of 100-200 mcg., was
administered, followed by 200-400 mcg. of mescaline, after a thirty
minute interval. The psychedelics were administered orally in a
non-clinical setting. An additional 100-200 mcg. of LSD was added a few
hours later if needed. The results were measured by the degree to which
the presenting problem was resolved; out of 25 patients, 4 reported no
improvement, 9 reported improvement, and 12 reported much improvement.
The experiential training preceding actual therapy along with the emphasis
on a non- clinical setting, made this study significant. The researchers
noted the transcendent mystical nature of the psychedelic session and its
effect on the patient. Savage, Savage, Fadiman, and Harman (1964)
corroborated the therapeutic methodology of Sherwood, et al., (1962).
They also developed a questionnaire to quantify the negative and positive
therapeutic effects of psychedelic therapy. Based upon the retrograde
assessment of 113 patients in the first group, 83% of the respondents
reported lasting benefits from psychedelic therapy. These reported
benefits included: increased ability to love, handle hostility,
communicate and to understand self and others. Improved relations,
decreased anxiety, increased self-esteem and a new way of looking at the
world were also reported. Savage et al., reported that for the second
group of 74 patients, 46% showed moderate or marked improvement, 35%
showed minimal improvement, 18% showed no change, and 1% was reported as
worse. From these results they concluded that post-LSD changes included
elevated mood, increase in extroversion, decrease in compulsive habits,
somatic complaints, and anxiety symptoms.
Both the Sherwood et al., and the Savage et al., studies noted that a
number of patients reported that they had overcome their fear of death.
Sherwood et al., reported that a 34 year old female stated that the
psychedelic experience made her view death as another level of reality.
The use of psychedelics to aid the dying resulted from the work of Kast
and Collins (1964). They became interested in LSD when they learned it
produced a marked distortion of the body image, altered body boundaries
and interfered with the ability to concentrate. These observations led
Kast and Collins to hypothesize that LSD could alter the perception of
physical pain. In a comparison of LSD, Demeral, and Dilaudid, they found
that the analgesic effect of LSD was superior to either of the two
analgesics. In addition, Kast and Collins observed that some of the
patients also showed a striking disregard for their impending death as a
side effect. Kast (1966) then went on to explore the effects of
intramuscular injections of 100 mcg. of LSD on 80 terminally ill
patients. A reduction of physical pain, in addition to a positive effect
on mood and sleep were noted. Kast felt that a certain change in
philosophical and religious attitudes took place that is not reflected in
numerical data and graphs. He noticed improved communication on the part
of the patient and the occurrence of happy, oceanic feelings lasting up
to twelve days. This was the first time an association was noted between
a transcendent experience and the relief of physical and emotional pain.
In a final study, Kast (1967) examined the effects of LSD on sleep
patterns, emotions, and attitudes toward illness and death. In this
study, the 128 patients used had severe metastic cancer and were given
100 mcg. of LSD orally. Pain decreased substantially for many in the group
and lasted an average of twelve hours. In addition, pain intensity for
the entire group decreased for a period of three weeks with concurrent
improvement of sleep and less evidence of concern about the terminal
Other researchers reported LSD's effect on the dying. Fisher (1970), for
example, published a paper emphasizing the significance of spiritual,
spontaneous, or psychedelic transcendental experiences in preparation for
death. These experiences helped the individual see death as a part of the
life cycle. Fisher discussed LSD therapy within the framework of a
research project comparing LSD to an experimental analgesic. He observed
dramatic results in pain reduction, psychological aftereffects and
adjustment to death. Kast's work showed up in a literature search
initiated by a member of the Spring Grove State Hospital's psychiatric
staff who had metastic cancer. The psychiatric unit was researching
brief, but intensive LSD psychotherapy at the time. She was granted an
LSD session and experienced a psychedelic, peak experience, which
relieved her depression and anxiety. The dramatic success led to an
expansion of the program to include the treatment of terminal cancer
patients (Pahnke, Kurland, Unger, Savage, & Grof, 1970). The following
studies represent a decade of research at Spring Grove, which later
became the Maryland Psychiatric Research Center (MPRC), using a form of
psychedelic psychotherapy with the terminally ill. These studies were the
largest, most sustained and systematic study of psychedelic psychotherapy
yet attempted (Yensin & Dryer, as cited in Schlichting & Leuner, 1995).
Pahnke, Kurland, Goodman, and Richards (1969) used 200- 500 mcg. of LSD on
22 metastic cancer patients. The results showed improvement in 14
patients, with 8 unchanged. Decreases were shown in depression, anxiety,
and fear. Pahnke, Kurland, Unger, Savage, Wolf, and Goodman (1970)
studied the effects of 200-300 mcg. of LSD on six metastic cancer
patients. Overall, they noted a decrease in the need for pain medication
and improvement in global change for all of the patients. This global
score was based on ratings for the patients on such areas as depression,
psychological isolation, anxiety, difficulty in management for all
physical complaints, tension, and pain.
