by Andy Roberts
Sandison became intrigued by the process of psychoanalysis while at Warlingham noting: “My colleagues regarded the utterances of psychotic patients as something to record in their notes and thus justify their continued detention in hospital. I saw them as priceless material in my understanding of madness.” 4
The problem with any form of analysis was that it relied on the therapist’s ability to elicit information from the patient. Some were extremely resistant to the process and could be in analysis for months or even years before a breakthrough was made. This meant that psychoanalysis was a time consuming and expensive treatment available to the few who could afford it. If a chemical could be found that made the patient more receptive to the therapist’s skill, then psychotherapeutic practice could be speeded up considerably. In theory, this would mean that more patients could be treated effectively over a shorter timescale.
Freud had considered this problem in 1938 speculating: “The future may teach us how to exercise a direct influence, by means of particular chemical substances, upon the amounts of energy and their distribution in the apparatus of the mind. It may be that there are other still undreamt of possibilities of therapy.”5 Freud had no idea that LSD had been synthesised that same year and would come to play a major role in psychotherapy within fifteen years.
In September 1952, at the end of his first year at Powick, Sandison accepted an invitation to join a study tour of Swiss mental hospitals. He accepted, not knowing just how important his visit would prove. Recalling the trip in 2001, Sandison remarked, “It was a journey into the unknown, but it was to have far reaching consequences both for me and the lives of many future patients.”
During the trip Sandison visited the Sandoz laboratories in Basel. He found the chemists there in a state of great excitement. Sandison “... knew nothing about LSD before (my) visit to the Sandoz labs ...” but found the chemists there to be “... absolutely a-buzz with LSD, they weren’t doing anything else at that particular time.”6
While at Sandoz, Sandison met Albert Hofmann and they discussed the effects of the drug on the small group of people who had experimented with it so far. Sandison was excited with the possibilities it offered and returned to Powick with the drug very much in his thoughts. He re-visited the Sandoz laboratories two months later, returning to England with a box of ampoules. These were a gift from Hofmann, each containing 100 μg of LSD, under the trade name Delysid. Sandison did not know it, but he was the first person to bring LSD to Britain.
At that moment in time there was, as Sandison states, “... no theoretical basis for supposing that LSD could be used as a practical tool in combination with psychotherapy, but it was clear ... it produced a loosening of mental associations, that it facilitated the transference, and that forgotten and sometimes painful memories could be released.” The few studies that had already been done with LSD suggested the drug had potential in psychoanalysis because it improved the contact between therapist and patient, thus speeding up the process of psychotherapy. So, on his return to Powick, and after discussions with colleagues, Sandison began the clinical use of LSD, incorporating it into the psychotherapeutic regime there.7
New drugs are now extensively trialled before their use is allowed on humans. In the Fifties, this was not the case and Sandison was able to use the drug without any interference. Although some laboratory tests had been carried out on the effect of LSD on humans, use of the drug was still very much in its infancy. If LSD were to be discovered in the twenty-first century it would have to undergo years of testing on animals, followed by an equal number of years of rigorous tests on human subjects before its use would be permitted in psychotherapy. But the early 1950s were, according to Sandison: “... before the Royal College and the Committee of Safety in Medicines. ...There were no ethical committees and no concepts such as Evidence Based Medicine whatsoever. One was left to get on with it, if one felt a treatment was right.”8
Sandoz supplied LSD to Sandison free of charge until he left Powick in 1964. Dr. Harold Holgate, the company’s London-based Chief Medical Officer gave him a great deal of assistance and Sandoz asked for nothing in return, though Sandison sent them copies of his published papers out of courtesy.
The results of the first year of LSD psychotherapy at Powick were published in a 1954 paper in the Journal of Mental Science. This groundbreaking paper was the first article about LSD to be published in Britain and effectively set down the ground rules for its clinical use. In the paper Sandison and his colleagues Spencer and Whitelaw gave the results of the psychotherapeutic use of the drug on thirty-six patients over the course of a year.
The thirty-six patients of Sandison’s study were regarded as being: “... very difficult psychiatric problems ... all in danger of becoming permanent mental invalids, life-long neurotics or of ending their lives by suicide.” These were individuals at the end of their mental tether, all suffering from extreme mental tension. Sandison believed that most of the thirty-six patients would have been considered suitable candidates for lobotomy.
The scientific paper also outlined the history of LSD and the early experiments that had taken place on the Continent and in America, before summing up the effects noted in the therapy at Powick. In less than a year of clinical practice with LSD, Sandison and his team had defined the characteristics of its effects on humans and related them to a specific form of treatment. Most notably Sandison and colleagues isolated three major experiences manifested by the patient’s unconscious which were often revealed at the height of the LSD session. These were:
1. the hallucinatory experiences resulting from a general non-selective disturbance of the unconscious;
2. the reliving of repressed personal memories; and
3. the appearance of impersonal images.
