The trials of psychedelic medicine: LSD psychotherapy, clinical science, and pharmaceutical regulation in the United States, 1949-1976

Abstract

Over the 1950s lysergic acid diethylamide (LSD) became the subject of widespread psychiatric research in the United States. Early research reported impressive results using the drug as a tool in psychotherapy, in a variety of ways and in a number of conditions. However, over the 1960s LSD psychotherapy research declined, before coming to a complete halt in the 1970s. The demise of LSD psychotherapy has commonly been linked to the growing controversy over the drug’s recreational use in the 1960s. With the drug’s image shifting from medical tool to dangerous public menace, medical opinion turned against it and the US federal government hampered research through strict regulation. This argument, however, often overlooks the broad changes in the regulation of pharmaceutical research and development that occurred during the period, as a result of the Drug Amendments of 1962. This thesis contextualises LSD psychotherapy research within these changes, providing an alternative analysis of its demise. Closely examining the regulation of LSD research through Food and Drug Administration files reveals that, in fact, the government not only did not deliberately hamper research, but also worked to ensure its survival in the mid-1960s. However, the amendments formalized pharmaceutical research and development in a way that frustrated the progress of LSD research. Most significantly, the amendments’ requirement for proof of drug efficacy through controlled clinical trials made mandatory a method of drug evaluation that struggled to accommodate LSD psychotherapy’s complex method of using drug effects to catalyse a psychological treatment. As explored through researchers’ publications and personal papers, the difficulties in balancing scientific standards in evaluation with the clinical requirements of treatment left them unable to establish a consensus on treatment efficacy. Research subsequently dwindled. In making this argument, this thesis explores how the Drug Amendments of 1962 widened the division between psychiatry’s biological and psychological treatments, and explores the complex interplay between clinical science, regulation, and therapeutics in twentieth century American medicine.