The Trials of Psychedelic Therapy: LSD Psychotherapy in America by Matthew Oram (review)

The colorful history of the hallucinogen LSD has attracted the attention of numerous historians of medicine, professional and otherwise, giving rise to nearly as many explanations of why a very promising new therapy for alcoholism of the early 1960s (high-dose LSD in conjunction with intensive psychotherapy) was abandoned by medicine within a decade. The enduring interest of the topic no doubt has much to do with recently renewed clinical interest in hallucinogens, and probably also the intellectual challenge of untangling the intertwined strands of pharmaceuticals development, popular drug abuse, and the unique cultural history of the 1960s. Commonly offered explanations of LSD’s fall from medical grace include emphasis on the disrepute caused by recreational use and advocates like Timothy Leary, which supposedly drove respectable medical researchers away from perfecting therapy with the drug; emphasis on the clash between psychodynamic therapists and biological psychiatrists, the latter being more powerful and supposedly intolerant of any treatment regime involving talking therapy; and emphasis on the rigorous clinical trials needed to establish LSD’s efficacy after the 1962 amendments to U.S. pharmaceutical regulation, which—depending on how sympathetic the author is to psychedelics—supposedly demonstrated either that the drug was worthless or else that controlled trials were fundamentally incompatible with a therapy that deeply involved a subjective element and could not be standardized on the same model as strict chemotherapies.

Oram offers the best developed version of the last explanation yet and brings valuable new empirical research to the topic by focusing on the research program at Maryland’s Spring Grove mental hospital, where the psychedelic therapy approach developed by Humphrey Osmond and associates in Saskatchewan during the 1950s (and reconstructed recently by Erika Dyck) was carried forward from the 1960s into the 1970s with the greatest fidelity and determination. Rich primary sources associated with Spring Grove allow Oram to discount a number of competing explanations of LSD’s medical demise. The Spring Grove researchers evidently were not dissuaded from testing LSD therapies by the drug’s growing notoriety, and neither were the federal regulators and funders supporting them—even after the Controlled Substances Act made the drug a highly controlled substance in the early 1970s. Nor were the Spring Grove researchers seriously marginalized or suppressed by harder-nosed biological psychiatrists. And neither were these psychedelic psychiatrists altogether unable to design trials meeting post-1962 standards of rigor. Yes, it was impossible to maintain a proper double-blind design, but adequately controlled trials were conducted that compared high-dose LSD with intensive psychotherapy to similar psychotherapy with a low LSD dose or an active placebo (a drug with unrelated effects) and/or talking therapy alone.

The end of LSD’s promise for these researchers, Oram argues through a close analysis mainly of published medical literature, came from their inability to demonstrate psychedelic therapy’s efficacy for alcoholism, and a number of other conditions, in these trials. That is, even the best trials mainly found no statistically significant, lasting benefit. This disappointing outcome reflects exaggerated expectations of a miracle cure encouraged both by the usual hopes around novel medication and also by the powerful subjective experience brought by LSD. Oram also argues that the outcome did reflect an inherent bias of the controlled trial testing regime against interventions like psychedelic therapy, but in rather subtle ways. For example, in one key trial failing to show long-term benefits for alcoholics treated with psychedelic therapy (using DPT, a shorter-acting hallucinogen), there were very high and variable rates of dropout and loss to follow-up; if volunteers for psychedelic therapy (and therefore good candidates for it, faith in the procedure’s transformative potential being essential in the minds of its proponents) found themselves assigned to a control group then dropped out, leaving only participants who found the control therapy acceptable, this would bias the outcomes in favor of the control group—and the routine care control...