The paper also discussed the nature of the patients’ hallucinatory experiences and expanded on how these were elaborated as forms of Identification Phenomena and Projection Phenomena. The former is the experience whereby the patient identifies themselves with another person or object, believing them to have become that person or object. The latter involves the patient projecting images or personalities onto other people or objects. Thus, a patient undergoing LSD therapy might identify with a snake for instance and “become” that creature.9
In the clinical setting at Powick, identification and projection phenomena were observed and occasionally guided by the doctors and nurses. Later this information would be framed in a psychoanalytical context and used to help with the patients’ resolution of mental health issues. In non-western cultures where indigenous people use hallucinogenic materials as part of their spiritual practice, identification and projection phenomena become the vehicle by which the shaman or tribal member contacts gods and spirits. In both western LSD psychotherapy and tribal culture there is a structured framework for the use of hallucinogenic drugs. This structure makes their use purposeful and meaningful and less likely to cause psychological trauma. Later, when LSD became widely used by the public, and despite the best efforts of the counter culture’s drug advocates, the LSD experience often had little structure. The result was that while the effect of the drug was just as powerful and revelatory as it had been in psychotherapeutic use people could not always extract useful meaning from the drug trip. In many cases the lack of purpose and structure led to mental confusion, “bad trips” or in extreme cases longer term personality problems.
The conclusion drawn by Sandison from this initial study was that LSD therapy was useful and had potential. Of the thirty-six patients, twenty had been in a variety of treatments prior to the LSD therapy. Sandison notes that: “... we think it reasonable to suppose that all of these would at best have been left with chronic neurotic disabilities had they not received LSD-25 therapy.” Of those twenty, fourteen recovered from their illness, three showed moderate improvement, two were not improved and one could not be assessed. Though it was the first paper dealing with the LSD therapy treatment in Britain the results, on paper at least, wer
e impressive.
Prospective candidates for LSD therapy were seen four or five times as out-patients as part of a holistic assessment process which took “... a complete history and established rapport with the patient and his relatives”. Once accepted for treatment the patient was admitted to Powick and introduced to drug therapy. This was done by giving injections of Sodium Pentothal, a rapid-onset, short-acting anaesthetic. If there were no problems at this stage the patient moved on to being given LSD as part of their therapy. The dosage of LSD given to patients varied. In researching the most appropriate dosage levels Sandison’s team became aware of one of LSD’s many contradictory effects: “100 micrograms given on one day may produce the most dramatic upsurge of unconscious material. The same dose repeated the following day may be without effect.” Though Sandison never pursued the reasons for this, it is obvious that set and setting are just as important for a patient in a clinical setting as they are when the drug is used recreationally.10
Patients selected for LSD therapy might have been told they were taking a drug called LSD, but in the early Fifties the initials would have meant nothing to them. There was no public awareness of the drug at that time, no knowledge of the drug’s effects or potential for causing permanent changes in belief and behaviour. Nor were patients asked to sign any documentation acknowledging or agreeing to LSD therapy. As Sandison notes: “We operated in a climate of openness rather than secrecy ... in 1954 patients and doctors operated in an atmosphere of mutual trust and, of course, patients were much more compliant and less questioning than today. On the whole, written consent did not fit the culture of the day.”11 In the Fifties the actions of doctors and other professionals such as teachers, the police and the judiciary were rarely questioned and they were regarded with respect by the majority of the population.
When LSD was first embraced by the counter culture, a guide was deemed to be crucial to the well being of the LSD user, particularly those taking the drug for the first time. Sandison and his team of professionals also understood the need to have someone acting as a guide for the duration of the patient’s LSD experience. In their case the nurse assumed this role: “She has to understand and yet not comment on the patient’s experience; she must not trespass on a delicate situation with bright and diverting remarks; she may answer but not ask questions; she must be prepared to be at the patient’s side if needed and to play an intuitive, passive, vigilant part.”12
Publication of Sandison’s scientific paper alerted the media to what was taking place at Powick. The Sunday Mercury reported that the new therapy “... consists of administering a new drug to the patient which transports him, in thought, back to his early childhood. The patient acts, speaks and thinks like a child and in this state is led step by step through buried memories until the incidents which may be causing his mental condition are reached. Once the source of the sickness is uncovered the work of the psychiatrist becomes comparatively easy.” The News Chronicle headlined with “Science has Alice-in-Wonderland Drug” and gave a sober, informed view of the possibilities of LSD treatment.13
The reference to Alice in Wonderland was an allusion to the pills given to Alice by the White Rabbit, which made her perceive she was of different sizes. The Alice in Wonderland theme in relation to LSD would be repeated time and time again throughout the media and the counter culture over subsequent years; most notably in the song “White Rabbit” by Jefferson Airplane in which Grace Slick, over a slowly building Bolero beat, chants a paean to the perceptual shifts offered by LSD, culminating with the operatic exhortation to: “Remember what the dormouse said, ‘Feed your Head.’”
