The danger of a psychotic reaction is especially great if LSD is given to someone without his or her knowledge. This was demonstrated in an episode that took place soon after the discovery of LSD, during the first investigations with the new substance in the Zurich University Psychiatric Clinic, when people were not yet aware of the danger of such jokes. A young doctor, whose colleagues had slipped LSD into his coffee as a lark, wanted to swim across Lake Zurich during the winter at -20!C (-4!F) and had to be prevented by force.
There is a different danger when the LSD-induced disorientation exhibits a depressive rather than manic character. In the course of such an LSD experiment, frightening visions, death agony, or the fear of becoming insane can lead to a threatening psychic breakdown or even to suicide. Here the LSD trip becomes a "horror trip."
The demise of a Dr. Olson, who had been given LSD without his knowledge in the course of U.S. Army drug experiments, and who then committed suicide by jumping from a window, caused a particular sensation. His family could not understand how this quiet, well-adjusted man could have been driven to this deed. Not until fifteen years later, when the secret documents about the experiments were published, did they learn the true circumstances, whereupon the president of the United States publicly apologized to the dependents.
The conditions for the positive outcome of an LSD experiment, with little possibility of a psychotic derailment, reside on the one hand in the individual and on the other hand in the external milieu of the experiment. The internal, personal factors are called set, the external conditions setting.
The beauty of a living room or of an outdoor location is perceived with particular force because of the highly stimulated sense organs during LSD inebriation, and such an amenity has a substantial influence on the course of the experiment. The persons present, their appearance, their traits, are also part of the setting that determines the experience.
The acoustic milieu is equally significant. Even harmless noises can turn to torment, and conversely lovely music can develop into a euphoric experience. With LSD experiments in ugly or noisy surroundings, however, there is greater danger of a negative outcome, including psychotic crises. The machine- and appliance-world of today offers much scenery and all types of noise that could very well trigger panic during enhanced sensibility.
Just as meaningful as the external milieu of the LSD experience, if not even more important, is the mental condition of the experimenters, their current state of mind, their attitude to the drug experience, and their expectations associated with it. Even unconscious feelings of happiness or fear can have an effect. LSD tends to intensify the actual psychic state. A feeling of happiness can be heightened to bliss, a depression can deepen to despair. LSD is thus the most inappropriate means imaginable for curing a depressive state. It is dangerous to take LSD in a disturbed, unhappy frame of mind, or in a state of fear. The probability that the experiment will end in a psychic breakdown is then quite high.
Among persons with unstable personality structures, tending to psychotic reactions, LSD experimentation ought to be completely avoided. Here an LSD shock, by releasing a latent psychosis, can produce a lasting mental injury.
The psyche of very young persons should also be considered as unstable, in the sense of not yet having matured. In any case, the shock of such a powerful stream of new and strange perceptions and feelings, such as is engendered by LSD, endangers the sensitive, still-developing psycho-organism. Even the medicinal use of LSD in youths under eighteen years of age, in the scope of psychoanalytic or psychotherapeutic treatment, is discouraged in professional circles, correctly so in my opinion. Juveniles for the most part still lack a secure, solid relationship to reality. Such a relationship is needed before the dramatic experience of new dimensions of reality can be meaningfully integrated into the world view. Instead of leading to a broadening and deepening of reality consciousness, such an experience in adolescents will lead to insecurity and a feeling of being lost. Because of the freshness of sensory perception in youth and the still-unlimited capacity for experience, spontaneous visionary experiences occur much more frequently than in later life. For this reason as well, psychostimulating agents should not be used by juveniles.
Even in healthy, adult persons, even with adherence to all of the preparatory and protective measures discussed, an LSD experiment can fail, causing psychotic reactions.
Medical supervision is therefore earnestly to be recommended, even for nonmedicinal LSD experiments. This should include an examination of the state of health before the experiment. The doctor need not be present at the session; however, medical help should at all times be readily available.
Acute LSD psychoses can be cut short and brought under control quickly and reliably by injection of chlorpromazine or another sedative of this type.
The presence of a familiar person, who can request medical help in the event of an emergency, is also an indispensable psychological assurance. Although the LSD
inebriation is characterized mostly by an immersion in the individual inner world, a deep need for human contact sometimes arises, especially in depressive phases.
LSD from the Black Market
Nonmedicinal LSD consumption can bring dangers of an entirely different type than hitherto discussed: for most of the LSD offered in the drug scene is of unknown origin.
LSD preparations from the black market are unreliable when it comes to both quality and dosage. They rarely contain the declared quantity, but mostly have less LSD, often none at all, and sometimes even too much. In many cases other drugs or even poisonous substances are sold as LSD. These observations were made in our laboratory upon analysis of a great number of LSD samples from the black market. They coincide with the experiences of national drug control departments.
The unreliability in the strength of LSD preparations on the illicit drug market can lead to dangerous overdosage. Overdoses have often proved to be the cause of failed LSD
experiments that led to severe psychic and physical breakdowns. Reports of alleged fatal LSD poisoning, however, have yet to be confirmed. Close scrutiny of such cases invariably established other causative factors.
The following case, which took place in 1970, is cited as an example of the possible dangers of black market LSD. We received for investigation from the police a drug powder distributed as LSD. It came from a young man who was admitted to the hospital in critical condition and whose friend had also ingested this preparation and died as a result. Analysis showed that the powder contained no LSD, but rather the very poisonous alkaloid strychnine.
If most black market LSD preparations contained less than the stated quantity and often no LSD at all, the reason is either deliberate falsification or the great instability of this substance. LSD is very sensitive to air and light. It is oxidatively destroyed by the oxygen in the air and is transformed into an inactive substance under the influence of light. This must be taken into account during the synthesis and especially during the production of stable, storable forms of LSD. Claims that LSD may easily be prepared, or that every chemistry student in a half-decent laboratory is capable of producing it, are untrue. Procedures for synthesis of LSD have indeed been published and are accessible to everyone. With these detailed procedures in hand, chemists would be able to carry out the synthesis, provided they had pure lysergic acid at their disposal; its possession today, however, is subject to the same strict regulations as LSD. In order to isolate LSD in pure crystalline form from the reaction solution and in order to produce stable preparations, however, special equipment and not easily acquired specific experience are required, owing (as stated previously) to the great instability of this substance.