Abstract
Lysergic acid diethylamide (LSD) has a notorious past; its drug career is filled with salacious tales of Central Intelligence Agency operatives dosing unwitting ‘Johns’ in undercover brothels, and young people dropping acid while flipping off ‘the man’. A lesser-known story is that of mental health professionals who gave patients LSD in the hope of treating their psychiatric conditions. Once heralded as a revolutionary treatment, psychedelic psychotherapy involved a single, high-dose LSD session designed to trigger a transcendental journey offering patients insights into troubling behaviours. In the 1950s and 1960s, researchers reported astounding success rates with this brand of drug therapy. But then, LSD was ripped from psychiatrists’ hands and thrown into the mushrooming counterculture where LSD users experienced mental breakdowns and scared worried parents, sparking a full-blown moral panic and the restrictive drug laws that brought down the whole field of psychedelic psychotherapy.
Or so the story goes. Popular and scholarly accounts of the demise of LSD therapy regularly reproduce what Matthew Oram dubs the ‘prohibition narrative’, but as he demonstrates in The Trials of Psychedelic Therapy, the story is not an accurate one. Drawing on an impressive collection of archival research, Oram offers a new take on the rise and fall of clinical psychedelic research in the USA. He convincingly argues that the decline of LSD therapy is not a tale of cultural anxieties and government legislation squashing research but, rather, an unintended consequence of changes in pharmaceutical research and development in the post-war era. His argument revolves around the passage of the Kefauver-Harris Amendment in 1962, an amendment that required FDA approval for premarket clinical drug research with new investigational drugs and that evaluated drug efficacy based on randomized controlled trials, or RCTs. Throughout the book, Oram shows how the Amendment drastically changed the fate of psychiatry in general and LSD therapy in particular, causing the field to slowly unravel, even before the sensationalized headlines about LSD frying people’s chromosomes.
The first half of the book focuses on the early history of LSD and the Amendment’s immediate consequences for the field. Oram contextualizes the emergence of LSD therapy within the larger post-war psychiatric scene – one characterized by eclectic treatment approaches and free reign for experimentation. LSD therapy thrived in this environment. The early enthusiasm surrounding LSD therapy, however, was short-lived. Oram follows several researchers’ failed attempts to secure an independent IND (Notice of Claimed Investigational Exemption for a New Drug) after the 1962 Amendment had passed. He shows how resistance from Sandoz Pharmaceuticals (LSD’s sole distributor), rather than government interference, prevented them from getting approval. But it was not just Sandoz representatives who held up the research. Oram covers a second dilemma posed by the Amendment: the proof of efficacy requirement, which was demonstrated using RCT models focused on isolating the pharmacological action of drug treatments. Psychedelic researchers argued that LSD’s therapeutic efficacy depended on careful attention to ‘set and setting’ – their shorthand for the subjective effects shaping the drug experience. RCTs did not gel with that model, and LSD researchers struggled (some even refused) to fit their therapeutic model into the new Gold Standard of clinical research.
In the second half of the book, Oram tells the story of the most prolific American psychedelic research group: the team at Spring Grove Hospital in Baltimore, Maryland. It started its research in 1963, right on the cusp of the LSD panic, which started spreading after Harvard University had sacked Timothy Leary and Richard Alpert amid the controversy surrounding their psilocybin research. The Spring Grove team outlived the LSD panic, receiving a steady stream of federal funds to carry out research merging psychedelic treatment models with RCT methodologies well into the 1970s. Meanwhile, other researchers attempted controlled studies on LSD therapy without optimizing set and setting, but failed to demonstrate treatment efficacy. These findings overshadowed the promising work coming out of Spring Grove, leading to a medical consensus that LSD therapy is not what it was reputed to be. Contrary to popular accounts, Oram shows that when trouble came for LSD therapy, it did not come quickly. The death was slow and quiet; research persisted for years, but steadily dwindled as a result of methodological failures and a lack of pharmaceutical investment.
While Oram is not the first person to point out that the 1962 Amendment reconfigured psychedelic science, he most forcefully challenges the prohibition narrative, demonstrating not only how the field was already struggling before the moral panic erupted, but that those problems persisted long after concerns about LSD had died down. As such, his book is a welcome intervention into the existing historiography of LSD’s fall from medical grace. More broadly, however, Oram’s book makes an important contribution to the history of psychiatry. He shows how regulatory shifts further propelled psychiatry towards a biological model, leaving other treatment models like LSD therapy, which did not fit neatly into this paradigm, to wither.
Orem’s accessible writing style should appeal to a range of audiences, from historians and psychiatrists to graduate students and popular science readers. His major argument is consistent and coherent, and his analysis raises interesting questions. If, as Oram demonstrates, prohibition did not ring the death knell for this promising treatment, then why is it the story that keeps being told? Why do so many people – historians, the media, and researchers themselves – fall back on this decades-old narrative? In the revival of psychedelic therapy, for example, researchers tend to play up the prohibitionist narrative, arguing that the government is stifling science (Nutt, King and Nichols, 2013). Prohibition might not have killed the field, but many ‘first wave’ and contemporary psychedelic researchers strongly believe that it impedes their work. Perhaps Oram’s book will offer new stories to tell in the emerging ‘psychedelic renaissance’.