The Brain
The Use Of Psychedelics In Dutch Psychiatry
by Stephen Snelders
October 1995
Part II Of II
G. W. Arendsen Hein
We have seen that the use of psycholytic therapy was for Bastiaans a way to solve problems in his therapeutic practice which he couldn't solve with the other methods he used. But the aims and even the method itself show a direct continuity with his earlier work. The same can be said of G. W. Arendsen Hein, another Dutch psychiatrist to which we shall now turn our attention.
Arendsen Hein started to use psycholytic therapy to solve the problems of patients that couldn't adequately be reached by methods such as sociotherapy and narcoanalysis. His aims were in direct continuity with his earlier practice. But like Bastiaans he seemed to encounter negative reactions of his colleagues.
Also interesting is his growing recognition of the role of religious factors in the human psyche, something which seems to be greatly encouraged by his experiences with LSD.
Arendsen Hein, Medical Doctor as well as Master of Law, worked from 1953 in the Foundation Veluweland at Ederveen. In this foundation attempts were made at psychiatric treatment of criminal, mentally disturbed adult recidivists, who were classified as psychopaths.
The therapy which was used was in the first place sociotherapeutic: the attempt was made to desocialize the patients by their participation in a community, guided by the psychiatric team, and, by group therapy and individual analysis, to free them from their neuroses.
But it became clear to Arendsen Hein that a number of patients were hardly reached by the therapeutic procedures. Among them there were the refractory patients, who failed to respond to all the therapeutic efforts, and who were a nuisance to themselves and to their environment, even in forms of group therapy.
How to break through their barriers of resistance? How to elicit the banned memories and emotional contents from their unconscious and make psychoanalytic practice possible? Like Bastiaans, Arendsen Hein started to use chemical means. CO2-inhalation had little success.
It proved to be a too violent method: release of emotions took place in complete unconsciousness and was after treatment readily forgotten. Narco-analysis had its worth for the reliving of recent traumatic experiences, but couldn't get at the level of the infantile roots of neuroses.
Besides that, there could afterwards be complete amnesia of what had happened during the treatment. Methedrine looked promising, and facilitated the process of association and the verbal expression when the patient really wanted to express himself.
If not, it had only superficial results, and besides that, it had the dangers of euphoria during the treatment, of addiction when frequently used, and of relapse in a state of resistance and amnesia or a bad hangover after the treatment.
None of these methods lived up to the expectations. So it was a natural step for Arendsen Hein in 1959 to consider using LSD for his refractory patients, after studying the reports on its use by foreign colleagues like Leuner and Sandison.
The medical team at Veluweland started to give LSD to patients who had the following indications: good physical health; no actual psychosis; average intelligence; some awareness of their disturbed mental state and a sincere wish to get well, but also insurmountable resistances and lack of introspective and integrative powers; and a failure of other therapeutic measures.
On average ten doses LSD, ranging from 50 to 450 gamma [micrograms], were given to 21 patients in ten or twenty weeks. And Arendsen Hein claimed results.
Under LSD, patients developed notable reduction of resistance, intensive abreaction of repressed emotional material, allegoric and symbolic presentation of conflicts, a strong inclination to introspection, lucid insight into hitherto misunderstood attitudes, reorganization of values, marked improvement of behaviour, and intensification of interhuman contact.
To critics who thought that this artificial break-down of barriers would lead to an insupportable flood of emotions, and so to disintegration of the ego and in the worst cases psychoses, Arendsen Hein replied that the ego seemed to have creative, auto-regulative and integrative powers, which could integrate the repressed material with help of the therapist, unless it concerned a case of manifest psychosis.
Two years after the treatment, fourteen of the patients were registered as clinically improved (twelve) or much improved (two). (Arendsen Hein 1963a, 1963b.)
In 1965 Arendsen Hein still thought that 'besides the unavoidable failures, there are in the Netherlands a handful of heavy guys about, who stayed afterwards free of recidivism and who have to thank, according to us and according to them, this LSD-group-pilot-project for their psychical recovery and rehabilitation in society (Arendsen Hein 1965:67).
