LSD 25 , an indole derivative from ergot, was synthesized by Hoffman in 1938, but for a good many years little attention was paid to the drug. Then, within the past year or two, interest in this psychedelic or "mind manifesting" drug has soared among both professionals and the lay public. LSD has been widely publicized in nonmedical publications, a number of sociologic studies exist, and a journal has been founded to report experiences resulting from its use.

Three different approaches to LSD have been described and studied to date. The first is the experimental administration of the drug in controlled laboratory setting, a record being kept of subjective and/or objective effects. Initially the so-called "model psychoses" induced by LSD were compared with schizophrenia and with delirium. However, this method of comparative study has proved to be somewhat disappointing.

The second aspect of study has been the psychotherapeutic use of LSD to increase awareness, lift repressions and facilitate insight during psychotherapy LSD is also used for treatment of specific disorders such as alcoholism.

The third type of study, and the one which concerns us most, has to do with the psychiatric side effects that follow ingestion of LSD. Most of this study is concerned with self-administered doses of the drug. The side effects occur regardless of the sources of the drug and regardless of the setting in which it has been administered, but far more LSD is bought on the black market (it is either imported illegally from Mexico or produced locally by amateur chemists) than is given experimentally or psychotherapeutically. LSD obtained on the street often contains a number of impurities; sometimes other compounds (among them atropine) are sold allegedly as LSD. Black market doses, usually diluted as they are passed on, contain an unknown number of micrograms of LSD.

Psychiatrists throughout the country have been observing increasing numbers of severe side effects from the drug over the past seven or eight months. (An excellent early personal account of a "bad trip" from LSD was "They Split My Personality" by Harry Asher, Saturday Review, June 1, 1963.) At the UCLA Medical Center, approximately one psychiatric disorder associated with LSD ingestion had been turning up every other month. However, beginning in September of 1965, the figure jumped to between five and fifteen cases a month. Other local facilities in the Los Angeles area have reported a similar increase. The new Federal Drug Abuse Control Amendments of 1965, which went into effect on February 1, have had no apparent effect in decreasing the number of LSD cases seen in our psychiatric emergency room. About one-third of the LSD cases at UCLA have required admission to the psychiatric hospital; approximately half of these to the ward on which the authors work.

In addition, we have conducted group therapy sessions once a week for several months among all the hospitalized LSD patients whose doctors would permit them to attend. The purpose was to learn what reactions these patients had experienced and to become acquainted with the patients themselves. The LSD users who come to the hospital are primarily young, single, Caucasian, male; few are religious. They live throughout the Los Angeles area, but particularly in the Hollywood section and the beach cities. Most of them are unemployed, but some are students. Many of our patients had used other drugs besides LSD, particularly marijuana; some had taken LSD as often as sixty times. These people came to the emergency room suffering from confusion, anxiety, depression, suspiciousness and hallucinations.

During this study we became curious about the overall LSD population. Were we seeing atypical reactions or were others reacting the same way to LSD but not being brought into the hospital? As word spread of our interest, informants began to appear at the hospital. They told us of other LSD users in the community and of their aberrant behavior. We heard about people wandering about in chronic states of confusion, and the psychiatrists on duty at the hospital received many phone calls about threatened or already attempted suicides and other disturbed behavior. Many of these people refused to come in to the hospital.

We then began to go out into the community and attended a number of LSD sessions held in private homes or "pads." We observed what we would consider obvious psychotlc behavior: suspiciousness, grimacing, inappropriate affect, apparent hallucinations and motor restlessness. These affects seemed eventually to wear off and the patients we saw did not apparently harm themselves that day. We heard about others who had had unpleasant symptoms or utterly lost contact, and then recovered only to have these symptoms return weeks or months later without their having taken LSD again.

Besides these acute difficulties, there are other, more chronic problems. For one thing, LSD seems to affect a person’s value system. We have found that in many instances formerly productive individuals have adopted the attitude that one should live merely for subjective experiences, and not play the various "games"—like work—that society demands. We have met this attitude in musicians, lawyers, psychologists and doctors. Since many people who experience this change of attitude are never seen by psychiatrists, one can only speculate as to its frequency.

