Trials of Psychedelic Therapy

When I began exploring the history of LSD psychotherapy research in 2008, I had little idea that the momentum was in fact building on a new era of psychedelic research. In the 1950s and 60s, researchers reported impressive results using LSD in conjunction with psychotherapy to treat a range of psychiatric conditions, and an astounding 50% success rate treating chronic, treatment-resistant alcoholics. From my initial research, two narratives quickly emerged explaining the drug’s medical downfall: either LSD’s significant therapeutic potential fell victim the moral panic and government crackdown following its rising recreational use in the 1960s, or, by contrast, that the research had had little scientific rigor, had since been largely debunked, and had been spearheaded by enthusiasts such as Timothy Leary whose objectivity was significantly skewed by their own use of the drug.

The new era of research, underway at prominent institutions including Johns Hopkins University, New York University, and the University of New Mexico, has largely picked up from where the previous era left off, exploring the effectiveness of the same treatment methods developed in the 1950s and 1960s. This research has therefore naturally been in close conversation with the past, as researchers attempt to avoid the pitfalls of the previous era. The primary focus has been on addressing the perceived lack of scientific rigor in past studies, which stemmed from studies being cut short by LSD’s prohibition before they reached scientific maturity. Now that the dust of the 1960s has settled, promising treatment approaches can be revisited, and given a more sober, rigorous evaluation through the modern controlled clinical trial methods required by the Food and Drug Administration.

In this way, the common historical narratives of LSD psychotherapy’s decline provides a clear path for modern scientists. Yet as I explored more deeply the regulation of LSD research in the 1960s and the fate of the studies of that era, elements of the common narrative began to come apart. Although I initially approached the topic convinced that government interference had terminated research, I struggled to find evidence that any legislation prohibiting the non-medical use of psychedelics significantly restricted medical research. Instead, I found that government agencies had actively supported research for much longer than had been recognized: to my great surprise, in FDA files I discovered that in 1966, when LSD’s manufacturer, Sandoz Pharmaceuticals, withdrew its sponsorship of research in response to the increasing controversy surrounding the drug—which had already lead to its partial criminalization—the FDA, National Institute of Mental Health, and Veterans Administration had stepped to in ensure legitimate research continued. At this point, had these agencies not acted, all LSD research would have ended. Instead, although it declined over the 1960s, limited but significant studies continued into the mid-1970s.

Secondly, looking more closely at the later clinical research with LSD showed that research methods evolved considerably over the 1950s-70s and largely reflected the evolving state-of-the-art. As well as a period of social and cultural upheaval, the 1960s saw a significant transformation of pharmaceutical research and development, with the passage of legislation that introduced FDA oversight of clinical research and the need to provide proof of drug effectiveness for FDA approval. While small uncontrolled studies had indeed characterized the LSD research of the 1950s, this was common for drug research in this era. In the 1960s researchers attempted to follow-up these studies with larger, and often sophisticated, controlled clinical trials. So neither prohibition nor a lack of scientific rigor seemed to explain the disappearance of LSD psychotherapy from psychiatry.

However, comparing the research and treatment techniques employed in the later studies revealed the challenges of demonstrating the effectiveness of LSD psychotherapy through the controlled trial methods required by the FDA: blind administration could not effectively be maintained, and the incorporation of significant psychotherapy was unconventional for drug treatments and complicated efforts to establish objectively comparable control conditions. As researchers attempted to overcome these hurdles, some altered the treatment techniques of those earlier researchers who had claimed remarkable results in order to establish a more standardized and easily testable treatment. This influenced often negative or lackluster results. Ultimately, I found that LSD psychotherapy’s decline was due less to prohibition than to the growing disinterest of the psychiatric community in a drug that had apparently failed to live up to the hype.

The history of LSD psychotherapy I discovered was therefore ultimately one of an unconventional but highly promising treatment that did not fit within an increasingly rigid model of pharmaceutical research and development. Rather than dominated by controversial figures such as Leary, little-known researchers such as Charles Savage and Albert Kurland persevered through the 1960s and 70s at a far remove from the counterculture and continued to publish their studies in leading psychiatric journals. Yet they struggled to design studies that would allow them to uphold both the integrity of their treatment and the scientific standards expected by the FDA and wider scientific community. From this perspective, the lessons that can be gleaned from the history of LSD psychotherapy become more complex, revealing scientific and regulatory challenges that remain for contemporary researchers and that have wide implications for American medicine and psychiatry.

Matthew Oram is a historian in Christchurch, New Zealand. He earned his PhD in history from the University of Sydney.