Pahnke, Kurland, Unger, Savage, and Grof (1970), described the
psychedelic therapy administered at the Maryland Psychiatric Research
Center (MPRC) as psychedelic peak therapy. The immediate goal of such
therapy was to achieve a peak or transcendental experience using a high
dose of psychedelics, usually 350-450 mcg. Intensive psychotherapy prior
to, and for weeks following the psychedelic drug session distinguishes
psychedelic-peak therapy from psychedelic therapy. The preparatory
psychotherapy focused on psychodynamic resolution and self-understanding,
and averaged about 20 hours per patient.
The MPRC researchers found that the setting had a profound effect on the
nature and outcome of the psychedelic peak psychotherapy session (Bonny &
Pahnke, 1972). The following is a description of the Protocol used at the
MPRC. The room used for the session was furnished like a living room,
with a couch and music provided. A music therapist was often present
during the session. Music complemented the therapeutic objective by
helping channel effective expression, facilitate relaxation, and provide
a sense of continuity during the various stages of consciousness
alteration facilitated by psychedelics. Quiet, reassuring music was
played until the effects of the drug were felt. During this time, the
therapist spoke with the patient about his expectations from the session.
Once the drug effects were felt, the patient was directed to lie down on
the couch, and was given eyeshades and a stereophonic headset in order to
better focus on the inner experience. The music therapist then chose
selections corresponding to the patient's psychological state in order to
facilitate a peak experience. At intervals during the session, the
eyeshades and headphones were removed in order to give the patient an
opportunity to verbalize any thoughts or feelings he cared to
communicate. The patient's psychiatric nurse and therapist were also
present throughout the entire period of drug action. During the immediate
post drug period, and for weeks afterward, psychotherapeutic work was
continued by the therapist. The researchers claimed 68% of the patients
who received a total of 450 mcg. of LSD achieved a peak experience (Bonny
& Pahnke, 1972).
Richards, Grof, Goodman, and Kurland (1972) administered 200-500 mcg. of
LSD to 31 cancer patients. The dosage was determined on the basis of the
patients psychological defenses and body weight. The results showed 9
patients dramatically improved, 13 moderately improved, and 9 essentially
unchanged based on an expanded version of the global index cited in
Pahnke, Kurland, Unger, Savage, Wolf, and Goodman (1970). In addition to
the original categories, three more were developed. These included denial
of the imminence of physical death, fear of death, and preoccupation with
pain and physical suffering. Twenty-five percent of the patients had peak
experiences and less fear of death afterwards.
Richards et al. (1972), studied the psychedelic DPT, a shorter acting drug
with properties similar to LSD. They were interested in DPT because it was
more convenient to use than LSD, which demanded a considerable commitment
of time. In contrast to LSD, DPT's duration of action is 1 1/2 to 6
hours, depending on dosage. Its effects terminate quickly, unlike the
wavelike termination period of LSD. Moreover, patients often reported
more energy after the session because of DPT's properties. Two studies
examined the effects of DPT in lieu of LSD.
Richards, Rhead, DiLeo, Yensen, and Kurland (1977) administered 75-127.5
mg. of DPT intramuscularly to 34 cancer patients who had received an
average of 20.5 hours of therapy during the preceding month. Following
the protocol used by Bonny and Pahnke (1972), Richards et al., examined
whether the patients experiencing a peak experience showed greater
clinical improvement than the group of non-peakers. To assess improvement,
two psychological tests, the Personal Orientation Inventory (POI) based
upon Maslow's concept of the self-actualizing person and the Mini-Mult,
an abbreviated form of the MMPI, were administered. In addition,
interviewers using the Brief Psychiatric Rating Scale assessed
psychological distress. Additional psychological inventories and the
interviews were used to assess clinical improvement in the patients. The
Psychedelic Experience Questionnaire (PEQ) and the Peak Experience Rating
Form (PERF) determined whether the patient had a peak experience as
defined by Pahnke and Richards (1966). The results indicated a greater
magnitude of clinical improvement for those experiencing a peak
experience than those who did not.