Another chronic difficulty is perceptual distortion. For example, a band leader phoned us because his players were producing such terrible music. Nor could he talk to them, for they were on LSD and utterly convinced that the band was playing the most beautiful music ever heard. A law student told us that LSD had given him such new insight and opened such horizons that he felt his legal studies were dull and boring by comparison. He speculated at length about the advisability of giving the world’s leaders LSD so that they would love and not hate. At last contact he had not decided whether to pursue his law studies or to continue with LSD full time. We have observed this degree of subjective distortion among many LSD users. A group of them whom we studied fairly intensively over several months were convinced that they could "pick up vibrations" from other people, that they could tell if someone else had used LSD by casual inspection, that they had a keen awareness of music and art. Nevertheless, objective tests showed that their ability to discriminate was below normal, and that their powers of observation had been actually decreased by LSD.

At various community dances which we attended, the young girls were in their "psychedelic slacks" and the teenage boys wore long hair and sunglasses. They moved beneath undulating lights in bright "psychedelic" colors. At such gatherings the drug seemed to replace personal contact and to substitute for the drives of sex and aggression. We watched seven or eight sailors dancing with one girl on the floor. There was little male-female awareness or physical contact; each was in his own fantasy world.

The criteria for mental health, according to Freud, are the ability to work and to love, and LSD users seem to deteriorate in those very areas. We have already mentioned the numerous individuals we have studied who have either lost their jobs or lost the incentive to work after using LSD. The ability to love, that is to have psychic intimacy with another person, seems also to be decreased by LSD. In contradiction to the claim that the drug helps one to get closer to people, we note that users become more introspective and invested in themselves. The extreme results are autism and psychosis.

Advocates of LSD have maintained that proper screening techniques would enable one to predict individual reactions to LSD and to eliminate those who would have "bad trips." Our experience at UCLA indicates that such predictions are extremely unreliable. We know of patients who, though carefully screened for research purposes, suffered severe LSD reactions, with dramatic alterations of their value systems, resulting in a diminished level of functioning. On the other hand, we have come across members of the community whom we would have judged fairly unstable but who showed little or no change after using LSD.

The number of high school students and teen-agers who take the drug is increasing rapidly. Most adolescents are struggling with feelings of aggression and sexuality, along with their need to establish an identity. LSD can seem a "magic" solution to such problems. It offers a ready-made identity with fellow users and the introspective experience helps to deny the feelings of both aggression and sexuality. Their conversation becomes "acid head" talk. Bad "trips" are "freak." Every stranger is "the man" (police) and to talk to one would be to "cop-out" (squeal). Suspicion to the point of paranoia is common. The adolescent is frequently overwhelmed by the LSD experience, with the result that the search for identity becomes a florid psychotic nightmare. There is perhaps no period of life more loaded with conflict, and one might therefore expect that adolescents who took LSD would experience severe complications, including panic states, prolonged psychosis and severe depressions.

Another disturbing aspect of LSD usage is the missionary zeal it seems to induce in many of its users. We have no doubt that the enthusiasm is sincere, since we have come upon cases of mothers who have given LSD to their children, brothers who have encouraged their sisters to take it, and many individuals who have selected their closest friends and used every means possible to convince them that they too should share in the world of psychedelia. In several instances, individuals have devoted a great deal of their energies to buying LSD and passing it out free among the population in an attempt to "save the world."

The right environment for taking LSD (often alluded to by acid heads as necessary for a good trip) means having a "sitter" to guide you through the LSD state. However, neither a favorable environment nor a guide guarantees a pleasant or meaningful experience. If the trip goes bad, and LSD users are brought to a medical facility in the acute phase, tranquilizers and barbiturates will help most of them, but not all. Many of our hospitalized patients have remained in the hospital for more than a month.

Until more is known about LSD and its short- and long-term effects, it must be considered a very dangerous drug. Unfortunately, the ready market for and easy manufacture of the drug have resulted in an almost unlimited black market supply, and the buyers are often the very people who have the most to lose from its use. We certainly hope that LSD research will be continued,. but we appeal to those who loudly proclaim that "everyone" should take LSD to remember the highly subjective response to the drug. We have known the most ardent enthusiasts to become the most eloquent opponents—often after just one bad experience.

The controversy continues to rage, some investigators maintaining that side effects are frequent, others stating that the potential gains far outweigh possible side effects. We are worried by what we have seen. California and other states are now considering legislation to supplement existing federal legislation; Sandoz Laboratories, the principal legitimate source, has discontinued manufacture. The future of LSD remalns controversial and uncertain.