A Swiss psychiatrist is treating severely ill patients with LSD to alleviate their fear of pain and death. Other psychedelic drugs are being tested on patients in the United States, Britain and Israel. Are psychotropic substances about to make a comeback in therapy?
Nothing's happening, Udo Schulz thought to himself with quiet regret. I must have been given the placebo. He was lying on a mattress in a brightly lit room, waiting for the first real drug experience of his life.
Schulz, 44, is German and suffers from cancer. He is also the first person in more than three decades who has been allowed to consume LSD legally in the context of a scientific study. The goal of the study is to determine whether lysergic acid diethylamide, the notorious drug of the hippy era, could be useful in the treatment of certain emotional disorders.
It was May 13, 2008, and it was quiet, as it usually is, in Solothurn, a small, picturesque Baroque town at the foot of the Jura Mountains in Switzerland. The Aare River, a tributary of the Rhine, flows at a more leisurely pace here than it does in the Swiss capital Bern, past Roman walls, the Krummer Turm ("Crooked Tower") and the imposing Cathedral of St. Ursus. There could hardly be a better spot for a study with such a potentially explosive impact on society than this inconspicuous little Swiss town.
The wall of the treatment room was decorated with a red tapestry, a gong, a drum and a portrait of a smiling Buddha. Peter Gasser, a psychiatrist, and fellow therapist Barbara Speich crouched next to the patient on thin foam rubber mats.
They sat there for at least half an hour, waiting. "Then I finally sensed that something was changing in my psyche," recalls Schulz. "Wow, it was fantastic!"
Transported to a Different World
Swiss chemist Albert Hofmann synthesized, ingested and discovered the effects of LSD in a laboratory at the pharmaceutical company Sandoz in Basel on April 19, 1943. Hofmann had originally intended to develop a circulatory stimulant derived from ergot, a fungus. Instead, he synthesized a highly potent hallucinogen. A single gram of LSD is sufficient to get 20,000 people high for hours.
Of course, the young scientist couldn't have known this on the day of his discovery. As a result, the first LSD trip in history began with a drastic overdose, when Hofmann swallowed 0.25 milligrams of the substance. "I was filled with an overwhelming fear that I would go crazy," he later wrote, describing his experience. "I was transported to a different world, a different time." Hours passed before he gradually became calm again. "Now I gradually began to enjoy the unimaginable play of colors and shapes," he wrote. The next day, he wrote, he was filled with "a feeling of well-being and new life."
Hofmann couldn't have dreamed that LSD would soon become the catalyst of a mass movement, glorified by artists like the Beatles, the Doors, Pink Floyd, the actor Cary Grant and the author Aldous Huxley. Little did he suspect that the CIA would secretly use it in interrogations or that the hallucinogen would send millions of people on spiritual and creative adventures but also drive some to madness and suicide. Nevertheless, he was convinced from the start that LSD had to be suitable for providing "mental relaxation."
Many psychiatrists shared Hofmann's hope that the substance he had discovered could help them gain insights into suppressed memories and trauma. Until the 1970s, LSD was frequently used to treat depression, anxiety and addiction and, less commonly, migraines, arthritis, paralysis and skin complaints. Thousands of scientific studies were published during that time, most of which were of dubious quality. A famous case was that of Auschwitz survivor Yehiel De-Nur, who, in six LSD sessions in 1976, relived his memories of the death camp. He later published a poetic and deeply disturbing book entitled "Shivitti: A Vision" about the experience.
Albert Hofmann's Problem Child
LSD discoverer Albert Hofmann died at the age of 102 on April 29, 2008 -- just two weeks before Udo Schulz was to travel by train from Murnau in Bavaria to Solothurn to take LSD as the first subject in the study. Schulz hoped that the substance could help him face the fears that had tormented him ever since he was diagnosed with cancer.
Hofmann had always warned against the dangers posed by his "problem child," and yet he continued to believe in the drug's healing powers up until his death. For the old man, the fact that research into the medical uses of LSD was now continuing after a 35-year hiatus represented the fulfillment of his "greatest wish in life."
Study director Gasser carries a heavy burden of responsibility. It isn't just a question of doing justice to Albert Hofmann's legacy. Many scientists from the United States and Europe, who have been fighting for years to be allowed to continue research into LSD and other psychedelic substances, are now pinning their hopes on the Solothurn-based psychiatrist.
"I would welcome it if it were easier to use psychoactive substances in therapy," says Rolf Verres, medical director of the Department of Medical Psychology at the University of Heidelberg Hospital. "In Germany, there is simply a deficit in this respect."
Elsewhere, however, a comeback of hallucinogens in psychotherapy seems possible. In the United States, Britain, Israel and Switzerland, a number of studies have been recently approved involving the use of Ecstasy and psilocybin, an agent derived from hallucinogenic mushrooms. The goal of the research is to determine whether these substances can help in the treatment of traumatized war veterans and patients with anxiety disorders. Some of the researchers involved in the studies say that initial results are consistently encouraging.
But before Peter Gasser embarked on his study, no researcher had dared to use LSD, the strongest and most notorious of the hallucinogenic drugs. The outcome of his study will play a key role in determining how authorities handle similar applications in the future.
'I Am Not a Messiah'
Gasser, 49, ignored media inquiries from around the world for almost one-and-a-half years, so as not to jeopardize his sensitive experiment. Today, as he invites SPIEGEL to visit his practice for the first time, the first thing he does is to make one thing clear: "I am not a messiah, nor am I someone who aims to change society." He is interested exclusively in research, not creeping legalization of the drug, says Gasser, and he wants to demonstrate that LSD can play a positive role in psychotherapy.
