Group Psychotherapy with a Variety of Hallucinogens

by Richard Yensen2

This paper was presented in September of 1973 at the eleventh annual meeting of the Association for Humanistic Psychology in Montreal, Canada. It was part of a joint presentation with Salvador Roquet, M.D. in order to present his innovations in psychotherapy to the United States and Canada. 2 Research Psychotherapist, Maryland Psychiatric Research Center, U.S.A. 1973 Richard Yensen

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I wish to share with you today some of the work of my colleague, Dr. Salvador Roquet, founder of the Asociacin Albert Schweitzer in Mexico City. Dr. Roquet began exploring the psychotherapeutic potential of hallucinogenic compounds in 1967. He organized a series of interdisciplinary expeditions to remote Indian villages in the interior of Mexico. The aim was to study the ritual use of hallucinogens medically, psychologically, and anthropolologically. The indigenous American populations' use of psychedelic plants has its roots in pre-Columbian times. Archeological evidence indicates that these peoples used hallucinogens as early as 2500 B.C. in Guatemala, and 300 A.D. in Mexico. This establishes the Indians as the first grass roots psychedelic researchers. Their use of these plants to communicate with the world of the spirit is based upon a belief in the supernatural origin of disease. Disease is believed to be brought on by: the incantations of a shaman, the ill effects of certain physical objects in the environment, or by problems of and interpersonal nature. This belief system is compatible with modern medicine, as the curanderos readily admit that disease may center on certain organs and physical intervention may be indicated. When one considers the emotional factors, which accompany disease in a society with limited medical knowledge, fear of death is the most prominent and with good reason for morbidity is high. In this light the use of hallucinogenic plant substances in a ritual healing ceremony can be seen as a treatment for the psychological distress of the ill and dying. This viewpoint receives further support from archeological finds in Peru, which document the concurrent development of the caste of shaman and surgeon among the Incas. The paired development suggests a belief in the value and complementary nature of both approaches in ministering to human suffering. Thus, a major reason for the use of mind altering plant substances in a ritual healing ceremony is the fear and anxiety the individual experiences when confronted with disease and its possible consequences. These rituals are conducted at night. The curandero may make use of an apprentice in the ceremony. Both the patient and usually the curandero as well ingest the sacred plant during the evening. Techniques of intervention during the drug effects include: symbolic extraction of maleficent influences by sucking them out physically with the curandero using his or her mouth, by transferring the person's ills to an animal which is then slaughtered, or by extracting evil forces with objects which are then destroyed. Catholic ritual has been integrated into these practices and the ceremony resembles a mass in many ways The curandero may be considered by some patients as a holy man of the Church and also a connoisseur of the darker side of the supernatural. The curandero may use some of the Church's prayers in the ceremony as well as speak directly to God on the patient's behalf requesting relief from ills.

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The curandero's chanting is the most powerful technique used to control the power and depth of the effects induced by the plant hallucinogens. The Indians in Mexico use a variety of plant substances in ceremonies which usually include five to ten participants although there have been reports of especially powerful shamans running rituals with as many as thirty participants suffering from physical or mental ailments involving the loss of the spirit. The aim of the participants in these sessions is to return to the source of all things and regain their lost spirit. The plant substances ingested in these ceremonies include the seeds of Rivea corymbosa and Ipomea violacea, which contain amides of lysergic acid; Stropharia cubensis, Psilocybe Mexicana, Psilocybe semperviva, and Sphinctrinus Zapotecorum mushrooms, which contain psilocybin; the seeds of Datura ceratocaula and and infusion made from the leaves of Salvia divinorum, whose active ingredients are unknown though it is suspected the Datura contains some mixture of hyoscyamine, scopolamine, and atropine as do other Daturas. Dr. Roquet was able to establish rapport with the Indians by treating their illnesses on a physical level and teaching them elements of hygiene. Once rapport was established the Indians were willing to share much of their knowledge of plants and dosages needed to achieve the desired effects. Dr. Roquet combined the knowledge gained from the Indians with his training as a psychoanalyst and scoured the psychotherapeutic literature for other useful techniques. It is interesting to note that, at this point, it was a great temptation for Dr. Roquet to collect and digest all the literature he could on the use of psychedelic drugs in psychotherapy. However, he felt that, if he was to make an original contribution, he'd best refrain at this point from reading a literature likely to prejudice him into following the paths and techniques of other investigators. From these elements Dr. Roquet forged a new and multidimensional approach to therapy with psychedelic drugs. He chose to call it Psychosynthesis for it is his contention that he can synthesize what the analyst would analyze. Psychosynthesis, as practiced by Dr. Roquet, is a group therapy with the groups ranging from ten to twenty-eight patients. Each group is a carefully selected balance, with patients of differing ages and sexes. An attempt is always made to include members who are just entering therapy, about to terminate therapy, and those who are in the main course of treatment. The group is heterogeneous not only with respect to age and sex but also length of time in treatment, and the drugs they shall receive during the session. The drug session takes place at night. Before the drug session itself, the participants meet in a large room for a leaderless group discussion. This allows each patient the opportunity to meet new members and review his or her expectations, fears, and previous experiences with the group. An important function of the pre-drug meeting is to allow projections and transferences to take place between group members. The pre-drug meeting lasts about two hours. The group then enters the treatment room, this is a large room with an array of paintings and posters selected for 1973 Richard Yensen

