A dangerous method ? Psychedelic therapy at Modum Bad, Norway, 1961–76
Petter Grahl Johnstad
History of Psychiatry, 2020, 1–10
Doi : 10.1177/0957154X19894537
After many years of disregard, the use of psychedelic drugs in psychiatric treatment has re-emerged in recent years. The prospect that psychedelics may again be integrated into mainstream psychiatry has aroused interest in long-forgotten research and experience from the previous phase of psychedelic therapy, which lasted from the late 1940s to the 1970s. This article will discuss one large-scale psychedelic therapy programme at Modum Bad Nervesanatorium, a psychiatric clinic which treated 379 inpatients with psychedelic drugs during the years 1961–76. The psychiatrists there initially regarded the psychedelic treatment as efficacious and without serious negative reactions, but reports of long-term harm have since surfaced. This article discusses how insights from Modum Bad might benefit the new generation of psychedelic treatment efforts.
Keywords : Biological psychiatry, Norway, psychedelic drugs, therapeutic usage, 20th century
Psychedelics are a group of drugs named after the Greek words ψυχή (psyche), meaning soul or mind, and δηλείν (delein), to reveal or manifest. They have also been referred to in various contexts as psychotomimetics, hallucinogens and entheogens. Known for their powerful psychoactive effect, the classical psychedelics include mescaline (the active constituent of the cactus peyote), psilocybin (the active constituent of ‘magic mushrooms’), lysergic acid diethylamide (LSD) and N,N-dimethyltryptamine (DMT). Plant-based psychedelics have a long history of use for ritual and healing purposes, especially on the American continent (Dobkin de Rios, 1990; Hultkrantz, 1997; Labate and Cavnar, 2014; Maroukis, 2012), and the synthesization, particularly of LSD in the mid-twentieth century, opened the door for experimental psychedelic treatment in Western psychiatry. The Swiss pharmaceutical company Sandoz, which owned the patent for LSD until 1963, marketed the drug by making it freely available to psychiatrists interested in researching its effects (Hofmann, 2009).
Early research in the late 1940s and 1950s investigated psychedelic treatment, especially for schizophrenia (Busch and Johnson, 1950; Hoch, Cattell and Pennes, 1952; Liddell and Weil- Malherbe, 1953; Pennes, 1954) and various kinds of neurosis (Chandler and Hartman, 1960; Sandison, Spencer and Whitelaw, 1954). The effect on the schizophrenic patient group was generally poor, sometimes leading to a worsening of the condition, but the psychoneurotic population was often found to respond well to psychedelic treatment. Research on this group therefore continued into the 1960s and early 1970s. In one notable study, which according to Rucker, Iliff and Nutt (2018) was probably the largest study of therapeutic utility of psychedelics in the pre-prohibition era, 81% of 243 non-psychotic patients were rated by clinicians as improved after treatment with LSD (Savage, Hughes and Mogar, 1967). There was also some research on using psychedelics as a treatment for alcoholism, with promising but mixed results (Ludwig et al., 1969; Maclean et al., 1961). A later meta-analysis with pooled data from these studies found significant improvement in abstinence 1–3 months after treatment, but not at 6 months (Krebs and Johansen, 2012).
Researchers soon realized that pharmacological treatment with drugs that cause ‘profound alterations of ego structure, awareness, cognition and affect might be occasionally expected to induce adverse reactions’ (Cohen, 1960: 30). Reports of such adverse reactions were, however, infrequent. In his early review study, Cohen (1960) had distributed questionnaires to 62 clinical psychedelics researchers, and received 44 replies representing data on almost 5000 individuals who on average had received LSD or mescaline five times each. He found no instances of serious physical side effects, and only a handful of reports of suicide or prolonged psychotic reactions, in a patient population that included schizophrenics and where the incidence rate of untoward events is generally high. There were also a number of reports about more temporary complications, including delusory and paranoid ideation and panic reaction, during the psychedelic state itself. Cohen (1960) concluded that psychedelic treatment is contraindicated for schizophrenics, but is otherwise safe when administered with proper care: the patient should be observed at all times during the session, and may require therapeutic support by psychiatrists who should themselves ‘probably have experienced the LSD state’ (p. 39). Although Cohen’s (1960) review indicated low risk of toxicity, researchers were later concerned about possible genetic damage from the use of psychedelics. These concerns were eventually put to rest (Dishotsky et al., 1971), but caused significant controversy at the time. After many years of research, there is no evidence that classical psychedelics are toxic to mammalian organ systems in normal dosage (Nichols, 2004: 134), although some newer phenetylamines have higher levels of toxicity (Nichols, 2016: 273).
Although promising, the clinical psychedelics research from this era is inconclusive. Studies were often experimental in nature, with small study groups and tentative findings. Furthermore, some lines of research pursued during this era were clearly dead ends, such as the attempted psychedelic treatment of schizophrenics and homosexuals (‘sexual deviants’). Most damaging of all, clinical studies from this period – with or without psychedelics – were often methodologically inadequate with regard to control groups, blind testing, statistical analysis and other issues (Nichols, 2004; Rucker et al., 2018). This methodological critique extends also to Cohen’s (1960) review. With time, these issues could perhaps have been redressed, but by the mid-1960s, time was no longer on the researchers’ side. Mounting fears of psychedelic drug abuse led to new prohibition laws in the USA, and within a few years psychedelics were classified under Schedule 1 of the 1971 United Nations Convention on Psychotropic Substances. The convention did not prohibit clinical research, but the restrictive Schedule 1 classification entailed that psychedelics were now legally defined as having no accepted medical use, and it also introduced a range of practical complications related to permits and safety regulations. By the 1980s, clinical psychedelics research had almost disappeared from view.