Richards, Rhead, Grof, Goodman, DiLeo and Rush (1979) quantified the
clinical improvement brought about by DPT- assisted psychotherapy with 30
cancer patients. Psychotherapeutic procedures utilized the same protocol
as those used in Richards (1975). The patients showed a decrease in
depression, anxiety, hysteria, paranoia, hypomania, and schizophrenic
qualities in the Mini-Mult after DPT-assisted therapy. Post therapeutic
results on POI variables showed the patients were living in the present
rather than the past, were more assertive and confident, had increased
feelings of self worth and acceptance, and had a greater capacity for
>From these results, Richards, Rhead, Grof, et al., concluded that DPT was
a better psychedelic alternative than LSD. Their only caveat, however,
was that the rapid onset of DPT increased the role of the therapeutic
relationship. Because the patient encountered potent psychological
material within ten minutes of DPT administration, as opposed to two
hours or more with LSD, the therapist had to be skilled in averting any
panic or paranoid reactions. According to Yensen and Dryer, the studies at
MRPC ended in 1976 due to political pressure (as cited in Schlichting &
Leuner, 1992). This was due to enactment of the Comprehensive Drug Abuse
Prevention and Control Act of 1970 which had made psychedelic research
difficult, particularly in light of its shift in emphasis on drug abuse
(Grinspoon & Bakalar, 1979). As a result, psychedelic research declined
in the U.S. (Lukoff, Zanger & Lu, 1990).
In spite of this emphasis on drug abuse research, several of the MRPC
researchers continued their psychedelic research and continued to publish
papers supporting it. For example, Yensen (1985) continued his study of
this area, advancing the proposition that LSD was a non-specific catalyst
of mental activity with a broad range of applications. Moreover, he
recommended the use of psychedelic treatments with terminal cancer
patients. Similarly, Kurland (1985) summarized the MPRC work in terms of
peak experience. As a result of such efforts, he proposed a positive
relationship between peak experience and successful reduction of death
fears accompanied by a relief of their depression, isolation, and sense of
alienation. From his work, Kurland estimated that one third experienced
such reactions. Another third of the terminally ill patients felt an
effect, but did not obtain significant relief. The remaining were
non-peakers who were neither helped nor harmed by the experience.
In contrast to its decline in the U.S., psychedelic psychotherapy
continued to flourish in Europe through the 1980's. Most of the research,
however, was done in private practice and if reported, was published in
the form of anecdotal clinical case studies. Bastiaans used LSD assisted
psychotherapy in Holland until he retired in 1988. Leuner utilized LSD,
ketamine, and non-scheduled MDMA analogues in psycholytic therapy in West
Germany until his death in 1996. In 1988, the Swiss government issued
five year licenses permitting MDMA, psilocybin, and LSD assisted
psychotherapy by certain members of the Swiss Physicians Association for
Psycholytic Therapy (Lukoff et al., 1990). In the United States, MDMA, a
short-acting hallucinogen, became the focus of limited psychedelic
research until it was listed as a Schedule I drug in 1985 (Lukoff et al.,
1990). MDMA is a relatively mild, short-acting drug which gives a
heightened capacity for introspection, intimacy, and self disclosure. It
does not produce the perceptual changes of LSD, and relieves anxiety and
depression (Grinspoon & Bakalar, 1986).
Greer, a psychiatrist, and his wife Tolbert, a psychiatric nurse, used
MDMA in their private practice before MDMA became a Schedule I drug. Up
until that time, California law permitted use of drugs not commercially
available if the drug was manufactured by a physician or pharmacist (Greer
& Tolbert, 1986). They administered oral doses of 75-150 mg. of MDMA to
29 subjects in their respective homes. These subjects were referred by
their psychotherapists for an MDMA session. Eyeshades and headphones were
used to facilitate an inner experience. When the effect of MDMA began to
subside, the subjects were offered a second dose of 50 mg. to prolong the
session and provide a gradual re-entry. Every subject was reported as
having experienced some benefit from the MDMA session, with 55% reporting
they had realized the purpose or goal they had established prior to the
session. Five subjects (17%) also reported a change in their attitude
towards death. The researchers concluded MDMA was physically safe for all
participants and is best used to facilitate communication between people
involved in a significant relationship. Greer & Tolbert (as cited in
Peroutka, 1990) administered 75-150 mg. of MDMA to 80 people with dosages
proportionate to the depth of the experience sought. If an individual
wanted to focus his attention internally, a larger dose was used. If a
couple wanted to spend time together, a smaller dose was used. Eyeshades
and music were provided. Psychotherapeutic interaction was not initiated
during the session unless requested, so as not to dilute the inner
process. After one-and-a half hours, patients were offered an additional
50 mg. to extend the peak experience and make re-entry more gradual. After
the MDMA state passed, the researchers spent one to three hours helping
integrate the experience. Total time spent with the patient was six to
eight hours. Approximately 90% of the patients had positive and useful
Greer and Tolbert (as cited in Peroutka, 1990) concluded that under the
right circumstances, MDMA decreased the fear response to a recognized