Gasser is the president of the small Swiss Medical Society for Psycholytic Therapy, which advocates the therapeutic use of hallucinogens. The organization has about 50 members, of which about one-third are based in Germany. In the early 1990s, Gasser completed supplementary therapeutic training with psychedelic drugs, when it was still possible to do so in Switzerland with a special permit. He also tried LSD as part of the training.
The drug's effect has a lot to do with the setting in which it is taken, says Gasser. "We create a relaxed atmosphere here, which is why the patients remain calm." Music is sometimes played in the background during a session, and Gasser occasionally plays the drum which is hanging on the wall. So far, none of the subjects has had a bad trip, he says, and the sedative that is kept on hand for emergencies has never been used. "If you handle LSD with care," the psychiatrist claims, "it isn't any more dangerous than other therapies."
The drug is chemically related to serotonin, a neurotransmitter produced naturally in the body. It affects the same regions of the brain, particularly the limbic system, where sensory input is filtered, processed and evaluated emotionally. LSD essentially disables the filtering function, so that the brain is flooded with information. It also elevates the release of the neurotransmitter dopamine in the so-called corpus striatum, further amplifying sensory overload.
As a result, the drug influences sensory perception, thought and moods. The sense of space and time changes, and the boundary between the self and the environment becomes blurred. This can be perceived as an exhilarating feeling of becoming one with the environment, or as a frightening loss of control over one's body and thoughts. Experts are unanimous in the view that LSD is not physically or emotionally addictive, however.
'A Feeling of Mystical Oneness'
But can the high truly help people to overcome their fears? Borwin Bandelow, a psychiatry professor at the University of Göttingen and Germany's most prominent expert on anxiety, is skeptical. "For every therapy in the world, you will find someone who tells you this sort of thing," he says. Nevertheless, says Bandelow, he would like to see the effects of psychoactive substances for the treatment of anxiety examined in well-controlled studies. "It's an extremely interesting subject," he says.
Altered sensory perception, objects that suddenly seem alive and the feeling of floating in mid-air are all spectacular, of course, says Gasser -- but they are merely secondary phenomena. More important, he says, is the deep self-awareness and the trusting relationship the patient can quickly develop with the therapist. "It can only be achieved at this intensity using LSD," he says.
Within the framework of the study, Gasser is permitted to treat 12 patients suffering from anxiety disorders as a result of a severe physical illness. Eight of them receive a capsule of 200 micrograms of LSD each, in two full-day sessions spaced several weeks apart. The remaining four patients, the control group, receive a dose of 20 micrograms, which is too small to have much of an effect. "With a substance like LSD, a placebo-controlled procedure is, of course, questionable," Gasser admits, noting that the patient quickly realizes what he or she has swallowed. But that is just the way things are done in medicament research, he says.
The three patients who have received the effective dose to date have all benefited from the treatment, says Gasser, but the study is still underway. Besides, he adds, a study group of only 12 patients is much too small to be able to make statistically valid statements. "What we hope to demonstrate in the end is that no serious incidents occurred, and that the results suggest that this is an effective treatment method."
'The Entire Room Suddenly Came Alive'
Udo Schulz finds it difficult to articulate his drug experience. He hesitates as he begins his account. "The potted plant, the tapestry, the entire room suddenly came alive," he says, interlacing his fingers and gazing meditatively out the window. And then, after a pause, he says: "You could say it was a feeling of mystical oneness."
Schulz's problems began in the spring of 2006. He had just started a new job as an orderly in a nursing home. At first, he attributed a growing loss of appetite to the stresses of the job. Then he noticed a feeling of pressure in his stomach after meals. He ate less and lost weight. Finally, a doctor sent him to the nearest hospital. After being hospitalized for several days, he was handed his file and sent to a final examination. "On the way there, I read the file, and I saw that the diagnosis was stomach cancer."
How does one react to this kind of information? "Well, at first I thought: This isn't my file. It's impossible. I've always lived a healthy life," says Schulz, twisting his mouth into a thin smile.
But he realized that he had to undergo surgery. One-third of his esophagus and a large part of his stomach were removed. The doctors did not find any signs that the cancer had spread and so Schulz did not need to do chemotherapy.
After that, however, fear began to dominate his life. He was tormented by the thought of never being productive again, of never regaining his strength, of losing his job and having to give up. He exhausted himself with his efforts to return to work and he suffered from insomnia. Conversational therapy with a psychologist did not help very much.
When Schulz happened upon an article on the Internet about the LSD study in Switzerland, it immediately appealed to him. "The preliminary tests showed that I'm apparently a person who suffers from these symptoms of anxiety," he says.
It has been a year since the LSD therapy, and Schulz is now working full-time again. Several months ago, he began working in outpatient geriatric care, which allows him to schedule his time more flexibly and take breaks. He hopes that the changes will enable him to cope with full-time work. He keeps himself physically fit by riding his bicycle and playing table tennis several times a week.
Schulz is convinced that the LSD helped him. The drug, he says, gave him a gentle push, an energy boost at a time when he felt miserable and listless. During the trip, he says, he felt for the first time his entire sadness and anger at the cancer. "All of a sudden, I was able to cry like a baby," he says, smiling again.
There is only one thing he regrets, says Schulz: The two sessions were much too short. "I would like to continue the LSD therapy," says Schulz, staring out the window. "But not if it's illegal."
Translated from the German by Christopher Sultan
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