In British Prime Minister Harold Macmillan’s “never had it so good” decade of the Fifties, the media were naïve about drugs and much more interested in scientific potential than sensationalism. They saw LSD as a product of the scientific process and in the Fifties it was widely believed that science was the answer to all medical problems, so all the newspaper reports about the new therapy at Powick were positive. The media’s tacit reassurance that LSD was both harmless and useful would have gone a long way in encouraging patients to accept LSD therapy as being the conventional thing to do were it offered. Over the next twenty years the media would slowly change their mind about LSD and would embark on a witch-hunt to vilify not only the drug, but also those who worked with it or took it in any capacity, medical or recreational.
Sandison’s 1954 paper set the scene for LSD therapy in the UK for the next two decades. The paper’s summary placed emphasis on what became the central tenet of psychotherapists who used LSD, which was: “... the property possessed by the drug of disturbing the unconscious so that repressed memories are relived with remarkable clarity and a change to an infantile body image.”14 As we will see while this was one way of addressing and using the LSD experience, it was not, by any means, the only way of using the drug. To an extent the medical profession were trapped in a narrow way of thinking about the use of LSD and within twenty years had been scared off exploring the drug’s potential by the media and disapproving governments.
For the first two years of LSD psychotherapy at Powick patients were treated in the main hospital building. This wasn’t ideal and so in 1956 Sandison approached the Birmingham Regional Hospital Board with a request to fund a specialised LSD unit. Funding was granted immediately and the LSD unit was operational within two years. The unit cost the taxpayer £50,000, the equivalent of over £1,000,000 in 2008: an unprecedented amount to spend on a new, controversial and barely tested treatment.
The speed with which the funding for this unusual project was granted, together with the high cost and the rapid completion of the building itself has led to speculation that there was more to the LSD unit than history has so far revealed. Documents held at London’s National Archives suggest that official bodies other than the Birmingham Regional Hospital Board had a covert interest in Sandison’s LSD research.
Dr. Joel Elkes, one of Sandison’s colleagues outside Powick, had also come into contact with LSD in the early 1950s. In 1951 he had founded Birmingham University’s Department of Experimental Psychology and had a special interest in the effects of drugs on consciousness. Elkes became fascinated with LSD after reading it was effective in doses of millionths of a gram. At first he believed this was a misprint, for no drug could be effective at such a miniscule dosage. After checking the article’s reliability and finding that LSD was effective in infinitesimal quantities, Elkes immediately sourced a quantity of LSD and ingested it: “The personal experience was intense and exquisite, and gave one an insight never to be forgotten of the full, mysterious sensation of the full psychedelic experience.”
Elkes’ interest in LSD grew and a few years later he attended a lecture on LSD given by Sandison at Powick, remarking: “I had the feeling I had listened to something important.”15 The pair became friends and Sandison soon realised that Elkes was an intelligent and outgoing individual with the ability to influence decision makers. Sandison recalls, when funding for the LSD unit was being applied for, “Joel Elkes gave the plan every possible help”. Sandison firmly believes Elkes was instrumental in paving the way for funding of the LSD unit but never questioned his motives.
Yet though they were good friends, Elkes kept concealed a great secret from Sandison: his close connections with the Ministry of Defence. By 1955, long before the planning and funding application for the LSD unit, Elkes had attended high level meetings at the MOD. These meetings were convened specifically to discuss LSD and Elkes played a key role in them, being recognised by the MOD as an expert in the field. Sandison admits he had no idea of Elkes’ links with the MOD, aware only that he was a signatory to the Official Secrets Act.
The MOD’s involvement with LSD will be clarified in the next chapter but Elkes’ interest in Sandison’s LSD research at Powick begs many questions. Writing in the medical journal the Lancet in 1955, Elkes voiced his concerns about the rapidly expanding use of LSD by psychotherapists, counselling: “Until mo
re is known about its mode of action, we urge those interested to refrain from using the drug in out-patients or in day-hospital patients, and restrict its use to in patients – and then only when constant supervision by trained personnel is available.”16 This would have been an admirably cautious statement were it not for the fact that within a year Elkes was actively supporting the development of Sandison’s research at Powick. The vast majority of those treated with LSD were day patients. Why had Elkes changed his mind in such a short space of time?
Was Elkes’ support of Sandison based purely on a shared professional interest? Alternatively, was he keen to see the LSD unit operational so he could share the results of Sandison’s research on civilians, feeding it back to his contacts at the MOD? If that was Elkes’ plan then Sandison fell for it completely: “Elkes knew as much as I could tell him about LSD as I believe it is the function of researchers to share their findings with others in the same field.”17 And what could the MOD learn from Sandison that they could not from their own research? Elkes’ mutually exclusive involvement with the MOD and Sandison is just one of the many puzzles scattered through LSD’s history that hint at the possibility of a bigger, possibly conspiratorial, picture.
But in 1956 all Sandison was aware of was that Elkes, a fellow professional who shared his interest in LSD, had friends in high places. When completed, the brick built single storey LSD unit stood in stark contrast to the imposing stone built Victorian mental hospital in whose grounds it stood. The specially designed building was designed so that up to five LSD sessions could be run at any one time, with two doctors and three nurses in attendance. The unit allowed the numbers treated with LSD to be increased and there was no shortage of those wishing to take up the new therapy.