threat to a patient's emotional balance, leading to a corrective feeling
that diminishes earlier, traumatic experiences. The learning that took
place during the session was easily consolidated into a patient's life
because MDMA does not distort perception, thinking, or memory in the
dosages administered. A case study was reported of a terminal cancer
patient who was better able to cope with his pain and adjust to his
current life changes due to four MDMA sessions. Greer and Tolbert (as
cited in Peroutka, 1990) explained the effect of these sessions: "... his
ability to hypnotically re-anchor his pain-free experience greatly
assisted him in reducing the pain by himself" (p.30). The scheduling of
MDMA in 1985 effectively stopped psychedelic research. In fact, Greer was
even denied FDA approval to continue his treatment of a terminal cancer
patient in 1986. Subsequent applications to the FDA to study MDMA in
humans were denied on the basis of neurotoxicity. The Multidisiplinary
Association for Psychedelic Studies (MAPS) and the National Institute on
Drug Abuse (NIDA) then embarked on a series of toxicity studies, that
resulted in FDA approval of a Phase I (safety) study of MDMA in a healthy,
normal population in 1992. The results suggested that MDMA could safely
be administered to humans in the context of research (MAPS, personal
communication, April 9, 1997). In 1996, Grob and Poland received private
funding to proceed on an FDA approved protocol design for a study
investigating the use of MDMA in the treatment of pain and psychological
distress in end-stage cancer patients. The FDA approved the safety
studies which preceded the research because the studies used volunteers
with prior drug experience (C. Grob, personal communication, April 8,
1997). The researchers speculate MDMA will prove useful as an adjunct to
pain reduction, as a treatment of anxiety and depression, or as a tool to
facilitate stimulation of the immune system (Doblin, 1996).
Twelve subjects, all screened and referred by their oncologists, will
participate. The subjects will be trained in a guided imagery technique
designed to reduce physical pain and psychological distress. They will
receive four sessions of MDMA, separated by two to four weeks within a
structured setting that includes guided imagery exercises. The
population will be selected for their desperate life circumstance (Grob,
1995). Grob's study also provides a protocol for future psychedelic
research because of the methods he will use to evaluate safety and
efficacy. First, this study will assess MDMA'S safety utilizing a
battery of neuropsychological tests. Pharmacokinetics, along with organ
and immune system function will be assessed by blood workups before,
during, and after specified sessions. Acute psychological effects will be
measured through the use of the Brief Profile of Mood States -SR
(POMS-SR) and the State-Trait Anxiety Inventory (STAI). The
Hallucinogenic Rating Scale (HRS) will also be administered (Grob, 1995).
Second, efficacy will be evaluated through the use of the McGill Pain
Questionnaire, Dallas Pain Questionnaire and the Memorial Sloan Kettering
Pain Card. Pain medication will also be monitored. Psychological treatment
efficacy will be measured through a battery of standardized tests.
Finally, immune system function will be evaluated by measuring tumor
size, location and the immunoglobulin antibody, Ig A. This protocol
design and subsequent approval process is scheduled for completion before
the summer of 1997. The design of this research and subsequent results
should help move psychedelic-assisted psychotherapy into mainstream
psychology. At present, this is the only ongoing research in the use of
psychedelic assisted psychotherapy with the terminally ill in the United
States due to continued emphasis on drug abuse research. However, Grob
has indicated that although there has been a policy shift by the FDA,
getting permission to use a psychedelic treatment model with a clinical
population has not been approved in twenty-five years (C. Grob, personal
communication, April 8, 1997). Any future psychedelic research should use
Grob's pilot as a model for comparison to facilitate FDA approval.
Achieving a balanced perspective about psychedelic drugs is difficult.
The way psychedelics are currently used and viewed make them a medical,
legal, and philosophical problem in Western society.
Evaluating psychedelics as drugs forces them to be viewed in the same
context as aspirin or antibiotics. The model for this evaluation is
Western physical medicine which looks to drugs to relieve a simply
defined problem, and be able to demonstrate this in drug studies. Drug
studies usually involve double blind experimental procedures to be able
to separate the effects of the drug from any preconceptions on the part
of the subject or experimenter (Reber, 1985). The psychological effects of
psychedelics, however, are so dramatic that it becomes apparent as to
which subject received the psychedelic and which received the placebo
(Lukoff, Zanger & Lu, 1990). Based on the Western medical paradigm,
anything called a drug must be simple medicine or a drug of abuse. Since
psychedelics are not simple medicine, they must therefore be drugs of
abuse (Grinspoon & Bakalar, 1986). The categorization of psychedelics as
drugs of abuse, places them in a Schedule I category by the Comprehensive
Drug Abuse Prevention and Control Act of 1970. This category is for drugs
having a high potential for abuse, no current medical use, and a lack of
safety for use under medical supervision (Grinspoon & Bakalar, 1979).
This legislation severely restricts experimental and therapeutic research.
