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

Psychedelics are back in vogue. In popular culture, political legislation, and scientific research, we appear to be witnessing an early twenty-first century renaissance of the heady acid days of the 1960s. The success of Michael Pollan's 2018 New York Times bestseller, How to Change Your Mind, the decriminalization of psilocybin-containing mushrooms in Denver in 2019, followed by all plant entheogens in Oakland the same year, alongside a surge of papers and pilot studies into psychedelic-assisted therapeutics throughout the 2010s, all indicate a relaxing of attitudes after half a century of alarmist proscription of hallucinogens.

It is in this context that Matthew Oram has published The Trials of Psychedelic Therapy: LSD Psychotherapy in America. In this meticulous account Oram traces the history of medical research into the use of Lysergic acid diethylamide (LSD) in the treatment of mental disorders in post World War II America. However, as Oram emphasizes in his introduction, this is not another addition to the profusion of books on 1960s drug culture. The double meaning in the title hints at the deeper concern at the heart of the book: the problematic relationship between experimental and non-orthodox therapeutics and institutionalized, state regulated medical research. Tensions between fringe and orthodoxy in modern medicine have been a persistent feature of health and healing in the western world from at least the mid-nineteenth century. Oram's examination of such tensions in the mid-twentieth century, when LSD offered medical researchers the tantalizing prospect of bridging the divide between cognitive therapy and psychiatric drug treatment, represents a nuanced and refreshing intervention in the historical literature on clinical medicine, drug regulation, and the mind sciences.

Oram begins the first of six chapters with a recap of the history of LSD, and from the outset its psychotherapeutic potential was clear. The drug was synthesized in 1938 by Swiss chemist Albert Hoffman while experimenting with ergot fungal alkaloids in the Basel laboratories of Sandoz Pharmaceuticals. Clinical tests on the drug were performed in 1947 by Hoffman, supervised by Arthur Stoll at the University of Zurich, where psychological effects on volunteers, including the revealing of repressed memories, led to its distribution to international researchers under the name Delysid for use in analytical psychotherapy. In the United States LSD was first employed in pharmacological research into psychosis, depression, and anxiety at the Naval Medical Research Institute in Bethesda in 1949, but it was the arrival of psychedelic therapy from Canada in 1950s, pioneered by Abram Hoffer for treating alcoholism, where high dose LSD was combined with psychotherapy that kickstarted a series of research projects into the psychotherapeutic use of the drug. The results were impressive, and LSD therapy was applied to terminal illnesses, neurotic illness, and narcotic addiction at psychiatric institutions in Spring Grove, Maryland, in St Louis, and later at New York's Mount Sinai hospital, Columbia University, and most notoriously, Stanford University.

However, as Oram reveals, in spite of the initial promise of LSD as a pharmacological complement to cognitive therapy, the increasing regulation of pharmaceutical research in the 1960s, as new drugs became subject to comprehensive clinical trials, seriously affected LSD therapy. The thalidomide scandal had previously highlighted the perils of leaving premarket drug testing to researchers and pharmaceutical companies. The ensuing Kefauver-Harris Drug Amendment (1962) changed the game as the FDA now regulated pre-market drug research and, significantly, required proof of effectiveness before being approved. This was a crucial issue as clinical tests repeatedly and conclusively showed that LSD psychotherapy was ineffective. The problem, as Oram notes, was that psychotherapeutic treatment using LSD did not correspond with the rigorous data-centric evaluation tests being applied to it using the standard, double-blind placebo-controlled trial method. In fact, he points out, the techniques of LSD therapy and patient response analysis were never adequately tested or considered. Simply, the dominant models of mainstream scientific medicine were too narrow and fixed...