But not everyone seems to have been enthusiastic about this project. As Arendsen Hein also wrote: 'Unfortunately a climate of suspicion and distrust arose around us in those days, which made a quiet unwinding of the therapeutic process that was started, with the necessary after care, impossible.' (Arendsen Hein 1965:67)
What exactly did happen is for me impossible to say at this moment: it is not easy to get access to the relevant archives. Perhaps it was something similar to the reaction on the rehabilitation of criminals - with the help of psilocybin - project by Leary and his team in Harvard in 1963. But that's only conjecture.
One important feature of Arendsen Hein's work with LSD has still to be mentioned. That was his recognition of the role of the 'peak-experience' which patients got on LSD. An experience which transcended the normal ego-boundaries, an experience of what has been called the 'cosmic consciousness'.
'It is as if lightning strikes and the inner panorama is suddenly brightly illuminated.' (Arendsen Hein 1965:72) This peak-experience transformed according to Arendsen Hein the experiencer, it gave him something new instead of his negative self-image.
It seems that the same thing happened to him on LSD, as he wrote: 'Have not most of us been living in a state of complete unawareness of our roots in the transcendental, until we saw this clearly under the influence of LSD?' (Arendsen Hein 1967:572)
Arendsen Hein had started his medical study under the inspiration of the theories of Alfred Adler with its stress on the social aspects of the human being. But already Adler had written of his social feeling developing towards a cosmic feeling, and the same seemed to happen to Arendsen Hein.
In 1965 he had come to the conclusion that besides the three dimensions of therapy which formed the common frame of reference: the patients' perception of the relations of himself with himself and his fellow men, and the personal and archetypal symbols of his unconscious, recognition of a fourth dimension was necessary.
This was the dimension of our cosmic and universal unconscious, which we could see under influence of LSD. Psychotherapists should investigate this dimension in their patients (Arendsen Hein 1967).
I do not think that this line of thought strengthened the position of the LSD-researchers in the debate about the advisability of their work against sceptic critics. But before I turn attention to this debate, I will mention my last example of the theme continuity and discontinuity with earlier developments in psychiatry: the work of C. H. van Rhijn.
C. H. van Rhijn
Cornelius H. van Rhijn worked in 1952 as psychiatrist at the Psychiatric Clinique at Brinkgreven, when the salesman of the pharmaceutical concern Sandoz brought with him some samples of LSD-25. Already the next year Van Rhijn started to give LSD-therapy to chronic alcoholics.
At Brinkgreven and since 1960 at his private practice in the city of Enschede, Van Rhijn has given LSD to patients in almost 1000 cases, and has acquired an enormously rich knowledge of the therapeutic process involved.
He has made significant contributions to the discussions around psycholytic therapy, which he saw as having the following objects: to loosen up a stagnated situation; to strive for quick results in emergency cases; to alleviate a compulsion neurosis; to give love and security to acceptance-frustrated neurotics; to dig repressed elements from the subconscious; to loosen up infantile fixations; deliverance from ego-dominance, guilt and isolation; and to make experimental studies on the nature of psychosis.
The best indication for treatment was according to him a good understanding with the patient (Van Rhijn 1967:208-209).
There is no space here to discuss his intricate theories about the effects of LSD. I will limit myself to two examples which show further light about our theme of continuity and discontinuity.
The problem was explicitly posed by himself in 1965, and he placed psycholytic therapy not against, but next to other methods of psychotherapeutic treatment. Like these methods, psycholytic therapy tried to elicit presentational symbols which stood for the meaning which was given to all kind of experiences.
A meaning which is composed of a trace of a sensual stimulus with evoked former experience, and evoked emotional relationship. The new thing about psycholytic therapy was the richness, the deepness, and the intensity of the produced hallucinations (on doses of 200 to 400 micrograms), which went much deeper than in dreams, hallucinations that revealed more to patent and therapist than dreams or fantasies (Van Rhijn 1963: 131-135).