The irony of this legislation is that the uncontrolled use of
psychedelics continues, while controlled legal use has become almost
The FDA under the current Democratic administration has permitted a
limited number of studies investigating the beneficial use of
psychedelics, in addition to the ongoing MDMA study (Heffter Research
Institute, 1996). Funding for such research is difficult due to other
priorities and the assumption that this research will foster the illegal
use of drugs. The current controversy over medical marijuana illustrates
how difficult it is to separate politics and research. This has not
stopped psychedelic research from continuing in private practice,
however, and the results disseminated through various publications and
conferences such as the International Congress of the European College
for the Study of Consciousness (ECSC). In addition, the founding of
(MAPS) allows people to contribute funds toward government approved
psychedelic research. This organization provides the "seed money" to
initiate research and generate outside interest and funding (Stafford,
1992). This is a slow process that discourages all but the most
persistent of researchers. Western society and philosophy is also uneasy
about experiences we can't quickly classify. Psychedelic experiences are
not easily classifiable and can blur the distinction between religious,
medicinal, and recreational activities (Grinspoon & Bakalar, 1986). Ring
(1988) suggested that psychedelic drugs can induce a genuine mystical or
religious experience. Pahnke proved this in 1964, by administering
psilocybin to ten theology students and a placebo, nicotinic acid, to 10
control subjects. Both groups listened to the same Good Friday service and
had their written reports of the experience evaluated afterwards. Pahnke
concluded that the mystical experiences reported by both groups were
indistinguishable from each other (as cited in Ring, 1988). The medicinal
use of LSD for pain reduction was explored by Kast (1964, 1966, 1967).
Weil (1972) explains the recreational use of psychedelics as due to an
innate drive to alter one's consciousness and escape from ordinary waking
Achieving a balanced perspective about psychedelics is indeed difficult
with the lack of information available. The problem is not so much how to
get these drugs off the streets, but how to get them back in the
laboratories, hospitals, and other supervised settings (Grinspoon &
Bakalar, 1986). The future of psychedelic research will be determined by
the results of the limited number of studies now under way and how the
media presents these results. To accomplish an unbiased presentation of
the results, the politics must be taken out of scientific research.
Proposed Model of Psychedelic-Assisted Psychotherapy with the
The proposed model of psychedelic assisted psychotherapy will use a
modified form of the psychedelic peak format developed at the Maryland
Psychiatric Research Center (Kurland, 1985). The terminally ill, e.g.,
cancer patients, who are aware of their prognosis, have approximately
three months to live, and have an open mind to psychedelics would most
benefit from this model. The attending staff would be the psychedelic
therapist, psychiatric nurse, and a doctor (on call). DPT will be the
psychedelic drug used, due to quick onset of action and re-entry. The
psychedelic therapist should be familiar with DPT's effects
experientially, physiologically, and psychologically. This protocol
could be used in various settings, hospital, institutions, or the patient's
There will be three phases of therapy: preparation, psychedelic
intervention, and integration. The total treatment period is
approximately four weeks. The preparation phase occurs the first week. It
consists of two sessions: the first session is an exploratory session
with the patient, the second session is with the family. The first meeting
between the therapist and the patient lasts about three hours. At this
initial session, the therapist guides the patient through the unresolved
issues in his life. No major effort is made to explore deep conflict
material. The session ends on a philosophical note, with the therapist
summarizing the session in terms of the patient's life philosophy. The
family attends the second session where any family issues outstanding from
the first session are discussed.
The second week of treatment consists of familiarizing the patient with
altered states of consciousness. Total psychological surrender to the
experience is emphasized with experiential training using the inhalation
of a 30% carbon dioxide - 70% oxygen mixture. This will provide
ventilation and abreaction. Eyeshades are used to eliminate visual
distractions. Instrumental, relaxing music will be provided through the
headphones. In addition to eyeshades and music, the choice of an aromatic
oil will be offered to the patient, to be diffused in the room. This
aromatherapy should stimulate the limbic system to release emotions and
memory (Jacobs, 1996). The therapist will emphasize the importance of
the patient allowing himself to feel and experience everything that
The psychiatric nurse will attend this session. This same nurse will be
present at the psychedelic session. The patient will be reclining on a bed
or comfortable sofa depending on his physical limitations. If the setting
is institutional, the room should be as comfortably furnished as possible
with emphasis on a living room type setting. Significant art work or
family photographs can be used based on the patients needs. If the
patient is anxious, guided imagery will be introduced to help the patient
relax and go with the experience. A second session is set up at the end
of the second week to go over the altered state experience. The patient is
assessed at this session for resistance to altered states and ease of
surrender to the experience. There are three categories of resistance/ease
with corresponding DPT dose: flexible (75 g.), resistant (100 g.), and
rigid (125 g.). All tranquilizing medicine is stopped the second week.