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their evocative quality. Toward the rear of the room there is a large table with a variety of audiovisual equipment. In the main part of the room, matresses are arranges along each wall. The central part of the room is clear so that the patients may walk freely if they so choose. As soon as all the patients have entered the room the sensory overload begins. The overload uses slides, movies, two stereo sound systems, and colored flood lights which flash intermittently. The elements included in the slides and films are as varied as possible. Within what seems a confusing barrage of unrelated images and sounds there is a main theme. Among the themes found useful are: death, birth, sexuality, religion, and childhood. Each evening's stimuli are assembled so that in addition to the main theme of the evening there are slides of particular importance for each client: scenes from childhood, family pictures etc. These pictures are then accompanied by music of importance for that particular patient. During the overload show a full length feature film is also shown. The two stereo sound systems are used with a wide variety of music and sound effects in order to modulate the depth and intensity of the group's emotional reactions. When maximum stimulation is desired a chaotic effect can be achieved by playing both stereo systems at the same time at high volume with different records. After approximately fifteen minutes of moderate sensory stimuli the psychedelic substances are administered. The substances used as therapeutic adjuncts are the seeds of Rivea corymbosa and Ipomea violacea, a variety of psilocybin containing mushrooms, Lophophora Williamsii (the Peyote cactus), Datura ceratocaula and Ketamine hydrochloride. Ketamine is an anesthetic drug which produces a dissociative anesthesia. Doctor Roquet and an anesthesiologist colleague found that Ketamine in subanesthetic doses produces profound changes in psychological functioning that can be helpful in psychotherapy. The sensory overload portion of the drug session lasts for about six hours. After this, pictures from each patient's chart are passed out. At this point passages from philosophers may be read aloud by the therapist and tape recordings of patient's previous psychotherapy sessions may be played back. This reflective phase is conducted without sensory overload or music. Patients may be given letters they have written to important figures in their life to read aloud to the group. Other participants may read from their descriptions of previous sessions or relevant passages from literature. This phase lasts two to three hours ending about sunrise. At the end of this phase all participants and the therapist sleep or rest for about an hour. After the rest the integrative phase begins. This session lasts from four to twelve hours. Each patient will discuss his or her experience with the group. Greater abreaction and more intense catharsis than occurred during the pharmacological drug peak are characteristic of this phase. During this session the personality of each participant is reintegrated around insights gained during the drug session. Members of the patient's family may visit at this time. The tone of the session is confrontation with on-going problems in the individual's life situation.

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The course of therapy consists of ten to fifteen drug sessions although as many as twenty may be necessary for refractory patients. The patient population consists mostly of neurotic outpatients though antisocial personality disorders and schizophrenics have been treated successfully. Doctor Roquet has developed a theory of personality from the work with psychedelics. Unfortunately, time does not permit a thorough discussion of theory. It is important, however, to throw some light on the aims of the Psychosynthesis treatment. Since the personality is a self-contained, self-validating belief system, in order to reorganize the structure of this belief system, it is necessary to disrupt the ongoing self-validating process that provides integrity for the system. The element of surprise is felt to be very useful in disrupting the normal flow of expectations that form personality. However, for a profound reorganization to occur it is necessary to completely disorganize or stop the functioning of the personality. Psychedelic agents and the specialized environment are used to disrupt the normal flow of associations and the functioning of the defense mechanisms. The patient's unconscious contents are made conscious and he is urged to confront the true self without customary distortions. This process can be terribly painful and is accompanied by some of the most profound emotional outpourings this investigator has observed to date. It is Doctor Roquet's hypothesis that there are four levels of possible experiences with psychedelic compounds: The first and most superficial is the level of minor perceptual distortions; The second is the level of wish fulfillment and fantasy. At this level one can achieve any of the profound mystical states described in the literature or merely run from one's problems with pleasant fantasies. Whatever the content of the experience, it will not result in any reorganization of the personality and does not yield true insight. This level was described by Freud as occurring in dreams and perhaps the best understanding of its value in therapy comes from the observation that one dreams of drinking water when thirsty, upon awakening it is still necessary to drink water. Freud also postulated that the wish fulfillment mechanism served to preserve sleep. In psychedelic sessions it appears to preserve the present adaptational structure of the psyche. The third level is that of existential anxiety and is usually accompanied by childhood memories, the feeling of eminent confrontation with death, and intense abreaction with catharsis. The fourth level is the most profound. It is characterized by experiences of death, rebirth, the void of Zen Buddhist and psychotic decompensation. The personality is stopped completely, all previous points of reference are lost and profound reorganization occurs. At this level, true life altering experiences of a mystical nature take place. The fourth level of experience is regarded as essential to successful therapy and it is the aim of Psychosynthesis to synthesize a healthy personality through the integrative qualities of these experiences. Roquet's clinical observations of the effects of this approach are parallel to Roland Fischer's concept of arousal statebound recall of experience. A memory is: "...the binding of a particular state or level of arousal with a particular symbolic interpretation of that arousal." These statebound memory systems can be evoked by

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presenting symbols of the original experience or by recreating the original level of arousal. Psychosynthesis uses a variety of drugs to create levels of central nervous system arousal likely to have been present when crucial memory and conceptual systems that make up an individual's personality were first imprinted. In addition the environmental stimuli are used to provide symbols of the imprinting experiences. This two-pronged approach seems to be quite effective in returning people to basic experiences of formative power in their lives. Roquet's work with group treatment presents the professional community with a new type of therapy capable of providing benefits one might otherwise expect only from a very successful long term psychoanalysis within a Jungian framework. It is hoped that in the future a controlled study may be conducted. Such research would test the validity of Roquet's approach scientifically and provide objective evidence regarding the efficacy of Roquet's exciting new treatment.

1973 Richard Yensen