I mention this insight from Van Rhijn to strengthen my own case about essential continuity between psycholytic therapy and earlier forms of therapy, and especially psychoanalysis. In the case of Arendsen Hein, we saw that his understanding of psychotherapy was deepened with the dimension of cosmic consciousness or peak-experiences.
Although this was perhaps a less accepted dimension in psychiatry, it was by no means unknown. Van Rhijn had studied after the Second World War with Henricus Cornelius Rümke, a very influential professor of psychiatry at the State University of Utrecht. Rümke somewhere formulated the thesis, that an intense feeling of happiness could bring the ego to the borderline of dissolution in the whole of the Being.
This was of course in line with the theories of Maslow on the peak-experience. Van Rhijn, who had also been interested in Tibetan yoga and who was intrigued by the manual of Leary, Metzner and Alpert on The Psychedelic Experience, which was published in 1964, tried this method with a few 'introvert, strongly inhibited men' and achieved success. But he did not pursue this method (Van Rhijn n.d.:23-24).
Opponents
My central thesis, which I have tried to illustrate with examples from the work of Van Praag, Bastiaans, Arendsen Hein and Van Rhijn, is that introduction and rediscovery of the use of psychedelics (or psycholytics, or hallucinogens) was possible because this use stood in a continuum with the development of psychiatry before that time.
We now have to ask ourselves why this continuum was broken: why after 1966, not only in the Netherlands but also in other countries, there was such a fierce reaction against the scientific study of psychedelics. We now have to look for the things in which psychedelic research differed from other lines of research in psychiatry, and from the developments in society as a whole.
Until now I've used in this paper examples from the work of pioneers of psychedelic research to establish lines of continuity. Now I shall turn attention to examples from antagonists of psychedelic research in Dutch psychiatry.
I will limit myself to antagonists who had a high degree of standing among their colleagues. It is noteworthy that they do not seem to have had any experience with LSD or other psychedelics, but this can't be seen as the reason for their opposition, as many other psychiatrist with as little experience did not turn against the research.
I've already mentioned H. Rümke, professor of psychiatry in Utrecht. His views on what Maslow called the peak-experience does not imply that he advocated any psychedelic method of reaching this state. On the contrary. In 1960 he published a text book on psychoses, and made also mention of 'experimental psychoses' like those which arose out of the use of LSD.
He stressed the dangers of them. He mentioned two examples of results of treatment: one ending in a heavy depression of a few months, the other one in a successful suicide, and concluded that this kind of experiment was inadmissible (Rümke 1960:222).
In the following volume of Rümke's text book, which was published just after his death in 1967, he repeated this opinion, and gave further examples: of a patient who became very instable, and even of patients of his who had never used LSD, but in whose paranoid delusions LSD started to appear.
And he saw an added danger of using the drug in the 'movement' which had arisen in the United States around Leary and Alpert and their missionary International Federation for Inner Freedom. Rümke saw no therapeutic results which legitimized the use of LSD (Rümke 1967:321-323).
Another professor I've already mentioned, who took the same position as Rümke, was Joh. Booij of the Free University of Amsterdam. Booij had been hopeful in the 1950s about the results of LSD-research: in 1968 he had become a declared opponent.
In articles in the influential journal of medicine Nederlands Tijdschrift voor Geneeskunde, Booij 'proved' his opposition against LSD-therapy by giving all kinds of examples of patients who became psychotic or tried to commit suicide, and even of a pregnant woman who 'went out and murdered by stabbing the man who had made her pregnant' (Booij 1968a, 5).
In the same article where he mentioned this example, Booij showed his incomprehension of the psychedelic experience. He wrote without understanding the term 'expanded consciousness', although he readily classified it as the delusional experience of the psychotic, either schizophrenic or suffering of a degenerative psychosis.
Besides stressing the dangers, Booij based his opposition to use of LSD by mentioning the lack of controlled studies proving positive effects of LSD, and by suggesting that the role of the therapist and the invested time was all-important in any positive effects that were achieved. With this last argument he answered the psychiatrist C. J. Schuurman, who wrote in a reaction about his positive results in the treatment of patients who were severely neurotic with the help of LSD (Schuurmans 1968; Booij 1968b).