Medication pertaining to the maintenance of the physical state is
The psychedelic intervention session is held early in the third week. The
therapist and psychiatric nurse will be present with a doctor on call
should an emergency arise. A light breakfast will be served, with any
last minute questions or concerns discussed immediately following
breakfast. The patient then receives an intramuscular shot of DPT,
according to the assessed dosage. Relaxing music provides the background,
along with the diffusion of the patient's choice of aromatic oil. The
patient is encouraged to adopt a meditative state without focusing on any
one thought during the latency period.
Once the effects of the drug are felt, the patient reclines and puts on
the eyeshades and headphones. Cathartic music characterized by insistent
rhythms and dynamic crescendos is used. Examples of this would be
Bernardo Rubaja's New Land and Pat Metheny Group's Off Ramp. At the
peak, uplifting lyrical music with slower rhythms such Enya's The Memory
of Trees and Steve Halpern's Comfort Zone would be appropriate. The music
serves to direct and structure the psychedelic session.
At the halfway point (approximately 1 1/2 hours), the patient's eyeshades
and headphones are temporarily removed, so the condition of the patient
can be checked on. If the patient needs an additional shot of DPT to
peak, another 50 g. is injected at this point. If there are no
complications, the session continues as described until the drug wears
off. The music is changed to relaxing music as the peak diminishes. The
therapist spends the first two hours after re-entry going over the
material that surfaced with the patient. The family then joins the patient
for an early dinner with the therapist in attendance. If there are some
immediate family issues that need to be addressed, the therapist assists;
if there are no issues, the session ends and the patient is free to go to
The next day the patient is contacted to set up a final counseling
appointment. This can be done during the remainder of the week. At this
session, the results of the psychedelic experience are compared with the
issues addressed during the first week.
If the patient requests another session, one is scheduled eliminating the
two week preparation phase. Instead, a pre-psychedelic session is held a
few hours before DPT administration. Unresolved issues are noted and the
session begins once the patient feels ready. Re-entry and integration take
place without family members, unless the patient requests their presence.
The therapist will continue to check on the patient during the remaining
weeks or months. A mutually comfortable interval is established for
psychotherapeutic sessions where the patient can continue to integrate
the material uncovered throughout the psychedelic session(s). This
continues until it is no longer needed or no longer possible.
The proposed model of psychedelic assisted psychotherapy elevates dying
from the purely physiological to a more conscious and spiritual process,
as Huxley suggested: "...the living can do a great deal to make the
passage easier for the dying, to raise the most purely physiological act
of human existence to the level of consciousness and perhaps even of
spirituality" (cited in Grof & Halifax, 1977). Psychedelic psychotherapy
attempts to facilitate a peak, mystical experience resulting in a more
peaceful, conscious, and spiritual death. The accompanying psychotherapy
confronts and resolves issues, which in turn lessens the physical pain
(Richards, 1975). The effects of DPT also allow the patient to shift his
focus away from pain, thus reducing the use of sensorium dulling
The proposed model also fits into the palliative care model: it helps in
control of pain, other symptoms, and control of psychological, social, and
spiritual problems (WHO, 1990). Psychedelic psychotherapy could be a
palliative care option for those who chose it.
The problem with the model as proposed, is that there is not enough
current research available upon which to base a more complete model of
psychedelic assisted psychotherapy. Each psychedelic has different
properties that may lend themselves to different personalities, but at
this time DPT is the only non scheduled psychedelic which has been used to
treat the terminally ill (MAPS, personal communication, March 18, 1997).
In addition to the scheduled drugs, there other short acting "designer"
psychedelics that could provide all the positive aspects with minimal
side effects. CZ-74 (a psilocybin derivative) and LE-25 (a phenethylamine)
are examples of this (Passie, cited in MAPS, 1996-97).
The association of dying with the failure of Western medicine makes death
into a purely physical event. Dying then becomes a difficult and painful
experience both emotionally and physically. Western society has the means
to make the passage easier for the dying using psychedelic assisted
Over forty years of research using psychedelics with the dying has shown
positive changes in the emotional symptoms of dying and pain reduction.
Patients who had peak experiences also showed a decrease in the fear of
death. In this context, death is not the enemy of Western medicine,
Psychedelic-assisted psychotherapy can help dying be of more than medical
significance. This relatively short and effective therapy can help
alleviate the emotional and physical distress of dying.
- Bonny, H., & Pahnke, W. (1972). The use of music in psychedelic (LSD)
psychotherapy. Journal of Music Therapy, 9, 64-87.
- Breitbart, W. (1989). Psychiatric management of cancer pain. Cancer, 63,
- Busch, A.K., & Johnson, W.C. (1950). LSD-25 as an aid in psychotherapy.
Diseases of the Nervous System, 11, 241-243.
- Doblin, R. (1996). An invitation for dialogue. Maps, 6 (2), 2.
- Feifel. H. (1977). New Meanings of Death. New York: McGraw-Hill Book Co.
- Fisher, G. (1970). Psychotherapy for the dying. Omega, 1, 3-15.
- Foley, K. (1985). The treatment of cancer pain. The New England Journal
of Medicine, 313(2), 84-94.
- Goldberg, I., Malitz, S., Kutscher, A. (1973). Psychopharmacologic Agents
for the Terminally Ill and Bereaved. New York: University Press.
- Greer, G., & Tolbert, R. (1986). Subjective reports of the effects of
MDMA in a clinical setting. Journal of Psychoactive Drugs, 18, 319-327.
- Greer, G., & Tolbert, R. (1990). The therapeutic use of MDMA. In S.J.
Peroutka (Ed.), Ecstasy: The Clinical, Pharmalogical and
Neurotoxicological Effects of the Drug MDMA. (pp 21-35). Boston: Kluwer
- Grinspoon, L., & Bakalar, J. (1979). Psychedelic Drugs Reconsidered. New
York: Basic Books.
- Grinspoon, L., & Bakalar, J. (1983). Psychedelic Reflections. New York:
Human Sciences Press.
- Grinspoon, L., & Bakalar, J. (1986). Can drugs be used to enhance the
psychotherapeutic process? American Journal of Psychotherapy, 40(3),
- Grob, C. (1995). A dose/response human pilot study - safety and efficacy
of 3,4 methylenedioxymethamphetamine (MDMA) in modification of physical
pain and psychological distress in end-stage cancer patients.
- Grof, S., & C. (1980). Beyond Death, the Gates of Consciousness. London:
Thames and Hudson Ltd.
- Grof, S., & C. (1990). The Stormy Search for the Self. New York: The
Putnam Publishing Group.
- Grof, S., & Halifax, J. (1977). The Human Encounter with Death. New York:
- Heffter Research Institute. (1996). Current Research Projects. (On line).
Available from America Online http://www.heffter.org/Research.html
- Heinemann, H. (1973). Humanistic Aspects of the Use of
Psychopharmacological Agents in the Care of the Dying Patient. In I.
Goldberg, S. Malitz, & A. Kutscher (Eds.), Psychopharmacological Agents
for the Terminally Ill and Bereaved (pp. 215-219). New York: Columbia
- Jacobs, J. (1996). The Encyclopedia of Alternative Medicine. Boston:
- Kast, E. (1967). Attenuation of anticipation: a therapeutic use of
Lysergic Acid Diethylamide. Psychiatric Quarterly, 41(4), 646-657.
- Kast, E. (1966). LSD and the dying patient. The Chicago Medical School
Quarterly, 26, 80-82.
- Kast, E., & Collins, V. (1964). A study of Lysergic Acid Diethylamide as
an analgesic agent. Anesthesia and Analgesia, 43, 285-291.
- Klerman, G. (1973). Drugs and the Dying Patient. In I. Goldberg, S.
Malitz, & A. Kutscher (Eds.), Psychcopharmacologic Agents for the
Terminally Ill and Bereaved (pp. 215-219). New York: Columbia University
- Kubler-Ross, E. (1969). On Death and Dying. New York: Macmillan
- Kubler-Ross, E. (1975). Death the Final Stage of Growth. New Jersey:
- Kurland, A. (1985). LSD in the supportive care of the terminally ill
cancer patients. Journal of Psychoactive Drugs, 17(4), 279-290.
- Lukoff, D., Zanger, R., & Lu, F. (1990). Transpersonal psychology
research review: psychoactive substances and transpersonal states. The
Journal of Transpersonal Psychology, 22(2), 107-148.
- McCue, J. (1995). The Naturalness of dying. JAMA, 273(13), 1039-1043.
- Munley, A. (1983). The Hospice Alternative. New York: Basic Books.
- National Hospice Organization. (1996). General Information: National
Hospice Organization. Available from: America on Line
- Noyes, R. (1972), The experience of dying. Psychiatry, 35, 174-184.
- Noyes, R. (1971). Dying and mystical consciousness. Journal of
Thanatology, 1, 25-41.
- Osmond, H. (1957). A review of the clinical effects of psychotomimetic
agents. Annals of the New York Academy of Sciences, 66(3), 418-434.
- Pahnke, W., Kurland, A., Goodman, L., & Richards, W. (1969). LSD-assisted
psychotherapy with terminal cancer patients. In B. Wells (Ed.),
- Pahnke, W., Kurland, A., Unger, S., Savage, C., & Grof, S. (1970). The
experimental use of psychedelic (LSD) psychotherapy. JAMA, 212,
- Pahnke, W., Kurland, A., Unger, S., Savage, C., Wolf, S., Goodman, L.