This discussion was part of a long discussion in 1968 in the Nederlands Tijdschrift voor Geneeskunde. With Booij sided the psycho-analyst J. Tas, who saw little result in a LSD-therapy which did not prepare the patient for the repressed material which was dug from his unconscious by a long process of psychoanalysis (Tas 1968).
Interesting is that Tas based himself on the position of classical psychoanalysis, while Booij had doubts about the effects of psychoanalysis or other treatment methods themselves. He tended to believe that neurobiological elements were decisive in the genesis of neuroses and psychoses.
For Herman van Praag, who took part in the debate on the side of defenders of LSD-research, this was an important reason for continuing the biological research of hallucinogens. For him, 'the hullabaloo about the hallucinogenic drugs entails the danger of this substances falling unnecessarily into disrepute.
However objectionable their use by laymen may be, from the medical point of view they seem to hold a promise in two different fields, the field of psychotherapy [in which the results were still uncertain] and that of biological psychiatry (Van Praag 1968, 1988).
The case of Van Praag is interesting, while he at the same time carefully delineated his own position from any association with the so-called propaganda for LSD which was conducted by forme scientists like Leary and Alpert.
This is important, because the discussion on LSD was for a large part taking place under the shadow of the rise of the psychedelic subculture in society, which was beyond the control of the medical profession and by definition characterized by recreational use.
This point was put forward by G. Ladee, Professor of Psychiatry in Rotterdam, who had taken LSD himself and had a clear eye for the religious effect, or the peak-experience which LSD could give. But this effect resulted according to him in the great objections which psychiatrists developed against LSD. Therapists who believed in LSD got results with it; therapists who didn't did not.
This led to an 'LSD-administration syndrome' in some therapists, with resulting resistances in others. These resistances were stimulated by all the talk about 'Love', the use in the youth culture, and the fact that psychedelics were not accepted drugs in western society like alcohol. Ladee himself continued to advocate controlled studies (Ladee 1968).
The rise of the psychedelic subculture and its association with revolutionary tendencies in society brought LSD clearly into a climate of discontinuity with existing traditions. In other words, they came to be seen as dangerous to society.
This development had little to do with the discussions within psychiatry. On the contrary, it added a totally non-scientific and even irrelevant element to this discussion. Because what had the value of LSD within psychotherapy and biological psychiatric research to do with the missionary zeal of Leary or his Dutch congenials to change society?
The discussion within psychiatry about the permissibility of LSD-therapy was a draw. Some were against it, some for. And even the latter advocated strict medical supervision and control, and did not (or said they did not) approve of recreational use of hallucinogens.
If Rümke took in 1960 a position against LSD-therapy, a report of the General Inspection of Mental Health came in 1962 to the conclusion that under the right supervision it was no more dangerous than other forms of therapy (Meijering 1962). The Inspection of Mental Health saw no need for further restrictions.
In that period, LSD was still respectable. This changed abruptly in January 1966, with the threat of the anarchist Provo movement to poison the drinking water of Amsterdam with LSD on the occasion of the marriage of the Crown Princess with a former German soldier. This threat was not meant for real.
It was part of the provocative tactics with which Provo fought against the existing order in society. But it led to a giant reaction of panic. Within weeks, the sale and use of psychedelics was prohibited by law. Researchers and therapists had to have special permission to use the substances: a permission which was only granted to a few (among whom were Bastiaans and Arendsen Hein).
Psychedelics were now firmly connected with discontinuity and with subversion. Paradoxically, this only increased their popularity in the emerging youth subculture (Snelders 1995).
But the discussion in psychiatry had little effect on this. As we have seen the problem was only largely debated in 1968. Since then no serious follow-up study of the results of psycholytic therapy has been conducted, no major research program into the effects of psychedelics on the human brain has been started.
By way of conclusion, I would think that a reappraisal of psychedelics in western society, and renewed research into their possible function in psychiatric research and in society, is only to be expected if the advocates of this research could find some way to stress the continuity of their work within western society, and to avoid the association with subversion and discontinuity.
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