(1970). Psychedelic therapy (utilizing LSD) with cancer patients. Journal
of Psychedelic Drugs, 3, 63-75.
- Pahnke,W. & Richards, W. (1966). Implications of LSD and experimental
mysticism. Journal of Religion and Health, 5(3), 175-208.
- Passie, T, (1996). Hanscarl Leuner pioneer of hallucinogen research and
psycholytic theory. MAPS, 6(1), 46-49.
- Rando, T. (1985). Grief, Dying and Death. Champaign, IL: Research Press
- Reber, A. (1985). The Penguin Dictionary of Psychology. New York: Penguin
- Restak, R., (1994). Receptors. New York: Bantam Books.
- Rhymes, J. (1997). Barriers to palliative care, Cancer Control Journal
- Richards, W. (1975). Counseling peak experiences and the human encounter
with death. Doctoral Dissertation, The Catholic University of America.
- Richards, W., Grof, S., Goodman, L., & Kurland, A. (1972). LSD-assisted
psychotherapy and the human encounter with death. Journal of Transpersonal
Psychology, 4, (121), 121-150.
- Richards, W., Rhead, J., DiLeo, F., Yensen, & Kurland, A. (1977). The
peak experience variable in DPT- assisted psychotherapy with cancer
patients. Journal of Psychedelic Drugs, 9(1), 1-10.
- Richards, W., Rhead, J., Grof, S., Goodman, L., DiLeo, F., & Rush, L.
(1979). Dpt as an adjunct in brief psychotherapy with cancer patients.
Omega Journal of Death and Dying, 10, 9-26.
- Ring, K. (1988). Paradise is paradise: reflections on psychedelic drugs,
mystical experience, and the near death experience. Journal of Near Death
Studies, 6(3), 138-148.
- Sandison, R.A., Spencer, A.M., & Whitelaw, J.D.A. (1954). The therapeutic
value of Lysergic Acid Diethylamide in mental illness. The Journal of
Mental Science, 100, 491-507.
- Sandison, R.A., & Whitelaw, J.D.A. (1957). Further studies in the
therapeutic value of Lysergic Acid Diethylamide in mental illness. The
Journal of Mental Science, 103, 332-343.
- Saunders, C. (1981). Hospice: The Living Idea. London: Edward Arnold.
- Saunders, C. (1977). Dying They Live: St. Christopher's Hospice. In H.
Feifel, New Meanings of Death, 1977 (pp. 153- 180). New York: McGraw Hill
- Savage, C. & C., Fadiman, J. & Harman, W. (1964). LSD: Therapeutic effects
of the psychedelic experience. Psychological Reports, 14, 111-120.
- Schultes, R. & Hoffman, A. (1979). Plants of the Gods. New York: Alfred
Van der Marck Editions.
- Sherwood, J., Stolaroff, M., & Harman, W. (1962). The psychedelic
experience - a new concept in psychotherapy. Journal of Neuro Psychiatry,
- Shapiro, A. (1973). Psychochemotherapy. In I. Goldberg, S. Malitz, & A.
Kutscher (Eds.). Psychopharmacologic Agents for the Terminally Ill and
Bereaved (pp. 133-164). New York: Columbia University Press.
- Stafford, P. (1992). Psychedelics Encyclopedia, Berkeley, California:
- Strassman, R.J. (1994). Human psychopharmacology of LSD,
dimethyltryptamine and related compounds. In A. Pletscher & D. Ladewig
(Eds.), 50 Years of LSD: Current Status and Perspectives of Hallucinogens
- Symposium of the Swiss Academy of Medical Sciences, Lugano - Agno
(Switzerland) October 21 and 22, 1993 (pp. 145-174). New York: The
Parthenon Publishing Group.
- Support Principal Investigators. (1995). A controlled trial to improve
care for seriously ill hospitalized patients. JAMA, 274,(20), 1591-1598.
- Weil, A. (1972). The Natural Mind. Boston: Houghton Mifflin.
- Weil, A., & Rosen, W. (1983). Chocolate to Morphine Understanding
Mind-Active Drugs. Boston: Houghton Mifflin.
- Weisman, A.D., & Sobel, H.J. (1979). Coping with cancer through self
instruction - a hypothesis. Journal of Human Stress 5, 3-8.
- World Health Organization. (1995). The World Health Organization
definition of palliative care. (On Line). Available from: America Online
- Yensen, R. (1985). LSD & Psychotherapy. Journal of Psychoactive Drugs.
- Yensen, R., Dryer, D. (1992). Thirty years of psychedelic research:
the Spring Grove experiment and its sequels. In M. Schlichting & H.
Leuner. (Eds.). World of Consciousness. (pp. 141-176). Berlin: